Balanoposthitis is a pathological condition that has a negative effect on the penis, causing inflammation of the foreskin and glans penis.
The foreskin, the “preputial bag,” is the fold of the motile skin that covers the head of the penis and extends beyond it. It is from the inside that is most susceptible to inflammation, since it forms a closed cavity (“bag”).
According to WHO statistics, 11% of male visits to a urologist are associated with balanoposthitis, this diagnosis accounts for almost 50% of all skin diseases of the penis.
Since the foreskin is removed during circumcision, balanoposthitis affects only “uncircumcised” men. It can appear at any age.
The disease has many causes, but most actively contribute to its development:
- poor hygiene
- narrowed compacted foreskin.
A number of factors may increase the risk of the disease. People with balanoposthitis often have one of several causes:
one of the most common causes of balanoposthitis. Although balanoposthitis by itself is not a venereal pathology, some sexually transmitted microorganisms may contribute to its occurrence:
- gonorrhea (gonococcus pathogen)
- herpes simplex
- human papillomavirus (HPV)
- primary or secondary syphilis
another common cause of balanoposthitis. Candida is a type of fungus that is usually found in small quantities in the human body.
may also increase the risk of balanoposthitis . Some of these conditions include:
- chronic balanitis (persistent inflammation of the foreskin)
- injuries and accidents
- irritation caused by friction or scratching
- chemical irritation
- diabetes mellitus (due to constant irritation of the foreskin with high glucose urine)
- taking antibiotics (causes an imbalance of microfolor , contributes to the release of fungi – candidate to the fore in the area of the preputial sac)
- local allergic reactions, including taking antibiotics
- reactive arthritis
- narrowed compacted foreskin.
Household irritants can also lead to balanoposthitis . For example, exposure to chlorine in the pool can cause irritation of the penis.
In other cases, balanoposthitis manifests itself several days after intercourse, may be the result of friction or the use of latex condoms.
For the reasons, distinguish different types of balanoposthitis :
- candidal or fungal (caused by the fungus “Candida”)
- autoimmune (when the foreskin becomes inflamed and rejected due to the imbalance of immunity in the body)
- infectious, when the cause of the disease are various viruses or bacteria that cause the infection:
- chlamydia (caused by the bacterium “chlamydia”),
- anaerobic (caused by bacteria that can live without air in the preputial sac),
- gardnerella (caused by gardnerella )
- Trichomonas (pathogen – Trichomonas).
- viral, including herpes (caused by the herpes virus)
- nonspecific, develops in patients with diabetes mellitus or alcohol abusers (under the action of glucose and alcohol excreted by the urine, the foreskin is so inflamed that its coarse constriction develops – Kouros )
Depending on the nature of the disease, balanoposthitis can be divided into:
- erosive (with small sores), as a subspecies – zirconium (with multiple sores of bright red color);
- ulcerative – may appear on the background of steroid treatment of joint pathologies, for example, systemic diseases – large ulcers form on the foreskin and head of the penis;
- follicular – with the formation of small inflammatory vesicles;
- xerotic – when the chronic form of inflammation of the foreskin leads to its coarsening and compaction;
- sluggish – the term is applicable to the chronic slow course of balanoposthitis without marked symptoms;
- relapsing – when, against the background of a chronic course, there is a surge in exacerbation of the disease, which is difficult to treat.
Stages of balanoposthitis
Also, depending on the stage of the disease, there are:
- catarrhal balanoposthitis (mild inflammation of the head and foreskin);
- purulent (more serious inflammation with the formation of pus);
- gangrenous (critical stage, fraught with infection of the blood and the whole body).
Symptoms of balanoposthitis appear near the glans penis and the foreskin, ranging from mild to severe.
Manifestations of balanoposthitis can hinder urination and sexual intercourse.
Common symptoms include:
- pain, sensitivity, and irritation;
- thickening and coarsening of the foreskin, enhancement of the skin pattern ( lichenification );
- discolored or “shiny” skin;
- itching or burning;
- very dry skin of the foreskin and glans;
- unusual discharge;
- unpleasant smell from the penis and discharge;
- narrowed compacted foreskin (phimosis);
- erosion or skin damage.
Symptoms of the chronic form
With a chronic course of balanoposthitis , the symptoms will look like this:
- moderate puffiness of the glans penis;
- constantly renewed raid on the head;
- redness and irritation of the penis head, foreskin, periodically undergoing.
In the late stages of chronic balanoposthitis or in the development of an acute process, such phenomena as:
- swelling and tenderness of the penis;
- turbid urine mixed with purulent discharge;
- discharge of pus from the foreskin, in some cases – blood;
In extremely advanced cases of balanoposthitis , the disease can be transferred to a necrotic form – gangrene, which manifests itself:
- ulceration of the foreskin and penis;
- blackening of the foreskin and head (the formation of necrotic tissue proper);
- the increase in pain and hyperthermia to 39C and above;
- signs of poisoning by necrosis decay products: muscle weakness, thirst, low blood pressure, impaired consciousness.
The combination of symptoms usually depends on the cause of balanoposthitis . For example, a process caused by a yeast infection may include symptoms such as itching, burning, and a white spot around the head of the penis and foreskin.
Differential diagnosis should be carried out with the following diseases:
- sclerosing lichen
- psoriasis (skin disease)
- penile cancer
- paraphimosis (pinch of the penis narrowed by the foreskin)
- cavernitis of the penis (inflammation of the internal structures of the penis)
- Reiter’s disease (rheumatic disease in combination with a ring-shaped lesion of the head of the penis)
- Zun ‘s disease (reddening of the head of the penis with the formation of pink glossy spots and “weeping” surface that occurs in older men)
- erythroplasia keira
- furuncle, abscess (inflammatory purulent cavity) of the cavernous body and penis
- cellulitis of the cavernous body and penis.
Phimosis, balanitis and balanoposthitis
Speaking of balanopostitis , it is often confused with two similar diseases: phimosis and balanitis. All three pathologies, one way or another, affect the penis. However, each condition affects a different part of it.
- Phimosis (N 47 ICD-10) is a condition that makes it difficult to remove the head of the penis as a result of the narrowing of the foreskin.
- Balanitis (N 48.6 according to ICD-10) is an inflammation of the glans penis.
- Balanoposthitis (N 48.1 ICD-10) – inflammation of both the glans penis and the foreskin.
Phimosis can occur along with balanitis or balanoposthitis . In many cases, it is both a symptom and a cause. For example, the presence of phimosis provokes irritation of the penis head and foreskin. As soon as this irritation occurs, such phenomena as pain and edema can impede the exit of the head from the leaves of the foreskin.
If you experience irritation around the head of the penis or foreskin, you should consult a doctor who specializes in urology (urologist) or skin diseases (dermatologist-venereologist).
It is unlikely that the pathology will pass without special treatment, although in rare cases it is possible. Most likely, without treatment, the light catarrhal stage will turn either into a chronic form or into a purulent, and then into a dangerous gangrene.
Balanoposthitis is fairly well amenable to therapy, provided that therapeutic measures are taken on time.
Your doctor will start by asking you about the symptoms and examining your penis. Doctors can take a swab from the head of the penis, the foreskin for research under a microscope or for seeding on microorganisms. It is possible to determine the sensitivity of the sown microorganism to specific antibacterial agents.
Depending on the symptoms, various tests may be required, such as a total blood test, for sugar, HIV, syphilis, urinalysis, foreskin biopsy (taking a piece of tissue for microscopic examination).
Balanoposthitis treatment consists of:
- external washings
- baths and lotions
- antibacterial drugs
- administration of antibiotics intramuscularly and / or intravenously.
Targeted (depending on the sensitivity of the results of sowing) the use of antibiotics gives a better result than empirical (blind) use of them.
In allergic and autoimmune forms, antihistamines and hormones, glucocorticoids, are prescribed.
Various ointments in the treatment of balanoposthitis , in general, have compromised themselves, since in 60% of cases undesirable reactions to the ointment base occur.
For viral infections, antiviral and immune preparations may be required.
From antiseptics for external empirical use (in the form of baths, washes, wraps), solutions have proven themselves well
- chlorhexidine digluconate 0.05%,
- a weak solution of potassium permanganate.
It is undesirable to use a solution of hydrogen peroxide, because of its much aggressiveness for the delicate skin of the foreskin. Not bad, in combination with chemical solutions, water herbal infusions of chamomile, succession, celandine, sage, oak bark , which do not irritate the skin and contribute to the restoration of the normal microflora of the preputial bag.
The duration of such therapy may be on average from one to two weeks.
In case of failure of the therapy “blindly”, a smear should be made for the diagnosis of a specific type of pathogen, then an antibiotic is prescribed as a local therapy, by mouth or by injection, depending on the severity of the process, taking into account the pathological microorganism.
Thus, antibiotics of the synthetic penicillin group are effective against pathogens such as staphylococcus and streptococcus.
In case of fungal infection, special anti- fungal creams are effective: Clotrimazole , Miconazole and Econazole, add tablet preparations – Diflucan (fluconazole).
In case of detection of herpes simplex virus, Acyclovir, Valacyclovir is prescribed in the course of therapy.
Important! Sexual partners are also subject to treatment and examination.
The treatment of balanitis and balanoposthitis is generally not different, since the parts of the organ affected by these processes are in close contact. In chronic, intractable cases with frequent relapses, as well as complications of the acute process, surgical treatment is carried out.
Operation at a balanoposthitis
Surgical treatment of balanoposthitis consists in a circular excision of the foreskin (circumcision).
Indications for surgery is
- the ineffectiveness of conservative therapy,
- frequent recurrences of the disease,
- combinations of balanoposthitis with phimosis and excess foreskin.
How is the operation?
The operation of circumcision (circumcision) is performed under general or conduction anesthesia and takes up to 30 minutes. In the hospital, such patients are, usually not for long – a few days. The stitches are removed for 5-7 days. In the hospital or clinic, before removing the stitches, observation, treatment of the stitches with a “green” is carried out. If necessary, prescribe baths with potassium permanganate, in case of inflammation may prescribe antibiotics.
The rehabilitation period is 2-3 weeks. For this period, sex, bathing in fresh and sea water, baths and saunas, alcohol and spicy foods are excluded.
In the prevention of great importance hygiene prepucialny bag, glans penis.
Timely treatment of phimosis (narrowed foreskin) and “excess” foreskin.
Timely treatment of sexually transmitted infections.