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Acute balanitis in adults

Published by Bupa's health information team, July 2008.

This factsheet is for men who have acute balanitis, or who would like information about it.

Balanitis is an inflammation of the head of your penis (glans). Often the foreskin is affected, and inflammation can spread down the shaft of your penis. When both the glans and the foreskin are inflamed the condition is called balanoposthitis, however, this is often also referred to as balanitis.

About balanitis
Symptoms of balanitis
Complications of balanitis
Causes of balanitis
Diagnosis of balanitis
Treatment for balanitis
Prevention of balanitis
Further information
Questions and answers
Related topics
Sources

About balanitis

Balanitis is an inflammation of the glans penis. The foreskin is often affected, as well as the shaft of the penis.

The glans is the head of the penis underneath the foreskin (the sleeve of skin that surrounds the top of your penis). The urethra, the tube for passing urine and semen, goes through the centre of the glans.

Acute balanitis is when your symptoms only last for a short time - a couple of weeks. This can be recurrent, when symptoms keep coming back. Balanitis can also be chronic (lasting for several weeks or longer).

Balanitis is a common condition, although it's not known exactly how many men are affected. Recently it was found that 11 percent of men attending genitourinary medicine (GUM) or sexual health clinics have balanitis. It can affect men of any age, and is more likely in men who haven't been circumcised.

Symptoms of balanitis

Symptoms of balanitis mainly affect the penis, although they can sometimes affect other parts of your body.

The symptoms of balanitis affecting your penis are:

a red rash at the tip - this may be scaly or ulcerated
pain, tenderness and swelling
itching and discomfort
discharge or pus from underneath your foreskin, which may smell fishy
you may be unable to pull back your foreskin

Other symptoms, affecting the rest of your body, include:

a sore mouth
pain in your joints
swollen or painful glands
a rash on another part of your body (not just your penis)
feeling generally unwell

If you have any of these symptoms, particularly those affecting your penis, you should see your GP.

Complications of balanitis

A possible complication of balanitis is being unable to pull back your foreskin (phimosis). This is more likely if your symptoms last a long time (chronic balanitis) or if they keep coming back (recurrent balanitis).

Also, inflammation at the tip of the penis can cause your urethra to narrow. This causes pain when you urinate and can make aiming difficult.

Causes of balanitis

Infection

We have lots of harmless organisms living on our skin which usually don't cause us any harm. However, if the conditions on your skin are right (warm and moist) they can multiply very quickly to cause an infection. The foreskin can provide the perfect environment for organisms to multiply, especially if your glans is not washed or dried properly - poor genital hygiene can increase your risk of getting balanitis.

There are many types of organisms that cause balanitis - the most common is Candida albicans. This is often referred to as candidal balanitis and causes a yeast-like infection that mainly affects men who haven't been circumcised.

Candida albicans also causes thrush in women. In men, the infection is often picked up during sexual intercourse with a partner who has vaginal thrush, and unless your partner is treated, it can cause recurrent balanitis.

Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) can also cause balanitis, these include:

genital herpes
gonorrhoea
syphilis
chlamydia
Trichomonas vaginalis

Diabetes

Diabetes, especially if it's uncontrolled or you don't know you have it, increases your likelihood of candidal balanitis because of the amount of sugar in your urine. It's a common cause of recurrent balanitis, and usually affects older men.

Irritant-contact balanitis

Recurrent balanitis is most often caused by skin irritants. This might include latex condoms, lubricants, soaps, detergents or antiseptics.

Side-effect of medication

A side-effect of certain medicines can cause balanitis symptoms - these include certain types of painkillers, sleeping tablets, laxatives and antibiotics.

Injury

Injury (trauma) to your penis can sometimes cause acute balanitis, this can include friction during sex.

Diagnosis of balanitis

Your GP will examine your penis and talk to you about your symptoms. Your symptoms can often indicate the cause of your balanitis, so it's helpful to keep a note of them for your GP.

He or she may take a swab from underneath your foreskin and a biopsy (a small sample of tissue). These will be sent to a laboratory for testing to determine what is causing your symptoms.

Balanitis can sometimes indicate diabetes. If you have recurrent balanitis, your GP will take a urine sample to test for this.

If your GP suspects you have a STI, you will be referred to a GUM clinic. GUM clinics specialise in identifying and treating sexual health conditions and conditions related to the urinary system (the system that produces urine). Here you will be screened for other STIs and given treatment.

Treatment for balanitis

Firstly, your GP will advise you to keep the head of your penis and foreskin as clean as possible, and not to use anything that might irritate the area, such as soap or latex condoms.

Self-help

Cleaning your penis twice a day with a weak saline solution (salt water) can be soothing and relieve discomfort. To make a weak saline solution, mix a teaspoonful of salt into half a litre (500ml) of warm water. Alternatively, you could also try using an aqueous cream (eg E45 cream) to soothe and clean the area.

If a skin irritant (eg soap or washing powder) is causing your balanitis, symptoms often go a couple of days after you stop using the product. But be careful, if you start using the product again, symptoms can come back.

Medicines

Depending on what has caused your balanitis, you will be prescribed either antifungal cream or tablets, antibiotics or a mild steroid cream.

Antifungals

The treatment for candidal balanitis is an antifungal cream, such Clotrimazole cream (eg Canesten). This should be applied twice daily until symptoms have settled, and then for two to three days after. Or you may be prescribed an antifungal tablet, such as Fluconazole (eg Diflucan).

Antibiotics

For balanitis caused by other bacteria your GP will prescribe antibiotic tablets such as Metronidazole (eg Flagyl) to be taken for at least a week. Alternatively, you may be prescribed an antibiotic cream such as Clindamycin cream (eg Dalacin) to be applied twice daily until the symptoms have cleared up. This treatment may also be used if you have a STI.

Steroid cream

A mild steroid cream (eg Hc45 Hydrocortisone Cream) may be prescribed to help reduce the inflammation on your glans, especially if you have irritant-contact balanitis or if your symptoms are due to side-effects of a medicine. Steroid creams are sometimes given in addition to other medication.

If your symptoms aren't responding to treatment or they keep coming back despite treatment (recurrent balanitis) you should tell your GP. He or she may give you a different medicine or refer you to a GUM clinic or urologist so your symptoms can be investigated further. An urologist is a doctor who specialises in identifying and treating conditions of the urinary tract.

Surgery

Very occasionally, circumcision is used to treat balanitis. Circumcision is an operation to remove the foreskin from the penis. It's usually done as a day case under general anaesthesia - this means you will be asleep during the procedure.

Prevention of balanitis

Good genital hygiene is essential in preventing balanitis. Try to keep the head of your penis and foreskin clean and dry. And, if you are prone to balanitis after sex, use a non-latex condom or make sure you wash and dry your penis shortly after having sex.

Also, make sure you wash your hands after using the toilet.

Further information

Malehealth
www.malehealth.co.uk