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==Causes ==
==Causes ==
Causes of balanitis are:{{familytree/start}}
==Differential diagnosis ==
{{familytree | | | | | | | | | | | | | | | | | A01 |A01='''Balanitis'''}}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | B01 | | | | | | | | | | | B02 | | | | | | | | | B03 |B01='''Infectious'''|B02='''Inflammatory dermatoses'''|B03='''Premalignant (penile carcinoma in situ)'''}}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | C01 | | | | | | | | | | | C02 | | | | | | | | | C03 |C01=[[Candida]] (albicans, krusei)<br>[[Streptococci]]<br>Anaerobes<br>[[Staphylococci]]<br>[[Trichomonas vaginalis]]<br>[[Herpes simplex virus]]<br>[[Human papillomavirus]]<br>[[Mycoplasma genitalium]]|C02=[[Lichen sclerosus]]<br>[[Lichen planus]]<br>[[Psoriasis]]<br>[[Circinate balanitis]]<br>[[Zoon's balanitis]]<br>[[Eczema]]<br>[[Allergic reactions]]|C03= [[Bowen's disease]]<br>[[Bowenoid papulosis]]<br>[[Erythroplasia of Queyrat]]}}
{{familytree/end}}
 
Causes of Infectious balanitis include:<ref>GENITOURINARY MEDICINE, Volume 72, Number 3: Pages 155-9, June 1996.</ref><ref>International Journal of Research in Health Sciences. Jan–Mar 2014 Volume-2, Issue-1</ref><ref name="pmid26396455">{{cite journal| author=Pandya I, Shinojia M, Vadukul D, Marfatia YS| title=Approach to balanitis/balanoposthitis: Current guidelines. | journal=Indian J Sex Transm Dis | year= 2014 | volume= 35 | issue= 2 | pages= 155-7 | pmid=26396455 | doi=10.4103/0253-7184.142415 | pmc=4553848 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26396455  }}</ref>{{familytree/start}}
{{familytree | | | | | | | A01 | | | | | | | | | | | | | | | |A01=Balanitis}}
{{familytree | |,|-|-|-|v|-|^|-|v|-|-|-|-|-|-|.| | | | | | | | | | }}
{{familytree | |!| | | |!| | | |!| | | | | | |!| | | | | | | | | | | | | }}
{{familytree | B01 | | B02 | | B03 | | | | | B04 | | | | |B01=Fungal|B02=Virus|B03=Parasite/Protozoal|B04=Bacteria}}                     
{{familytree | |!| | | |!| | | |!| | |,|-|-|-|+|-|-|-|v|-|-|-|.|}}
{{familytree | |!| | | |!| | | |!| | |!| | | |!| | | |!| | | |!|}}
{{familytree | C01 | | C02 | | C03 | |C04| | C05 | | C06 | | C07 | |C01=Candida (albicans, krusei)<br> Dermatophytosis <br>Pityriasis versicolor<br>Histoplasma capsulatum<br>Blastomyces dermatitidis<br>Cryptococcus neoformans|C02=Herpes simplex virus<br>Varicella zoster virus (VZV)<br>Human papilloma virus (HPV)|C03='''Protozoal'''<br>Entamoeba histolytica<br>Trichomonas vaginalis<br>Leishmania species<br>'''Parastic'''<br>Sarcoptes scabiei var hominis<br>Pediculosis<br>Ankylostoma species|C04='''Gram negative bacteria'''<br>E.coli, Pseudomonas, Haemophilus parainfluenzae, Klebsiella, Neisseria gonorrhoea, Haemophilus ducreyi, Mycoplasma genitalium, Chlamydia, Ureaplasma, Gardnerella vaginalis, Citrobacter, Enterobacter<br>|C05='''Spirochaetes'''<br>Treponema pallidum, Non specific spirochaetal infection<br>|C06='''Gram positive organism'''<br> Haemolytic Streptococci(Group B Streptococci), Staphylococci epidermidis/aureus|C07='''Acid fast bacilli'''<br> Mycobacterium tuberculosis, Leprosy<br>'''Anaerobes'''<br>(Bacteroides)}}
{{familytree/end}}
==[[Balanitis differential diagnosis|Differentiating diagnosis]]==
{| class="wikitable"
! colspan="3" |Symptoms
! colspan="4" |Signs
|-
!
!Malaise
!Pruritus
!Skin lesions
!Regional lymphadenopathy
!Erythema
!Swelling
|-
|[[Candidiasis|Candida balanitis]]
|✖
|✔
|[[Erythematous]] [[Rash (patient information)|rash]] with soreness and/or [[itch]]
|✔
|✔
|✖
|-
|[[Trichomonas vaginalis]]
|✖
|✔
|Superficial erosive [[balanitis]]
|✖
|✔
|✖
|-
|[[Treponema pallidum]]
|✖
|✖
|Multiple circinate lesions
|✔
|✖
|✖
|-
|[[Herpes simplex]]
|✔
|✔
|Grouped [[vesicles]] on [[erythematous]] base
|✔
|✔
|✖
|-
|[[Human papillomavirus|Human papilloma virus]]
|✖
|✔
|[[Warts]]
|✖
|✖
|✖
|-
|[[Lichen sclerosus]]
|✖
|✔
|White patches on glans
|✖
|✖
|✖
|-
|[[Lichen planus]]
|✖
|✔
|Purplish lesions on the [[penis]]
|✖
|✖
|✖
|-
|[[Psoriasis]]
|✖
|✔
|Red scaly plaques
|✖
|✔
|✖
|-
|[[Reiter's Syndrome|Circinate]]
|✔
|✔
|Greyish white areas on the [[glans]]
|✖
|✖
|✖
|-
|[[Zoon's balanitis]]
|✖
|✔
|Well-circumscribed orange-red glazed areas
|✖
|✖
|✖
|-
|[[Eczema]]
|✖
|✔
|Mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
|✖
|✔
|✔
|-
|[[Fixed drug eruption]]
|✖
|✔
|Well demarcated and [[Erythema|erythematous]] lesions
|✖
|✔
|✖
|-
|[[Bowen's disease]]
|✖
|✔
|Multiple, small, well-demarcated [[Papillomatosis|papillomatous]] [[papules]]
|✖
|✖
|✖
|-
|[[Bowenoid papulosis]]
|✖
|✔
|Single or multiple, sharply demarcated associated with [[Scaling skin|scaling]] and crusting
|✖
|✖
|✖
|-
|[[Erythroplasia of Queyrat]]
|✖
|✔
|Velvety patches and [[plaques]] of [[keratinization]] on [[penis]].
|✔
|✖
|✖
|}
==[[Balanitis epidemiology and demographics|Epidemiology and Demographics]]==
==[[Balanitis epidemiology and demographics|Epidemiology and Demographics]]==
*There are no comprehensive studies studying the [[incidence]] and [[prevalence]] in general population. A recent study has shown that balanitis commonly occurs in around 10% of the patient population visiting the [[STD]] clinic, with [[infectious]] etiology responsible for around 50% of the cases.<ref name="pmid8707315">{{cite journal| author=Edwards S| title=Balanitis and balanoposthitis: a review. | journal=Genitourin Med | year= 1996 | volume= 72 | issue= 3 | pages= 155-9 | pmid=8707315 | doi= | pmc=1195642 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8707315  }}</ref>
*[[Candidiasis|Candida]] is the most common cause being responsible for 30-35% cases with infectious etiology.<ref name="pmid8566986">{{cite journal| author=Dockerty WG, Sonnex C| title=Candidal balano-posthitis: a study of diagnostic methods. | journal=Genitourin Med | year= 1995 | volume= 71 | issue= 6 | pages= 407-9 | pmid=8566986 | doi= | pmc=1196117 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8566986  }}</ref>
==[[Balanitis risk factors|Risk Factors]]==
==[[Balanitis risk factors|Risk Factors]]==
Pathophysiology of Infectious balanitis varies from pathogen to pathogen:<ref name="pmid1156848">{{cite journal| author=Taylor PK, Rodin P| title=Herpes genitalis and circumcision. | journal=Br J Vener Dis | year= 1975 | volume= 51 | issue= 4 | pages= 274-7 | pmid=1156848 | doi= | pmc=1046564 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1156848  }}</ref><ref name="pmid6121604">{{cite journal| author=Cree GE, Willis AT, Phillips KD, Brazier JS| title=Anaerobic balanoposthitis. | journal=Br Med J (Clin Res Ed) | year= 1982 | volume= 284 | issue= 6319 | pages= 859-60 | pmid=6121604 | doi= | pmc=1496281 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6121604  }}</ref><ref>GENITOURINARY MEDICINE, Volume 72, Number 3: Pages 155-9,</ref><ref name="pmid20002652">{{cite journal| author=Lisboa C, Santos A, Dias C, Azevedo F, Pina-Vaz C, Rodrigues A| title=Candida balanitis: risk factors. | journal=J Eur Acad Dermatol Venereol | year= 2010 | volume= 24 | issue= 7 | pages= 820-6 | pmid=20002652 | doi=10.1111/j.1468-3083.2009.03533.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20002652  }}</ref><ref name="pmid2482855322">{{cite journal| author=Edwards SK, Bunker CB, Ziller F, van der Meijden WI| title=2013 European guideline for the management of balanoposthitis. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 9 | pages= 615-26 | pmid=24828553 | doi=10.1177/0956462414533099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24828553  }}</ref><ref>{{cite journal| author=Hernandez BY, Wilkens LR, Zhu X, Thompson P, McDuffie K, Shvetsov YB et al.| title=Transmission of human papillomavirus in heterosexual couples. | journal=Emerg Infect Dis | year= 2008 | volume= 14 | issue= 6 | pages= 888-94 | pmid=18507898 | doi=10.3201/eid1406.070616 | pmc=2600292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18507898  }}</ref><ref>Sobel JD (1985). "Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis". Am. J. Obstet. Gynecol. 152 (7 Pt 2): 924–35. <nowiki>PMID 3895958</nowiki>.</ref>
{| class="wikitable"
!Pathogen
!Risk factors
|-
|[[Candidiasis|Candidal Balanitis]]
|
*[[Diabetes]]
*[[Immunocompromised]] conditions
*Age>40 yrs
|-
|[[Anaerobic organism|Anaerobic Infection]]
|
*Tight [[foreskin]]
*sub-optimal penile hygienic maintenance
|-
|[[Aerobic organism|Aerobic]]
[[Aerobic organism|Infections]]
|
*Uncircumcised penis


*[[Diabetes]]
*[[Immunocompromised|Immunocompromise]] conditions
|-
|[[Trichomonas vaginalis]]
|
*Multiple sexual partners
*Unprotected sexual activity
*Co-existing [[venereal diseases]]
|-
|[[Treponema pallidum|Treponema]]
[[Treponema pallidum|pallidum]]
|[[Risk factors]] include:<ref name="pmid2356911">{{cite journal| author=Rolfs RT, Goldberg M, Sharrar RG| title=Risk factors for syphilis: cocaine use and prostitution. | journal=Am J Public Health | year= 1990 | volume= 80 | issue= 7 | pages= 853-7 | pmid=2356911 | doi= | pmc=1404975 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2356911  }}</ref><ref name="pmid17675391">{{cite journal| author=Zhou H, Chen XS, Hong FC, Pan P, Yang F, Cai YM et al.| title=Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen, China. | journal=Sex Transm Infect | year= 2007 | volume= 83 | issue= 6 | pages= 476-80 | pmid=17675391 | doi=10.1136/sti.2007.026187 | pmc=2598725 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17675391  }}</ref><ref name="pmid15247352">{{cite journal| author=Hook EW, Peeling RW| title=Syphilis control--a continuing challenge. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 2 | pages= 122-4 | pmid=15247352 | doi=10.1056/NEJMp048126 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15247352  }}</ref><ref name="pmid16205297">{{cite journal| author=Buchacz K, Greenberg A, Onorato I, Janssen R| title=Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention. | journal=Sex Transm Dis | year= 2005 | volume= 32 | issue= 10 Suppl | pages= S73-9 | pmid=16205297 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16205297  }}</ref><ref name="pmid25514173">{{cite journal| author=Solomon MM, Mayer KH| title=Evolution of the syphilis epidemic among men who have sex with men. | journal=Sex Health | year= 2015 | volume= 12 | issue= 2 | pages= 96-102 | pmid=25514173 | doi=10.1071/SH14173 | pmc=4470884 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25514173  }}</ref><ref name="newell">Newell, J., et al. "A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 2. Risk factors and health seeking behaviour." Genitourinary medicine 69.6 (1993): 421-426.</ref>Multiple sexual partners, prostitution, illicit drug use, unprotected sex
men who have sex with men, residence in highly prevalent areas, [[Human Immunodeficiency Virus (HIV)|HIV]] infection, presence of other [[STI]]<nowiki/>s, previous history of STIs, [[intravenous drug]] use, health care professionals who are predisposed to occupational risk, and low socioeconomic status
|-
|[[Herpes simplex]]
|
*Multiple sexual partners
*Low [[socio-economic status]]
|-
|[[Human papilloma virus]]
|[[Risk factors]] responsible for sexual transmission of [[Human papillomavirus|HPV]] include:
Number of sex partners<ref name="pmid21414655">{{cite journal |vauthors=Bell MC, Schmidt-Grimminger D, Jacobsen C, Chauhan SC, Maher DM, Buchwald DS |title=Risk factors for HPV infection among American Indian and white women in the Northern Plains |journal=Gynecol. Oncol. |volume=121 |issue=3 |pages=532–6 |year=2011 |pmid=21414655 |pmc=4498572 |doi=10.1016/j.ygyno.2011.02.032 |url=}}</ref><ref name="pmid14702152">{{cite journal |vauthors=Tarkowski TA, Koumans EH, Sawyer M, Pierce A, Black CM, Papp JR, Markowitz L, Unger ER |title=Epidemiology of human papillomavirus infection and abnormal cytologic test results in an urban adolescent population |journal=J. Infect. Dis. |volume=189 |issue=1 |pages=46–50 |year=2004 |pmid=14702152 |doi=10.1086/380466 |url=}}</ref>, acqusition of new partner<ref name="pmid21414655" />
, having non monogamous sex partner<ref name="pmid9217656">{{cite journal |vauthors=Koutsky L |title=Epidemiology of genital human papillomavirus infection |journal=Am. J. Med. |volume=102 |issue=5A |pages=3–8 |year=1997 |pmid=9217656 |doi= |url=}}</ref><ref name="pmid12543621">{{cite journal |vauthors=Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA |title=Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students |journal=Am. J. Epidemiol. |volume=157 |issue=3 |pages=218–26 |year=2003 |pmid=12543621 |doi= |url=}}</ref>, starting sexual activity in young age<ref name="pmid9217656" />, vaginal delivery and multiple deliveries<ref name="pmid9464728">{{cite journal |vauthors=Tseng CJ, Liang CC, Soong YK, Pao CC |title=Perinatal transmission of human papillomavirus in infants: relationship between infection rate and mode of delivery |journal=Obstet Gynecol |volume=91 |issue=1 |pages=92–6 |year=1998 |pmid=9464728 |doi= |url=}}</ref>, age over 40 for women<ref name="pmid21495248">{{cite journal |vauthors=Ting J, Kruzikas DT, Smith JS |title=A global review of age-specific and overall prevalence of cervical lesions |journal=Int. J. Gynecol. Cancer |volume=20 |issue=7 |pages=1244–9 |year=2010 |pmid=21495248 |doi= |url=}}</ref>, history of [[Chlamydia infection|Chlamydia]] infection<ref name="pmid9332762">{{cite journal |vauthors=Kjaer SK, van den Brule AJ, Bock JE, Poll PA, Engholm G, Sherman ME, Walboomers JM, Meijer CJ |title=Determinants for genital human papillomavirus (HPV) infection in 1000 randomly chosen young Danish women with normal Pap smear: are there different risk profiles for oncogenic and nononcogenic HPV types? |journal=Cancer Epidemiol. Biomarkers Prev. |volume=6 |issue=10 |pages=799–805 |year=1997 |pmid=9332762 |doi= |url=}}</ref>,  and long term [[Oral contraceptive|OCP]] use<ref name="pmid1649312">{{cite journal |vauthors=Ley C, Bauer HM, Reingold A, Schiffman MH, Chambers JC, Tashiro CJ, Manos MM |title=Determinants of genital human papillomavirus infection in young women |journal=J. Natl. Cancer Inst. |volume=83 |issue=14 |pages=997–1003 |year=1991 |pmid=1649312 |doi= |url=}}</ref>
|}
==[[Balanitis screening|Screening]]==
==[[Balanitis screening|Screening]]==
There is no established clinical guidelines for screening patients for balanitis.
There is no established clinical guidelines for screening patients for balanitis.
==[[Balanitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Balanitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
===Natural history===
If left untreated, Infectious balanitis may result in complications, which include [[pain]], [[phimosis]], and urinary retention.
===Complications===
Complication of Infectious balanitis include:<ref name="pmid248285532" />
*[[Pain]]
*Erosions
*[[Fissures]]
*[[Phimosis]]
*[[Paraphimosis]]
*Painful [[erection]]
*Reduced urinary flow
*[[Urinary retention]]
===Prognosis===
[[Prognosis]] is usually good with treatment.
===Natural history===
'''Bowenoid papulosis'''
If left untreated, [[papules]] may increase, or decrease, or disappear with time, or  progress  into [[squamous cell carcinoma]](Studies have reported risk of progression of bowenoid papulosis to [[squamous cell carcinoma]] at 2.6%).<ref name="pmid23806153">{{cite journal| author=Kutlubay Z, Engin B, Zara T, Tüzün Y| title=Anogenital malignancies and premalignancies: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 362-73 | pmid=23806153 | doi=10.1016/j.clindermatol.2013.01.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806153  }}</ref>
====Erythroplasia of Queyrat====
If left untreated, Erythroplasia of Queyrat may progress into invasive [[Squamous cell carcinoma]], with an incidence ranging from 10% to 33%.<ref name="pmid23806153" />
====Bowen's Disease====
If left untreated, Bowen's disease may progress into invasive [[Squamous cell carcinoma]](Incidence of Bowen's disease to develop into invasive squamous cell carcinoma is 3% to 5% for cutaneous and 10% for genital lesions). The [[malignant]] potential of Bowen's disease is increased when its existence is compounded by concomitant disease such as [[HPV]] infection, Lichen sclerosis or [[Lichen planus]], or in patients with poor genital hygiene and smokers.<ref name="pmid23806153" />
===Complications===
Complication of penile carcinoma in situ include:<ref name="pmid23806153" />
*[[Pain]]
*Transformation into invasive [[squamous cell carcinoma]]
===Prognosis===
The [[prognosis]] is usually good with treatment.
==Diagnosis==
==Diagnosis==
[[Balanitis diagnostic criteria| Diagnostic Criteria]] | [[Balanitis history and symptoms| History and Symptoms]] | [[Balanitis physical examination| Physical Examination]] | [[Balanitis laboratory findings| Laboratory Findings]] | [[Balanitis chest x ray|X-ray]]|[[CT-Scan]]| [[MRI]]|  [[Balanitis other diagnostic studies|Other Diagnostic Studies]]
[[Balanitis diagnostic criteria| Diagnostic Criteria]] | [[Balanitis history and symptoms| History and Symptoms]] | [[Balanitis physical examination| Physical Examination]] | [[Balanitis laboratory findings| Laboratory Findings]] | [[Balanitis chest x ray|X-ray]]|[[CT-Scan]]| [[MRI]]|  [[Balanitis other diagnostic studies|Other Diagnostic Studies]]
Line 257: Line 31:
[[Balanitis medical therapy|Medical Therapy]] | [[Balanitis primary prevention|Primary Prevention]]  | [[Balanitis secondary prevention|Secondary Prevention]] | [[Balanitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Balanitis future or investigational therapies|Future or Investigational Therapies]]
[[Balanitis medical therapy|Medical Therapy]] | [[Balanitis primary prevention|Primary Prevention]]  | [[Balanitis secondary prevention|Secondary Prevention]] | [[Balanitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Balanitis future or investigational therapies|Future or Investigational Therapies]]


== Classification  ==
  {| align=center
 
There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:<ref name="pmid24828553">{{cite journal| author=Edwards SK, Bunker CB, Ziller F, van der Meijden WI| title=2013 European guideline for the management of balanoposthitis. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 9 | pages= 615-26 | pmid=24828553 | doi=10.1177/0956462414533099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24828553  }}</ref>
* [[Infectious balanitis|Infectious]]
* [[Inflammatory dermatoses]]
* [[Penile carcinoma in situ]]
 
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | A01 |A01='''Balanitis'''}}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | B01 | | | | | | | | | | | B02 | | | | | | | | | B03 |B01='''Infectious'''|B02='''Inflammatory dermatoses'''|B03='''Premalignant (penile carcinoma in situ)'''}}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | C01 | | | | | | | | | | | C02 | | | | | | | | | C03 |C01=[[Candida]] (albicans, krusei)<br>[[Streptococci]]<br>Anaerobes<br>[[Staphylococci]]<br>[[Trichomonas vaginalis]]<br>[[Herpes simplex virus]]<br>[[Human papillomavirus]]<br>[[Mycoplasma genitalium]]|C02=[[Lichen sclerosus]]<br>[[Lichen planus]]<br>[[Psoriasis]]<br>[[Circinate balanitis]]<br>[[Zoon's balanitis]]<br>[[Eczema]]<br>[[Allergic reactions]]|C03= [[Bowen's disease]]<br>[[Bowenoid papulosis]]<br>[[Erythroplasia of Queyrat]]}}
{{familytree/end}}
 
==Diagnosis and management==
<small><small>Adopted from National Guideline on the Management of Balanoposthitis UK 2008</small></small><br>
{| align=center
|-
|-
|
|
Line 297: Line 53:
|}
|}


==Synopsis==
==References==
{| class="wikitable"
! colspan="3" |Symptoms
! colspan="4" |Signs
|-
!
!Malaise
!Pruritus
!Skin lesions
!Regional lymphadenopathy
!Erythema
!Swelling
|-
|[[Candidiasis|Candida balanitis]]
|✖
|✔
|[[Erythematous]] [[Rash (patient information)|rash]] with soreness and/or [[itch]]
|✔
|✔
|✖
|-
|[[Trichomonas vaginalis]]
|✖
|✔
|Superficial erosive [[balanitis]] 
|✖
|✔
|✖
|-
|[[Treponema pallidum]]
|✖
|✖
|Multiple circinate lesions
|✔
|✖
|✖
|-
|[[Herpes simplex]]
|✔
|✔
|Grouped [[vesicles]] on [[erythematous]] base
|✔
|✔
|✖
|-
|[[Human papillomavirus|Human papilloma virus]]
|✖
|✔
|[[Warts]]
|✖
|✖
|✖
|-
|[[Lichen sclerosus]]
|✖
|✔
|White patches on glans
|✖
|✖
|✖
|-
|[[Lichen planus]]
|✖
|✔
|Purplish lesions on the [[penis]]
|✖
|✖
|✖
|-
|[[Psoriasis]]
|✖
|✔
|Red scaly plaques
|✖
|✔
|✖
|-
|[[Reiter's Syndrome|Circinate]]
|✔
|✔
|Greyish white areas on the [[glans]]
|✖
|✖
|✖
|-
|[[Zoon's balanitis]]
|✖
|✔
|Well-circumscribed orange-red glazed areas
|✖
|✖
|✖
|-
|[[Eczema]]
|✖
|✔
|Mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
|✖
|✔
|✔
|-
|[[Fixed drug eruption]]
|✖
|✔
|Well demarcated and [[Erythema|erythematous]] lesions
|✖
|✔
|✖
|-
|[[Bowen's disease]]
|✖
|✔
|Multiple, small, well-demarcated [[Papillomatosis|papillomatous]] [[papules]]
|✖
|✖
|✖
|-
|[[Bowenoid papulosis]]
|✖
|✔
|Single or multiple, sharply demarcated associated with [[Scaling skin|scaling]] and crusting
|✖
|✖
|✖
|-
|[[Erythroplasia of Queyrat]]
|✖
|✔
|Velvety patches and [[plaques]] of [[keratinization]] on [[penis]].
|✔
|✖
|✖
|}
== References ==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Balanitis]]
[[Category:Balanitis]]

Revision as of 18:12, 1 March 2017

Balanitis Microchapters

Patient Information

Overview

Classification

Infectious balanitis
Non-infectious balanitits
Zoon's balanitis
Balanitis xerotica obliterans

Causes

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]

Synonyms and keywords: Balanoposthitis

Overview

Balanitis is inflammation of glans penis. When inflammation involves the foreskin and prepuce, it is termed as balanoposthitis. Based on the etiology, balanitis can be mainly categorized into infectious, inflammatory dermatoses, and penile carcinoma in situ. Patients with balanitis may present with asymptomatic or symptomatic lesions with itch or pain in the genital region. Risk factors, pathogenesis, clinical presentation, diagnosis and management varies depending on etiology.

Historical Perspective

Balanitis is an ancient disease,The term Balanitis is derived from a Greek term balanos or acorn.

Classification

There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:[1]

Pathophysiology

Causes

Differential diagnosis

Epidemiology and Demographics

Risk Factors

Screening

There is no established clinical guidelines for screening patients for balanitis.

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | X-ray|CT-Scan| MRI| Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

 
 
 
 
 
 
 
 
 
 
Balanitis/balanoposthitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take history and examine
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perpuce retracts
 
 
 
 
 
 
 
 
 
 
 
 
 
Perpuce does not retract
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ulceration present
 
 
 
 
Erythema,subpreputial discharge
 
 
 
 
 
Prepuce scarred
 
 
 
Prepuce swollen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow genital ulcer protocol
 
Fowl smelling
 
 
No odour
 
 
 
Refer to surgical opinion
 
 
 
Treat as genital ulcer disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Metronidazole 400 mg bd
 
 
Antifungal+1% Hydrocortisone cream apply bd
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Review
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If better discharge
 
If not better 1) Reassess-try alternative pathway 2) Erythromycin 500 bd 3) Potent steroid cream
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ Edwards SK, Bunker CB, Ziller F, van der Meijden WI (2014). "2013 European guideline for the management of balanoposthitis". Int J STD AIDS. 25 (9): 615–26. doi:10.1177/0956462414533099. PMID 24828553.

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