UNIT6:BALANITIS AND BALANOPOSTHITIS
Key Unit competence:Take appropriate decision on balanitis and balanoposthitis
Introductory activity 6.0
The Image A and B illustrate the structures of male reproductive organs. Observethem and respond to the attached questions.
1) Which one of these two figures (A&B) would reflect the normal or abnormal
structure of the male reproductive organ in humans?
2) What explanations can you give to justify the abnormal structure of the
male reproductive organ you have found?
3) What do you think can cause the modifications that you have observed?
4) What are the manifestations of such abnormalities in the human body?
5) How can health personnel identify or notice these abnormalities of malereproductive organ in humans?
6.1. Description of Balanitis and Balanoposthitis
Learning Activity 6.1
You are at health center on day duty in consultation, you receive Mr. K C., a 26
year’s old uncircumcised male patient. He was complaining of urethral discharge
and painful urination. During history taking he reveals you that he had the same
signs and symptoms, 6 months ago and bought some drugs from the pharmacy
and symptoms disappeared. Once asked if he had sex in previous time, he
reveals you that he had it twice before developing the signs and symptoms and
he confirms that he did not told his girlfriend. During the physical exam of external
genitalia, you notice that the glans and the prepuce are inflamed, reddened, with
foul smell white discharge under the foreskin. At this stage, different diseases
are presumed including gonorrhea, balanitis, syphilis and candida. Urinalysis,
urethral opening swab and blood test were requested for better diagnosis.
Finally, the exams revealed a balanitis/ balanoposthitis caused by gonorrhea.
After confirming balanitis/ balanoposthitis. The treatment of gonorrhea was given
and KC was advised to have circumcision and to bring her girl friend to gettreatment as well.
Questions related to the case study:
1) What are possible risk factors which might probably exposed K.C to this
problem?
2) Identify the signs and symptoms as described in the case study
3) Which statement by the patient indicates the most likely cause of the
recurrence of his infection?
a) “I took the Vibramycin twice a day for a week.”
b) “I haven’t told my girlfriend about my infection yet.”
c) “I had a couple of beers while I was taking the medication.”
d) “I ve only had sexual intercourse once since my medication”
4) Why blood tests were included in the diagnostic tests to find the diagnosis
of K.6.1.1. Definition and the Balanitis and Balanoposthitis
Balanitis is often confused with two similar conditions: phimosis, balanoposthitis
and prosthitis. All these conditions affect the penis. However, each condition affects
a different part of the penis.• Phimosis is a condition that makes it difficult to retract the foreskin.
• Balanitis is inflammation of the head (glans) of the penis.
• Balanoposthitis is inflammation of both the penis head (glans) and the foreskin.
• Prosthitis is the inflammation of the prepuce
6.1.2. Causes and pathophysiology of Balanitis and Balanoposthitis
Balanitis and Balanoposthitis are mostly caused by poor hygiene in uncircumcised
men. Other causes may include:
• Sexually transmitted diseases/infections(STDs/STIs) such as Gonorrhea,
chlamydia, trichomonas vaginalis, mycoplasma genitalium, genital helps,
human papilloma virus(HPV), syphilis
• Genital yeast infection (candidiasis).
• Diabetes
• Scabies (tiny burrowing parasite) infection.
• Skin conditions that cause itchy, dry, scaly skin (ex. In psoriasis and eczema
diseases conditions).
• Reactive arthritis, a type of arthritis that develops in response to an infection
somewhere in the body
• Reactive arthritis, a type of arthritis that develops in response to an infection
somewhere in the body.
Beside poor hygiene among uncircumcised men, other predisposing factor
include: over-the-counter (OTC) medications, and no- retraction of the foreskin.
Balanitis can be classified under different types
• Balanitis (also called Zoon’s balanitis):
– This is the main type of balanitis,
– usually affects uncircumcised, middle-aged men
– the head of penis is inflamed, painful, and reddened
• Circinate balanitis:
– This is the type of Balanitis which occurs as a result of reactive arthritis,
(an arthritis that develops in response to an infection in the body).
– Inflammation, redness, pain, and small lesions (sores) on the head of the
penis are present
• Pseudoepitheliomatous keratotic and micaceous balanitis:
– very rare form of balanitis
– It mostly affects men over 60– scaly warts on the glans is present
6.1.3 Signs and symptoms of Balanitis and Balanoposthitis
Generally, signs and symptoms of balanitis may appear suddenly or gradually.
They can include:
• Swelling
• Pain and irritation on the glans (head of the penis).
• Redness or red patches on the penis.
• Itching under the foreskin.
• Areas of shiny or white skin on the penis.
• White discharge (smegma) under the foreskin
• Foul smell.
• Painful urination.
• Sores or lesions on the glans (rare and specific to Pseudoepitheliomatouskeratotic and micaceous balanitis)
6.1.4 Diagnostic measures of Balanitis and Balanoposthitis
The Balanitis and Balanoposthitis can be diagnosed through a complete history,
physical examination as well as some diagnostic test to determine the underlying
cause like infection
• Urinalysis
• urethral opening swab
• blood test: glycaemia (to exclude Diabetes mellitus), full blood count (to
determine the type of infection)
NB: In people with recurrent balanitis and balanoposthitis, HIV test is advisableSelf-assessment 6.1
1) What are the signs and symptoms of balanitis and balanoposthitis?
2) Briefly explain the pathophysiology of Balanoposthitis?
3) All types of balanitis share almost the same signs and symptoms. What
is the specific sign and particular sign for circinate balanitis?4) List the treatment goals of Balanitis and Balanoposthitis
6.2.1 The treatment of Balanitis and Balanoposthitis
The treatment and management of balanitis depends on the underlying cause and
contributing factors. Whatever the treatment plan, the goal of treatment is to:
• Minimize sexual dysfunction
• Minimize urinary dysfunction
• Exclude penile cancer
• Treat premalignant disease
• Diagnose and treat sexually transmitted disease.
Depending on the cause, the treatments can include:
• Antibiotics: If a sexually transmitted infection (STI) is confirmed to be the
cause of balanitis, the antibiotics will be prescribed. The antibiotic will also
depend on the type of infection (Gonorrhoea, chlamydia, trichomonas vaginalis,
mycoplasma genitalium, genital helps, human papilloma virus(HPV), syphilis
• Circumcision: is a surgical procedure in which the foreskin covering the
penis is surgically removed. Circumcision is recommended in case of
recurring symptoms of balanitis in uncircumcised
• Antifungal creams: is prescribed if the yeast infection is the underlying
cause of balanitis. Antifungal like clotrimazole will be applied the glans (head
of the penis) and foreskin as prescribed.
• Diabetes management: If you have diabetes, your provider will show you
how to manage the condition.
• Improved hygiene: this consist of washing and drying under the penis’s
foreskin (glands) often to reduce the risk of reoccurrence of balanitis.
6.2.2. Evolution and complications of Balanitis and Balanoposthitis
Untreated balanoposthitis does not usually cause serious complication except
when its underlying cause are cancerous origin.Generally untreated inflammation of the glans of the penis (balanitis) is frequently
associated with a degree of the inflammation of the foreskin (posthitis), a situation
which can lead to the following:
• Phimosis: retraction of the penis’s foreskin. The foreskin may swell, cause
pain, and blockage during urinating. The swelling is typically described as
balloon-like swelling or ‘ballooning’).
• Paraphimotic: a surgical condition whereby the penis’ foreskin becomes
trapped behind the head of the penis, and cannot be pulled over the head
to its normal position. This is typically very painful and considered a medical
emergency. It must be treated as soon as possible, otherwise the blood flow
to the glans may be restricted, and complete circumcision will need to be
carried out in advanced cases.
• Structure of urethral meatus: the scarring around the opening of the
waterpipe, due to chronic inflammatory changes, can lead to the narrowing
of the water hole.
6.3 End unit assessment
End of unit assessment
1) An abnormal finding noted during physical assessment of the male
reproductive system is
a) Descended testes.
b) Symmetric scrotum.
c) Slight swollen and reddish glans of penis
d) The glans covered with prepuce.
2) List the complications of Balanitis and Balanoposthitis
3) What are the preventive measures for Balanitis/ Balanoposthitis?
4) How clotrimazole cream for balanitis is used?
5) What are the treatment modalities of Balanitis/ Balanoposthitis?