Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term and not a diagnosis.
There are numerous causes; these can be broadly divided into inflammatory, infective, and pre-cancerous.
The aim of diagnosis and management should be to exclude STI, minimise problems with sexual and urinary function, and reduce the risk of cancer of the penis.
A specific causative condition should be identified and treated aggressively. Non-specific balanoposthitis is a diagnosis of exclusion.
Patients will typically present in a primary care setting. Input from specialists, particularly dermatologists and urologists, may be very helpful in the management of poorly responsive or complex cases.
Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term rather than a diagnosis. It can be regarded as a special sort of dermatosis that occurs within a skin fold (i.e., an intertrigo). By definition, balanoposthitis cannot occur in a circumcised male, although balanitis (inflammation of the glans penis) might. There are many possible causes of balanoposthitis, and these can be broadly divided into inflammatory, infective, and pre-cancerous.
History and exam
Key diagnostic factors
- presence of risk factors
- uncircumcised state
Other diagnostic factors
- multiple sexual partners
- high-risk sexual behaviours
- post-inflammatory hypo- or hyper-pigmentation
- red scaly patches
- personal/family history of atopy (eczema, hay fever, asthma, type I allergies)
- personal/family history of psoriasis
- urinary dribbling
- red plaques
- papules or micro-papules
- congenital or acquired dysfunctional foreskin
- uncircumcised state
- poor hygiene; urinary dribbling or leakage
- human papillomavirus (HPV) infection
- inflammatory skin diseases
1st investigations to order
- swab for microbiology (Gram stain and culture) and PCR
- swab for virology
- dark-field microscopy
Investigations to consider
- skin biopsy
- patch testing
irritant contact dermatitis
allergic contact dermatitis
reactive arthritis (Reiter's disease)
carcinoma in situ/penile intraepithelial neoplasia (PeIN)
- Eczema and dermatitis
- Atopic dermatitis
- Seborrhoeic dermatitis
- Sexually transmitted infection treatment guidelines, 2021
- British Association of Dermatologists guidelines for the management of lichen sclerosus
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