Social Hygiene Handbook, Hong Kong.



                               Dr. K.W. CHOW

An extract of:



   Balanitis is used to describe acute and chronic forms of
the inflammation of the glans penis and prepuce owing to
traumatic, irritant or infective. The condition should more
properly be called balano-posthitis. Balanitis means
inflammation of the glans and  posthitis means that of the prepuce.


   According to the different aetiological causes, balanitis
can be classified into various clinical varieties:

   1. Irritant

   Poor hygiene, retained soap, detergent, retained smegma
or inadequate drying may cause an irritant dermatitis.
Contact dermatitis affects the shaft rather than the glans,
except when medicament or contraceptives are involved.

   2. Traumatic

   Frictional trauma and accidental wounds cause fissures,
erosions or localized area of erythema and oedema.
Postcoital frenal erosions are not uncommon.

   3. Infective

   This is the common cause of balanitis.

   a. Candidal balanitis

   Candidal balanitis most frequently follows intercourse
with an    infective sexual partner. The pathogenicity of
the yeast depends on    the host factors and diabetes is the
most important one.

   The clinical features include a non-purulent surface, a
slightly    scaling edge and satellite erode pustules. The
groins may also be    affected. Microscopy and culture
confirm the diagnosis and should be    taken from both
partners and from the anal as well as the genital

   Recurrent candidal balanitis causes fissuring of the
prepuce, with    fibrosis and sclerosis.

   b. Trichomonal balanitis

   This occurs more commonly in those with long prepuce. It
presents as    superficial or erosive balanitis. Phimosis
may occur.  More severe     lesions of chancriform type or
penile abscess are occasionally seen.

   c. Mycoplasma balanitis

   Balanitis may accompany mycoplasma urethritis, either as
a primary    infection or secondary to gonorrhoea.

   d. Chlamydial balanitis

   In men the most common manifestation is non-gonococcal
urethritis but    it may also present as non-specific
irritant balanitis.

   4. Premalignant, malignant or idiopathic

   In chronic unresolving 'balanitis', the following
conditions should be    excluded:

   a. Erythroplasia of Queyrat (Bowen's disease)

   b. Extramammary Paget's disease

   c. Plasma cell balanitis of Zoon

   d. Balanitis xerotica obliterans (BXO, Lichen sclerosus
et atrophicus)

   e. Circinate balanitis in Reiter's disease

   f. Lichen planus

   g. Psoriasis


   Mild forms of balanitis respond to repeated cool bathing
with    potassium permanganate (1:8000) and the application
of  mild    antibacterial creams, with or without weak

   The underlying cause should be treated if possible.
Specific remedies    are available for candidal balanitis.
Both partners should be treated    concurrently. There is
now large variety of effective anticandidal    agents of the
polyene or azole group. Ketoconazole, Itraconazole and
   fluconazole are the oral alternatives for severe cases.
Cure rate is    about 90 percent. Intestinal or urethral
reservoir, and re-infection    account for the 10% failure
rate of refractory cases.

   Mycoplasma balanitis responds to tetracyclines in high


   Patients who are worried about the possibility of
venereal diseases    may inspect the genitalia frequently.
They may notice for the first    time in their life certain
conditions of no clinical significance and
   for which require only reassurance.

   1. Penile pearls (syn. pearly penile papules, papillae of
the coronal  sulcus or glans penis, hirsuties papillaris
penis, coronal papilla) These tiny swellings which are
congenital anomalies may look like    early acuminate warts
but are arranged in rows around the coronal    sulcus or
scattered over the glans penis. They are merely hypertrophic
   papillae with normal epidermal covering. They have no
clinical    significance and it is important not to
misdiagnose them as genital    warts.

   2. Tysons glands

   These are secretory glands which are symmetrically
located on either side of the frenulum. They appear as
small para-frenal papules which can easily be mistaken by
anxious patients as genital warts.

   3. Fordyce Spots

   This condition arises from the presence of ectopic
sebaceous glands.
   It may be found under the prepuce and on the vulva. The
lesion appear
   as multiple small, white or yellow spots in submucosa.

   4. Lymphocele (syn. sclerosing lymphadenitis, benign
transient lymphangiectasis)

   In this condition the lymphatics in or near the coronal
sulcus may become temporarily blocked and appear as
worm-liked translucent masses of cartilage-like hardness.
Some cases may follow prolonged or frequent intercourse
or are associated with a genital lesion. However in the
largest series reported, the majority were unexplained
although the patients had coitus. The condition resolves
within a few weeks and no treatment is necessary.

Cite as:
(File revised 13 October 2000)

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