Sandbox:Balanitis

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

Causes

Causes of Balanitis include the following:

1. Candidal balanitis
2. Anaerobic balanitis
3. Aerobic balanitis
4. Lichen sclerosus
5. Lichen planus
6. Zoon’s (plasma cell) balanitis
7. Psoriasis and circinate balanitis
8. Eczema (including irritant, allergic and seborrhoeic)
9. Non-specific balanoposthitis
10. Fixed drug eruptions

Premalignant conditions:

1. Erythroplasia of Queyrat
2. Bowen’s disease
3. Bowenoid papulosis

Miscellaneous

Stevens-Johnson syndrome

Differentiating Candida Vulvovaginitis from other Diseases

Candida Vulvovaginitis must be differentiated from the following diseases which have a similar presentation:

Disease	Findings
Trichomoniasis	Presents with purulent, malodorous, thin discharge associated with burning, pruritus, and dysuria, with the signs of vaginal inflammation and elevated vaginal pH (>4.5) Motile trichomonads on wet mount are demonstrated Positive culture (Gold standard) Positive nucleic acid amplification test (NAAT)
Atrophic vaginitis	Progressive symptoms Presents with yellow and malodorous vaginal discharge, vaginal dryness, postcoital bleeding, and dyspareunia with the signs of vaginal inflammation and elevated vaginal pH (>5) Diagnosis is critical and laboratory tests help to confirm hypoestrogenic state
Desquamative inflammatory vaginitis	Chronic clinical syndrome with unknown etiology Presents with dyspareunia, dyspareunia, yellow, grey, or green profuse vaginal discharge with the signs of vaginal inflammation and elevated vaginal pH (>4.5) Microscopy shows large number of parabasal (immature squamous epithelial cells) and inflammatory cells
Bacterial Vaginosis	Presents with dysuria, vaginal discharge Fishy odor (positive whiff test) Normal vaginal PH (<4.5) On speculum examination signs of vaginal inflammation are demonstrated.

Epidemiology and Demographics

• Epidemiological studies on Candida vulvovaginitis are hard to perform, because of several factors:
  • Candida vulvovaginitis is not a reportable disease.
  • The diagnosis of Candida vulvovaginitis is based on clinical presentation and positive laboratory findings. Relying on a positive culture alone would likely overestimate the prevalence of Candida vulvovaginitis.
  • The use of over-the-counter (OTC) topical anti-fungals makes it difficult to conduct epidemiological studies.
• Candida is the second most common cause of vaginal infection in young women following Bacterial Vaginosis.

Age

• Incidence of Candida vulvovaginitis is higher in pregnant women.
• Women in reproductive age group are prone for Candida vulvovaginits and at least one episode is reported in 70 to 75% in this population group.
• 40 to 50% of patients with a prior yeast infection have multiple episodes of yeast infection.
• Among the adult population 5 to 8% women have more than four episodes of infection.
• In 20% asymptomatic healthy adolescent women, candida species can be isolated from the vagina.

Race

Candida vulvovaginitis is more prevalent among African American women than white American women.

Risk Factors

Risk factors for Balanitis include:

• Uncircumcised penis
• Antibiotic use
• Corticosteroid use
• Immunocompromised
• Diabetes
• Not usually considered sexually transmitted

Screening

There are no screening procedures for Balanitis.

Diagnosis

History and Symptoms

Symptoms include:

• Redness of foreskin or penis
• Other rashes on the head of the penis
• Foul-smelling discharge
• Painful penis and foreskin