What Is Balanoposthitis?

Balanitis is the inflammation of the turtle's head caused by trauma, irritation or infection. Because balanitis often coexists with inflammation of the inner surface of the foreskin, balanitis and foreskin are often referred to collectively as balanoposthitis. The main clinical manifestations are local swelling, erosion and ulcer formation. Foreskin balanitis can retrogradely infect the urinary system, causing cystitis and pyelonephritis. In addition, if the inflammation is not cured for a long time, it can directly affect sexual life, leading to impotence and premature ejaculation. The disease occurs in summer and autumn, and most often occur in young and middle-aged men, especially those with long foreskins or phimosis.

Basic Information

English name

balanitis

Visiting department

Urology

Multiple groups

Young men

Common causes

Bacterial infection, friction and trauma, etc.

Common symptoms

Local erythema, edema, pain

Contagious

no

Causes of balanitis

Foreskin balanitis is related to a variety of factors, which can be divided into infectious and non-infectious factors. Under normal circumstances, a large number of bacteria, yeasts and fusiformis can be parasitic in the foreskin sac, and when local or systemic resistance weakens, these microorganisms can become pathogenic pathogens. It is mainly caused by bacteria, such as Escherichia coli, Staphylococcus, Streptococcus, followed by Candida. Trichomonas, Mycoplasma, Chlamydia, Gonorrhoeae, etc. can also cause foreskin glans inflammation.

Non-infectious factors include irritation of urine, alkaline substances (such as detergents) and foreign substances (such as condoms); friction and trauma; long foreskin and insufficient cleanliness leading to accumulation of foreskin dirt can cause damage to the glans foreskin mucosa , Aggravating the infection of various pathogenic bacteria.

Clinical manifestations of balanitis

Acute superficial balanitis

It is mainly found in young people who are sexually active. The infection is usually the same as the strain of bacterial vaginosis of sexual partners. At the beginning of the onset, the local skin was flushed, and the glans consciously felt burning and itching. Opening the foreskin in the acute phase shows edema erythema, erosion, exudation and bleeding in the glans, and blisters may occur in severe cases. If secondary infections occur, ulcers can form, overhanging purulent exudate, and local pain and tenderness are obvious. Some patients may be accompanied by mild systemic symptoms such as fatigue and fatigue. In the chronic phase, there were only flaky flushes on the inner foreskin and coronary sulcus, or cracked porcelain-like clefts.

2. Circular festering balanitis

It may be the early mucosal damage of Reites disease, or it may be related to the long-term stimulation of foreskin. The clinical manifestations are the erythema of the glans, which gradually expands, and is ring-shaped or polycyclic, and superficial ulcers can form in the future. The main feature of this disease is that there are one to several circular lesions on the glans, with a red eroded surface in the middle and white narrow strips on the edges, which are connected in a ring shape. Symptoms can be aggravated if secondary infections occur, and they lose their ring features.

3. Candidal balanitis

Caused by Candida infection, Candida albicans is the most common. The clinical manifestations are foreskin and glans erythema, the surface is smooth, there is a little desquamation on the periphery, there are small herpes or pustules scattered around, and slowly expand around. Acute edema, erythema, erosion, and exudate may occur. Severe cases can affect the penis body, scrotum, medial thigh and groin. Mostly caused by sexual contact, can also be secondary to diabetes, wasting diseases and long-term large amount of antibiotics or hormone treatment.

4. Plasma cell balanitis

More common in middle-aged patients. Generally there are no obvious subjective symptoms. The glans is persistent, limited, infiltrating, dark reddish-brown patches, with clear boundaries, smooth surfaces, many small red spots or erosions, easy bleeding, and no ulcers. Histopathology has diagnostic value, which is characterized by infiltration of zonal inflammatory cells in the superficial layer of the dermis, with a large number of plasma cells mixed in between.

5. Amoebic balanitis

When the foreskin is inflamed, the barrier effect of the epithelium is lost, which can easily lead to infection with amoeba. The clinical manifestations are invasive erythema, erosion, superficial ulcers, obvious tissue necrosis, and pain.

6. Mica-like and keratinizing pseudoepithelial balanitis

More common in patients over 50 years old, often accompanied by phimosis. The skin of the turtle's head is infiltrated and hypertrophic, with localized hyperkeratosis, mica-like crusts, and silver-white. The glans loses its normal elasticity and gradually shrinks.

7. Trichomonas balanitis

It is a mild temporary erosive glans inflammation caused by trichomoniasis. Patients often feel itching, and symptoms worsen during urination. At the beginning of the turtle's head, erythema and pimples appeared, with clear boundaries and a gradually expanding range. The erythema may have needles to small blisters with large grains. The blisters may expand and merge with each other and form a mildly eroded surface.

8. Dry occlusive balanitis

The initial stage of the disease was chronic balanitis, hypertrophy of the mucosa, ivory white in the lesion area, and scaling of the epidermis. Locally, scar-like atrophy occurred in the late stage. Can cause narrowing of the outer urethra and foreskin adhesions.

Balanitis diagnosis

Mainly based on clinical manifestations, combined with etiology and pathological examination, such as those caused by Candida infection, Candida can be found by direct microscopic examination and culture of the diseased site; those caused by Amoebia, take secretions for smear examination, can find Miba protozoan; plasma cell balanitis pathological changes have diagnostic value. The disease should be distinguished from fixed drug rash caused by drugs.

Balanitis Treatment

General processing

(1) Maintain local cleanliness, avoid various irritation, and clean the glans and foreskin daily.

(2) Avoid unclean sexual intercourse, and tentative sexual life during treatment. If it is trichomonas or candida balanitis, the couple should be treated at the same time.

(3) Avoid the use of corticosteroids in the acute stage to avoid worsening the infection. Foreskin with severe edema, do not forcibly turn the foreskin up.

(4) If there is ulcer or erosion on the inner foreskin and the glans, change the medicine in time, and change the medicine twice a day.

(5) Eat less spicy food and avoid alcohol and tobacco.

Local treatment

Erosion or exudation or purulent discharge of 1% ethacridine solution or 1: 8000 potassium permanganate solution wet compress, dry and desquamated glucocorticoid ointment. Candida infection patients can use sodium bicarbonate solution to clean the affected area and then apply imidazole ointment. Trichomonas infections are rinsed with 0.5% to 1% lactic acid solution or 0.5% acetic acid solution, and then applied with anti-inflammatory ointment. Intermittent administration of medium-effect non-fluorine-containing hormone ointments has a better effect on plasma cell balanitis.

3. Systemic medication

Systemic antibacterial drugs should be targeted according to pathogens and drug sensitivity tests. For the treatment of acute superficial foreskin balanitis and circular erosive foreskin balanitis, sensitive antibiotics against Gram-positive cocci can be selected first. Trichomonas foreskin balanitis is treated first with metronidazole. Candida albicans is usually used for the treatment of foreskin balanitis caused by fluconazole or itraconazole.

4. Surgery

If the foreskin is too long or the phimosis causes repeated foreskin balanitis, the author should perform circumcision after the inflammation subsides.