Symptoms and treatment of balanoposthitis in men. Balanoposthitis: what is it and how is it diagnosed Balanoposthitis disease and its treatment

Balanoposthitis is a disease that affects both women and men and even children.

Let's look at what balanoposthitis is, the main causes and symptoms of the disease. And also what is the danger of balanoposthitis and methods of its treatment.

ICD-10 code

N48.1 Balanoposthitis

Causes of balanoposthitis

Balanoposthitis is an inflammation that affects the head and penis in men. The disease can appear at any age, as the cause of inflammation can be a fungus, bacteria or contact dermatitis. Most often, children suffer from balanoposthitis. In childhood, the foreskin covers the glans penis, which significantly increases the risk of developing the disease. Boys with phimosis and narrow foreskin are susceptible to inflammation.

In some cases, inflammation appears due to violations of hygiene rules or poor mobility of the foreskin. Treatment of an inflammatory disease is aimed at eliminating painful symptoms and maintaining normal hygiene conditions.

As a rule, men are more likely to suffer from balanoposthitis in adulthood. The disease is a combination of prostitis and balanitis, that is, two separate diseases. So, with balanitis, inflammation affects the glans penis, and with pardon, the tissues of the foreskin. But most often, both problems occur at once, which is why the disease is called balanoposthitis.

The causes of balanoposthitis are varied, but, as a rule, inflammation appears due to a mixed infection. It is very difficult and not always possible to determine exactly which bacterium caused the disease. The most common causes of balanoposthitis: yeast fungus (the causative agent of candidiasis), streptococci, bacteroids, gardnerella. For the appearance of balanoposthitis, a combination of two factors is necessary - an infectious irritant and suitable conditions for its development. So, the infectious factor of the disease is the entry of the pathogen into the preputial sac.

The main causes and predisposing factors of balanoposthitis:

1. Unprotected intercourse with a partner who has vaginal dysbiosis. (In dysbiosis, the female vagina contains many bacteria that cause inflammation of the glans penis).
2. Anal sex without a condom and oral sex with a partner who has oral diseases.
3. Non-compliance with the rules of intimate hygiene leads to the fact that smegma begins to accumulate under the foreskin, which is an excellent field for the growth of any infections. It is smegma that causes inflammation and subsequently balanoposthitis.
4. The narrow foreskin and phimosis (the glans penis opens with difficulty or does not open at all) complicate the hygiene process, which leads to stagnation of decomposing smegma in the preputial sac.
5. Metabolic disorders and chronic diseases, for example, diabetes mellitus, are another cause of balanoposthitis. Drops of urine with a high sugar content fall on the glans penis and foreskin, which creates conditions for the development of infection.
6. Trichomonas or gonorrheal urethritis can also be the cause of balanoposthitis. Due to purulent discharge from the urethra, the resistance of the mucous membrane of the glans penis decreases, which leads to inflammatory manifestations.

All of the above causes and predisposing factors can cause balanoposthitis. Any infection that enters the glans penis immediately causes inflammation. Balanoposthitis proceeds for a long time, with periods of exacerbation, which is less treatable.

Balanoposthitis after sex

Balanoposthitis after sex is not uncommon. So, diseases of the vagina in a partner and unprotected intercourse are the main causes of balanoposthitis after sex in men. But the disease does not manifest itself immediately, but begins to mature. So, the incubation period of balanoposthitis depends on its type and can last from 2 days to several weeks, or even months. The danger is that during sex, partners pass pathogens to each other that cause discomfort. At the same time, even compliance with all the rules and norms of hygiene is not a protection against balanoposthitis after sex.

At the first signs of the disease, as a rule, neither men nor women are in a hurry to seek medical help. But, despite the manifesting painful symptoms, no one refuses sex. In some cases, hiding the symptoms of balanoposthitis in one of the spouses is the reason for infidelity. Timely diagnosis of the disease and treatment is an ideal option for preventing the development of infection and inflammation. But do not forget about the security measures that will help protect against balanoposthitis.

Balanoposthitis after circumcision

Balanoposthitis after circumcision occurs extremely rarely, since the procedure for removing the foreskin protects against the accumulation of bacteria and harmful microorganisms. Circumcision is the most effective and fastest method for eliminating balanoposthitis. Completely or partially removed foreskin opens the head of the penis and solves physiological problems. At the same time, the frenulum, which is the center of nerve endings, lymphatic and blood vessels, is not injured. Due to this, the operation avoids serious complications during the rehabilitation period.

If balanoposthitis is caused by phimosis, then circumcision allows you to solve two problems at the same time. The operation opens the glans penis and removes the foreskin, where bacteria and microorganisms accumulated, provoking inflammatory processes. Balanoposthitis after circumcision can occur if a man has a chronic form of this disease, erectile dysfunction, squamous cell carcinoma, or chronic prostatitis is impaired. In acute balanoposthitis, circumcision is contraindicated. Before the operation, it is necessary to eliminate the inflammatory process.

Is balanoposthitis transmitted?

Whether balanoposthitis is transmitted and how contagious this disease is is a very topical issue for patients who first encountered such an inflammatory process. Despite the fact that balanoposthitis is caused by fungal or bacterial microflora, the disease is predominantly not transmitted. So, for the occurrence of the inflammatory process, the presence of predisposing factors is mandatory. These factors include reduced protective properties of the immune system, damage to the integrity of the epithelial integument of the foreskin and the glans penis.

Urologists note that balanoposthitis is sexually transmitted, that is, a man can infect a woman. This is due to the fact that balanoposthitis is characteristic of both men and women. But a viral or fungal infection that caused the disease can easily infect a woman. This is possible with unprotected intercourse, that is, without a condom. Pathogenic or infected microflora of the female vagina can also cause infection in a man and the further development of balanoposthitis.

The main forms of balanoposthitis, sexually transmitted:

• Fungal balanoposthitis - the most common candidal balanoposthitis (thrush). The disease is transmitted during oral sex, since fungi can also multiply on the mucous membrane of the tongue and oral cavity.
• Gardnerella balanoposthitis is an inflammation caused by Gardnerella vaginali (anaerobic bacterium). The peculiarity of the bacterium is that it does not manifest itself for a long time. Unprotected intercourse provokes the development of balanoposthitis, which can turn into nonspecific urethritis.
• Circinar balanoposthitis - most often occurs due to infection with chlamydia. The peculiarity of this form is that red spots of a cylindrical shape with clearly defined boundaries appear on the glans penis. It is possible to become infected with circinary balanoposthitis during unprotected intercourse, oral and anal sex.

Symptoms of balanoposthitis

Symptoms of balanoposthitis appear individually for each patient and depend on the form of the disease. There are not so many typical manifestations of inflammation. The main symptoms are pain localized on the glans penis and itching. Very often, at the beginning of the development of the disease, the patient does not notice signs of an inflammatory process. And this is not surprising, since balanoposthitis is characterized by an atypical, asymptomatic course in the first stages of development.

But in most cases, the symptomatology of balanoposthitis manifests itself as skin hyperemia, swelling of the glans penis, plaque in the coronal sulcus and on the head, rash, swollen lymph nodes in the groin, erosive and ulcerative lesions.

The peculiarity of balanoposthitis is that the disease can be manifested by a large number of different symptoms, which at first glance are not interconnected. But professional urologists combine the symptoms of balanoposthitis into three groups:

1. Discomfort in the glans penis, causing inconvenience (pain, itching, burning, pain). Some patients note increased sensitivity and premature ejaculation due to balanoposthitis, which negatively affects the duration of sexual intercourse.
2. Cracks, ulcers, redness, dryness, irritation, red spots and other external signs of the disease.
3. Intense discharge from the head of the penis. Normally, smegma is formed in a small amount, but due to balanoposthitis, the discharge can be so intense that the patient has to carry out hygiene procedures and change underwear several times a day.

All of the above symptoms can appear both simultaneously and separately. But the presence of any of the above symptoms may indicate the presence of balanoposthitis. Without proper treatment, the disease begins to progress and becomes pustular-ulcerative, phlegmonous or gangrenous. In some cases, patients develop inguinal-femoral lymphadenitis. And due to the acute course of inflammation, chronic pain and hyperemia of the skin, phimosis may develop, as cicatricial wrinkling of the skin occurs.

The incubation period of balanoposthitis

The incubation period of balanoposthitis is the length of time from the moment of infection until the first symptoms of the disease appear. If we talk about balanoposthitis, then it is necessary to understand that infection can occur not only due to unprotected intercourse, but also due to a weakened immune system and the presence of chronic diseases.

Most often, balanoposthitis is caused by non-specific microorganisms: Proteus, Candida fungi, staphylococci, streptococci, E. coli. The appearance of inflammation can provoke the use of corticosteroids or long-term antibiotic therapy. In this case, it is meaningless to talk about the incubation period.

Balanoposthitis is a disease that does not have a time frame for the appearance of the first symptoms after infection. The incubation period of balanoposthitis depends on factors such as:

• What microorganisms caused the inflammatory process. Urologists note that microbes and bacteria of ureplasma, chlamydia, mycoplasma, gardnerella and Candida fungi can be transmitted during anal and oral sex, causing symptoms of balanoposthitis.
• The individual characteristics of the body and the protective properties of the immune system also play an important role in the incubation period of the inflammatory process.

So, if the patient's immune system is weakened, then due to external infection, the incubation period of the disease can last from several days to a week. If the immune system is normal, then the incubation period can last from three weeks to a month. But some types of balanoposthitis, for example, gardnerella, in the first stages are asymptomatic.

Temperature with balanoposthitis

Temperature with balanoposthitis is a rare symptom that occurs only in the acute course of the disease or in patients with a weakened immune system. As a rule, high temperature occurs due to the progression of the disease and the increase in painful symptoms. So, along with a high temperature, patients may experience hyperemia and swelling of the glans penis.

In some cases, the temperature with balanoposthitis indicates that there are several foci of inflammation in the body. With such symptoms, it is necessary to urgently seek medical help. The doctor will prescribe treatment to relieve painful symptoms and high fever. And after passing the tests and diagnostics, the urologist will prescribe treatment and preventive measures to eliminate balanoposthitis.

Allocations with balanoposthitis

Discharge with balanoposthitis is one of the symptoms of the inflammatory process in the body. In any healthy man, the formation of smegma (sebum secretion) occurs on the head of the penis. As a rule, the discharge is not significant and, if the rules of hygiene are observed, do not cause problems. With balanoposthitis, the discharge intensifies, which makes it necessary to carry out hygiene procedures several times a day. In some cases, due to heavy discharge, a man has to change his underwear.

If hygiene rules are not followed, discharge during balanoposthitis will increase, causing concomitant symptoms: pain, burning, itching, swelling of the glans penis, and so on. In any case, heavy discharge for men is not the norm and requires the consultation of a urologist.

Forms

ICD 10 is an international classification of diseases. Balanoposthitis refers to urological diseases, in the registry and medical records it has the code N48.1

In addition to balanoposthitis, the group of urological diseases according to ICD-10 includes:

• N00-N99 Diseases of the genitourinary system.
• N40-N51 Diseases of the male genital organs.
• N48 Other diseases of the penis.
• N48.1 Balanoposthitis

Balanoposthitis in men

Balanoposthitis in men is the most common sexually transmitted disease. Balanoposthitis presents two different lesions - fasting and balanitis. Postitis is an inflammation of the tissue of the foreskin, and balanitis is an inflammatory process on the glans penis. The simultaneous presence of both diseases is called balanoposthitis. There is primary and secondary balanoposthitis, they differ in the nature of their occurrence. Let's take a closer look at the etiology of balanoposthitis in men.

• Primary balanoposthitis in men develops due to non-compliance with the rules of personal hygiene. The disease can also appear due to phimosis and the accumulation of smegma in the preputial sac. Because of this, mechanical irritation of the mucous membrane occurs, and then, in the process of decomposition, chemical irritation of the foreskin and glans penis. The causes of primary balanoposthitis may be associated with the use of strong antibiotics or the use of intimate hygiene products, which include chemicals.
• Secondary balanoposthitis in men develops against the background of chronic diseases (urethritis, diabetes mellitus, allergic diseases). Colds, mechanical trauma, temporary lack of hygiene measures, frequent change of sexual partners or hypothermia can serve as a factor in the development of the disease. This category of balanoposthitis requires special treatment, since the disease can recur.

Balanoposthitis in women

Balanoposthitis in women is a Trichomonas form of a fungal disease. The symptoms of balanoposthitis and the causes of its occurrence in women are no different from the symptoms and causes of this disease in men. Balanoposthitis can appear due to a yeast fungus, be a symptom of urethritis, or act as an independent disease. Balanoposthitis may appear due to chronic diseases, long-term use of drugs or reduced protective functions of the body. That is, the disease is of an infectious nature and very often appears along with candidiasis, that is, thrush.

In order to diagnose balanoposthitis and prescribe effective treatment, a woman needs to undergo a series of studies, take tests and smears. Based on the results of the tests, the doctor determines the form of the disease and its cause, draws up a treatment regimen.

Treatment of balanoposthitis in women and men is the same. In the early stages of the disease, the doctor prescribes regular hygiene procedures with furacilin solution or hydrogen peroxide. In advanced cases, the doctor prescribes general or local antibiotics. As a rule, the duration of treatment does not take longer than 7-10 days.

Complications and consequences

A question that interests many men who have been diagnosed with this disease. The danger of balanoposthitis is that without treatment, the inflammatory process from the head of the hollow member gradually affects the urethra, which leads to the development of urinary tract infections. And due to inflammation of the foreskin, cicatricial phimosis may begin to form. If the disease is chronic and often recurs, then this can cause reduced sensitivity of the glans penis and atrophy of the receptor apparatus. As a result, balanoposthitis negatively affects the quality of sexual life and potency in general.

Balanoposthitis is an infectious inflammation of the glans penis and foreskin. The disease has several varieties, which depend on the course of the disease and the localization of inflammation. The etiological factors of balanoposthitis are harmful microorganisms (fungi of the genus Candida, staphylococci, Escherichia coli, gardnerella).

Balanoposthitis is acute and chronic, and depending on the severity of inflammation: superficial, erosive and gangrenous. The danger of the disease is that it is transmitted during sexual intercourse. So, if a partner has colpitis of various etiologies, then this can cause infection of a man and the appearance of balanoposthitis.

Complications of balanoposthitis appear in those patients who refuse therapy or have not completed the treatment regimen prescribed by the urologist. Complications also arise due to improperly selected therapy and exacerbation of chronic diseases. Let's look at the main complications of balanoposthitis:

• Lymphagenitis is an inflammatory disease that affects the vessels of the penis and inguinal lymphadenitis. Due to the lack of treatment, such a complication can lead to amputation of the penis or lead to gangrene.
• Gangrenous balanoposthitis is a serious complication that occurs due to the advanced erosive form of balanoposthitis. With gangrenous inflammation, the patient's temperature rises, intoxication of the body, swelling, necrotic purulent sores on the genitals are observed. It is this form that always causes phimosis, and can also cause perforation of the foreskin and slowly healing ulcers.
• Oncology is the most dangerous of all possible complications of balanoposthitis. Malignant tumors of the penis are irreversible, accompanied by prolonged inflammation and other pathological symptoms.

Consequences of balanoposthitis

The consequences of balanoposthitis largely depend on the type and form of the inflammatory and infectious disease. The consequences are affected by the age of the patient and the characteristics of the body, the presence of chronic diseases and the symptoms that manifest themselves with balanoposthitis. Also, the consequences of the disease are affected by incorrect and untimely treatment. Let's look at the consequences of inflammation, which most often occur:

• Atrophy of receptors on the glans penis. This significantly reduces the sensitivity of the penis and leads to violations of sexual functions (problems with potency, decreased sensation during orgasm).
• An uncontrolled inflammatory process that occurs with balanoposthitis can move to other organs and cause a number of concomitant diseases.
• Urethritis, that is, inflammation of the walls of the urethra, is the most common consequence of balanoposthitis, causing cramps and pain during urination, as well as the accumulation of purulent masses in the urethra.
• A prolonged inflammatory process leads to deformation and compaction of the tissues of the penis. Scars, phimosis and paraphimosis appear on the penis (infringement of the glans penis). Paraphimosis causes severe pain, blueness and enlargement of the glans penis.

Diagnosis of balanoposthitis

Diagnosis of balanoposthitis begins with a visual examination by a urologist, microscopy, smears and bacterial culture to determine the pathogen and draw up a treatment plan. An analysis is mandatory to exclude syphilis, as well as a blood test to determine the level of sugar and consultation with an allergist. The peculiarity of balanoposthitis is that the disease, as a rule, does not cause difficulties in diagnosis. If balanoposthitis is suspected, the patient must undergo and pass a number of the following tests and diagnostic methods:

• Visual examination by a urologist.
• Bacterial culture of secretions from the surface of the head of the penis and urethra.
• Blood sugar and glucose levels.
• Research on sexually transmitted diseases.
• Serological tests for syphilis.
• Smears-imprints from the glans penis and foreskin.

In the process of diagnosing balanoposthitis, the doctor must differentiate such diseases as:

• Psoriasis.
• Cancer of the penis.
• Lichen sclerosus is a chronic lesion of the skin of the penis, which manifests itself in the form of whitish plaques.
• Leukoplakia of the penis.
• Reiter's disease is a ring-shaped lesion of the head of the penis that causes erosion on the mucous membrane of the penis.
• Balanitis Zun - redness of the head of the penis, the appearance of red shiny spots.

Analyzes for balanoposthitis

Analyzes for balanoposthitis is one of the diagnostic methods that allows you to accurately determine the type of inflammation and prescribe an effective treatment. Let's look at the main tests for balanoposthitis, which must be passed:

• Scraping from a damaged surface to identify pathogenic microorganisms and fungi. Most often, a culture method is used to differentiate bacteria.
• PCR (polymerase chain reaction) - used to determine vaginosis-associated microorganisms.
• Bacterial culture to detect anaerobic microflora (Gardnerella vaginalis, Mobiluncus spp.).
• Tests for sexually transmitted infections by PCR.
• Microscopy of smears-imprints from intact vesicles to detect genital herpes.
• Bacteriological studies of secretions from the head of the penis (streptococci, staphylococci).
• Blood sugar test and examination by an allergist.
• Cultural and bacterioscopic examination for trichomoniasis and gonorrhea.

Forecast

The prognosis of balanoposthitis completely depends on at what stage of the development of the disease the patient sought medical help, and how much the inflammatory process is running. As a rule, the prognosis of balanoposthitis is favorable. But some forms of the disease can become chronic or recurrent. With advanced or acute balanoposthitis, the urologist may prescribe circumcision, that is, excision of the foreskin. In particularly difficult cases, the penis is amputated and a drain is placed to remove urine.

Balanoposthitis is an inflammatory lesion of the head and foreskin of the penis. The danger of the disease is that even newborn children are susceptible to it. And some forms of inflammation are transmitted during sexual intercourse and can occur in women. Compliance with the rules of intimate hygiene, changing underwear and using condoms during intercourse will help to avoid inflammatory lesions. But at the first symptoms of inflammation and any other ailments in the genital area, it is necessary to seek medical help and treat balanoposthitis.

This is an inflammation of the glans penis and prepuce. Symptoms are pain, swelling, rashes, accumulation of secretions in the preputial sac. The diagnosis is established during a physical examination, to determine the cause, laboratory diagnostics are carried out: microscopy of a smear from the urethra, bacteria culture and antibiotic sensitivity, PCR tests for STIs. A skin biopsy is performed in the absence of positive dynamics during therapy to exclude a neoplastic process. Treatment depends on the pathogenetic factor, can be conservative (antibiotics, antihistamines, corticosteroids), with tumor pathology and in the absence of an effect, surgical.

ICD-10

N48.1

General information

Balanoposthitis more often develops in boys aged 1 to 5 years and in men with high-risk sexual behavior (polygamous relationships, non-traditional orientation, penile-anal contacts). Experts say that 30-50% of men experience inflammation of the head of the penis and prepuce, expressed to one degree or another, at least once, this pathology accounts for 11% of all visits to the urologist. Most cases respond to conservative therapy. Balanoposthitis of candidal etiology is especially difficult in people with decompensated diabetes mellitus, AIDS, severe hypovitaminosis. The recurrent course often provokes cicatricial phimosis, which requires hospitalization in the department of clinical urology and surgery.

Causes of balangoposthitis

A certain role belongs to immunosuppressive disorders of any origin (reception of antibiotics or hormones, chemoradiotherapy, concomitant severe generalized infection). Inadequate hygiene leads to the multiplication of microflora in smegma, which initiates inflammation. In older men, balanoposthitis develops due to sclerotic processes between the head and prepuce skin in the absence of a sexual life. The condition causes many diverse etiological factors:

• Specific diseases. Neisser's gonococci, trichomonas, chlamydia are the most frequently detected pathogens in genital infections. In 35-50% there is a combined composition of microflora. Urogenital candidiasis in 90% is complicated by inflammation of the head and prepuce. Also, an inflammatory reaction in this area is diagnosed against the background of herpes, HPV and donovanosis.
• Nonspecific diseases. In a child, inflammation of the genitals can develop with childhood infections, SARS, tonsillitis. In adults, the cause of balanoposthitis is chronic diseases of the urogenital area: prostatitis, urethritis, orchiepididymitis. Staphylococcus aureus, group B streptococci are the most commonly isolated bacteria. Recurrent balanoposthitis occurs in all patients with cicatricial changes in the prepuce.
• Traumatization. Violation of the integrity of the skin as a result of a bite, infringement of the zipper of trousers, tear of the frenulum during sexual contact or aggressive masturbation are the entrance gates for infection. The microflora can spread from the urethra during catheterization, bougienage. Secondary inflammation joins after urological operations. Sometimes balanoposthitis provokes a smegmolite stone formed in the prepuce due to thickening of the infected smegma.
• Dermatological pathology. In men who are forced to use urocondoms or diapers due to incontinence, contact dermatitis and secondary balanoposthitis develop on the head of the phallus and the foreskin due to constant irritation with urine. Psoriasis, lichen planus, lichen sclerosus, etc. are accompanied by inflammatory changes in the genitals. Bowen's disease and Queyre's erythroplasia, both predictors of penile cancer, have similar manifestations.

Pathogenesis

Agents that cause balanoposthitis are divided into infectious (pathogenic, opportunistic microorganisms) and non-infectious (trauma, burns, contact with chemicals, etc.). In the genital area, the circulatory and lymphatic networks are extremely developed, which is manifested by pronounced exudation during inflammation, up to the development of phimosis and paraphimosis. Elevated temperature and humidity in the prepuce, the alkaline reaction of smegma (and glucose in diabetes mellitus) contribute to increased reproduction of aerobic and anaerobic microorganisms and viruses.

Violation of hygiene rules, as well as frequent contact with aggressive environments, lead to the implementation of pathogenic properties in conditional pathogens or to the predominance of pathogenic microflora over conditionally pathogenic. In children, balanoposthitis often develops after rough retraction of the foreskin with phimosis, prolonged stay in diapers, or with the generalization of any infectious disease.

Classification

Balanoposthitis can be primary or accompany any pathological process (DM, tumor). According to the type of pathogen, specific and nonspecific balanoposthitis are distinguished, according to the nature of the course - acute or chronic, complicated or uncomplicated. Specialists use a classification that takes into account the predominance of clinical manifestations, on the basis of which the following forms are distinguished:

• Simple catarrhal. The inflammatory process is slightly expressed, there are areas of hyperemia on the head of the penis and foreskin. This form is typical for men with latent STIs, for age-related patients with a burdened premorbid background (DM, metabolic syndrome, cardiovascular insufficiency).
• papular. Hyperemia is moderately expressed, but nodular elements are visualized. This type of balanoposthitis is associated with lichen planus, psoriasis, and Queir's erythroplasia.
• Scleroatrophic. It occurs in the elderly; on examination, you can see cracks, erosion, areas of sclerosis and atrophy with a slight background hyperemia. Cicatricial phimosis is typical.
• Verrucous and vegetative. The appearance of growths and vegetations is preceded by papillomavirus infection, urogenital tuberculosis, etc. Moderate hyperemia.
• Granulomatous. It is typical for patients with severe immunosuppression as a result of the progression of opportunistic infections, for example, generalized urogenital candidiasis. Granulomatous growths accompany chronic recurrent balanoposthitis.
• Vesicular. Redness of the skin and the appearance of vesicles are preceded by severe itching. A typical example is herpetic eruptions accompanied by reactive balanoposthitis.
• Pustular. Hyperemia is variable (from slight redness to severe), multiple pustules are visualized (for example, balanoposthitis against the background of donovanosis).
• bullous. The appearance of blisters on the hyperemic skin indicates the toxic-allergic nature of the disease. The size of the blisters varies, without treatment and with continued contact with the provocative agent, erosions form.
• Erosive and erosive-ulcerative. It occurs in a number of pathologies: syphilis, Vincent's disease, tuberculosis.
• Gangrenous. Associated with chancre, may also precede fulminant Fournier's gangrene. The most severe type of balanoposthitis with probable self-amputation of the penis and the development of lethal complications.

Symptoms of balanoposthitis

Clinical manifestations are variable, depending on the pathogen, the severity of the process, concomitant pathology. The nature of skin rashes is different. For all types, edema, hyperemia (of varying severity), soreness, restriction of the mobility of the foreskin are common, with dermatological pathology - skin itching. The most favorable catarrhal form manifests itself clearly: patients complain of excruciating itching, severe pain in the affected area, burning during urination, swelling of the skin of the prepuce and head.

With fungal balanoposthitis, as the infection progresses, deep cracks appear, due to increasing infiltration, the foreskin does not move. The discharge is whitish, with a kefir smell, films may be present on the surface of the inner leaf of the flesh and the head, after their removal a bleeding wound remains.

Herpetic balanoposthitis is manifested by characteristic transparent vesicles-vesicles, gradually their contents become cloudy, and the element itself resolves with the formation of a yellow-brown crust. The temperature may rise, the general condition suffers: weakness, chills, loss of appetite. Some patients have enlarged regional lymph nodes. The severity of the pain syndrome is due to the involvement in the process of the nervous tissue, where the virus persists.

The more weakened the immune response, the higher the likelihood of the transition of the vesicular form into erosive-ulcerative and gangrenous inflammation. In the gangrenous form, the general condition is severe, which can be explained by intoxication and fever, the genital organ is sharply enlarged in size, pus and ichor flow out of the tissues. Tachycardia and pressure drop may be present, which is a predictor (harbinger) of a possible bacteriotoxic shock.

Chronic balanoposthitis has blurred symptoms: episodic hyperemia, there is no pronounced discharge from the prepuce, discomfort increases after sexual contact, physical activity. The use of acute and alcohol exacerbates adverse symptoms. Chronization of the process often leads to atrophy, while the skin of the genitals is dry, wrinkled, thin, easily injured and periodically bleeds.

Complications

Complications are represented by phimosis (if balanoposthitis is primary), frequent recurrences of infectious and inflammatory processes of the urinary tract, impaired sexual function. The likelihood of developing penile cancer is higher in patients with phimosis and balanoposthitis. Cases of the formation of smegmolites (stones from smegma) in the prepuce are described. In children, the infection often spreads to the upper urinary tract (pyelonephritis, hydronephrosis). With the gangrenous type, self-amputation of the penis can occur. Against the background of a weakened immune system, fungal septicemia develops, bacteriotoxic shock.

Diagnostics

The etiological factor of inflammation of the head and skin of the preputial sac needs to be clarified. A morphological study is justified if balanoposthitis does not go away against the background of persistent treatment. Instrumental diagnostics is not required, except for a neoplasm of the penis with reactive inflammation. Laboratory diagnostics is aimed at a comprehensive examination, including the identification of diseases that support balanoposthitis (DM, AIDS, atherosclerotic processes, circulatory disorders). The diagnostic algorithm includes:

• History taking and examination. A urologist establishes a connection between inflammation and a causative factor: traumatization, unprotected sexual intercourse, taking antibiotics, using spermicides, etc. It is impossible to establish a provocative factor in 30%. On examination, the nature of the rashes, the state of regional lymph nodes are assessed.
• Laboratory tests. Initially, smear microscopy is performed. With an increase in the number of leukocytes, bacteria, further examination is indicated: PCR analysis for STIs, sowing of biomaterial on nutrient media. Testing for HIV, syphilis. If there is information about the patient's trip to endemic areas, it is justified to undergo a diagnosis for donovanosis. If genital tuberculosis is suspected, a consultation with a phthisiourologist and special tests are recommended.

Balanoposthitis treatment

Therapeutic measures depend on the cause, priority is given to the treatment of the underlying disease. The patient is explained the need for personal hygiene. With venereal genesis, both partners receive drugs. Men with allergies should avoid irritants (scented soaps, gels, cosmetic sprays). During intercourse with insufficient moisture, you can use a neutral lubricant. Treatment options for balanoposthitis include:

• Systemic drug. Antibacterial drugs are prescribed to suppress the secondary infection that has joined, antihistamines and corticosteroids - for itching and allergic manifestations. For herpes, HPV infection, antiviral drugs and immunomodulators are used. Antifungal drugs are used in combination with hormone therapy for candidiasis against a background of weakened immunity, with generalization of lesions.
• Local. Hormonal, antibacterial and antifungal drugs can be applied topically in the form of creams, ointments, sprays. Irrigation with antiseptic solutions helps to relieve symptoms of a bacterial infection. Children are prescribed warm baths with decoctions of herbs that have anti-inflammatory effects.
• Operational. Complicated balanoposthitis occurring against the background of dermatological diseases, accompanying cancerous and precancerous pathologies, with cicatricial phimosis is an indication for surgical treatment - circumcision (circumcision). If the cause of the inflammation is phimosis with a narrow foreskin ring, preputioplasty may be performed. With a concomitant tumor of the penis, the volume of the operation depends on the type of neoplasm and stage.

Forecast and prevention

The prognosis for primary uncomplicated balanoposthitis is favorable, for the secondary it depends on the concomitant pathology. If conservative measures are ineffective, surgical treatment always relieves unpleasant symptoms. Prevention involves observing the rules of intimate hygiene, avoiding casual sex without a condom, and undergoing regular preventive examinations by a urologist. Careful care is needed for the genitals of boys: diapers should be changed in a timely manner, diaper rash should not be formed, and no attempt should be made to roughly move the head of the penis with physiological phimosis.

Urological disease, expressed in severe inflammation of the glans penis and foreskin. The disease is quite common among modern men, since it occurs not only with mechanical action on a delicate organ, for example, in the case of wearing too tight underwear, but also during unprotected sexual contact. In this case, the complications of the disease can be the most severe, up to gangrene of the genital organ. For what reasons does balanoposthitis develop in men, how to identify it and can it be completely cured?

Although balanoposthitis and balanitis (only the head of the penis becomes inflamed, the foreskin remains healthy) do not belong to sexually transmitted diseases, the pathogen can enter the body of a new carrier during intercourse. Representatives of pathogenic microflora include:

If there are no provoking factors, then microorganisms can live on a man's body for months without causing him any trouble. But as soon as favorable conditions come, the disease will begin to develop rapidly.

The main provoking factor is a weakened immune system. For example, if a man has not treated a cold for a long time, is irresponsible about his health, does not follow the daily regimen and diet, then microbes already receive all the conditions for rapid reproduction and development of balanoposthitis. The reasons for the onset of the inflammatory process of the penis include:

• injuries received, for example, during too aggressive sexual intercourse;
• gross violation of the rules of personal hygiene;
• too tight underwear;
• diabetes;
• phimosis, especially when trying to forcefully move the foreskin and expose the head of the penis;
• oncological diseases;
• exposure to chemical irritants;
• allergy.

All these factors contribute to the development of the inflammatory process, which is called balanoposthitis.

The disease is purely male, but the causative agent of the disease is transmitted from man to woman. In addition, a lady runs the risk of catching harmful products of the inflammatory process during unprotected intercourse, for example, purulent discharge.

Kinds

Since there are many causes of the onset of the disease, and the pathogens are diverse, doctors distinguish several main forms of balanoposthitis in men. Each of them differs in its symptoms and possible consequences, but the treatment of all is approximately the same:

• erosive form. It is characterized by the formation of reddish ulcers on the head and foreskin. They cause pain, over time, an inflammatory infectious process begins to develop.
• Candidiasis form. The main reason is a decrease in immunity. It is expressed in the appearance of a white coating on the genitals.
• allergic form. It occurs due to a negative reaction of the immune system to a chemical or biological stimulus. Symptoms are unstable, differ depending on the type of allergen.
• Chlamydia form. Symptoms and causes are similar to candidal balanoposthitis, it is more difficult to treat, pathogenic microflora quickly spreads among sexual partners.

If the disease is not treated, then over time it becomes chronic. In such a situation, therapy will become long and difficult, the disease can persist for months. Such balanoposthitis is dangerous in that in some cases the symptoms disappear, a man can “look through” the onset of the development of complications, believing that the disease has receded.

Symptoms

The initial stage of balanoposthitis is characterized by very vivid symptoms, the totality of which is characteristic only of this disease. The timing of their manifestation depends on the form of the disease and the specific pathogen, but usually they do not exceed a few days after the onset of the inflammatory process at the cellular level. The signs of balanoposthitis are as follows:

• the glans penis and the foreskin are covered with small sores;
• over time, a white coating is added to the sores;
• itching, burning, sometimes pain;
• discharge from the urethra with an unpleasant odor;
• discomfort in the penis, especially during intercourse (not recommended until completely cured) and urination;
• swollen lymph nodes;
• fever (not always).

If we are talking about the allergic form of balanoposthitis, then one of the main symptoms is swelling of the glans penis. At the same time, there will be no pain and burning sensations, but the itching will impress any man. All these signs are so characteristic that it is difficult to confuse balanoposthitis with another disease. This gives its "plus" - the diagnosis does not cause difficulties, which means that the treatment will be timely.

Diagnostics

Balanoposthitis is almost any inflammatory process that develops on the glans penis and foreskin. This allows you to quickly and accurately carry out primary diagnostics, but without identifying a specific causative agent of the disease, it is impossible to prescribe the correct therapy. At best, there will be no result. Moreover, you should not use alternative methods of treating the disease without first going to a specialist. Here is a list of doctors who can make a preliminary diagnosis and prescribe the necessary tests:

• therapist;
• venereologist;
• allergist;
• dermatologist;
• urologist.

You should start the examination with a therapist, but if it is reliably known that the symptoms appeared after contact with a certain irritant, for example, a new model of a condom, then go to an allergist.

The main tests that are assigned during the examination:

• general blood analysis;
• urine test;
• analysis of secretions of the penis;
• bioseeding;
• analysis for syphilis and other sexually transmitted diseases.

Sometimes ultrasound is prescribed, but only in the acute form of the disease, when the issue of surgical intervention is being decided.

Traditional treatment

Therapy for balanoposthitis in men is prescribed individually strictly after the examination. Self-selection of drugs is unacceptable, since there are many causes of the disease, there is no universal cure. Please note that along with drug treatment should be engaged in strengthening the immune system. To do this, you should streamline the daily routine and nutrition, as well as take immunomodulators and vitamin complexes. Without this, therapy will not be very effective.

Usually, doctors select drugs based on the causes of the disease and its stage. The most effective remedy for suppressing infection is ointment. These include:

(costs about 700 rubles);
• Levomekol (the cost usually does not exceed 130 rubles);
• Candide (it usually costs no more than 200 rubles, but in some regions the price reaches 400 rubles).

These ointments have a pronounced antiseptic effect that can suppress the activity of almost any pathogenic microflora.

But not everything is so smooth - if the patient is faced with a severe sexually transmitted disease, for example, syphilis, as well as balanoposthitis, which has become chronic, you will have to take antibacterial pills. The most popular among them:

• Azithromycin (considered one of the most effective remedies for balanoposthitis, costs about 150 rubles);
• Doxycycline (less effective drug, but safe for the gastrointestinal tract, costs about 30 rubles);
• Levomycetin (costs around 100 rubles, but you can find much better deals, mainly in online pharmacies).

Please note that the dosage and treatment regimen is prescribed only by a doctor. It takes into account possible allergic reactions, side effects of drugs, as well as the nature of the disease. Self-activity in the treatment of balanoposthitis is unacceptable!

Treatment at home

These methods can be classified as folk methods of treatment. Although they have been tested by generations of patients, it is still not worth resorting to them without a preliminary examination and the approval of a doctor - not all home methods are able to cope with microorganisms, and the degree of neglect of the disease should also not be discounted. The basis of home therapy for balanoposthitis is:

• baths with chamomile (pharmacy fee costs about 50 rubles);
• cauterization of ulcers with furatsilin (costs around 100 rubles);
• treatment of affected areas with Miramistin (the price is about 200 rubles, but in some outlets the cost can reach up to 700 rubles).

These techniques cannot replace the drug therapy prescribed by the doctor, they only complement it and increase the effectiveness of the drugs. Please note that during the treatment of balanoposthitis, a man should exclude the use of alcohol and tobacco products, and also refrain from sexual intercourse. The sexual partner of the patient must undergo examinations and, if necessary, a therapeutic course with him.

Treatment usually does not take more than 10 days, but if the cause of the disease is a serious venereal infection, then therapy can take several months. The main thing is to undergo examinations in time and start treatment, otherwise the consequences can be very sad!

You can also watch a video where the doctor will tell you how balanitis and balanoposthitis differ, what needs to be done when these diseases are detected.

Balanoposthitis is an inflammation of the glans penis and foreskin. The glans is the thickening at the tip of the penis. This is a very vulnerable part of the male body because it is equipped with many sensitive nerves. In uncircumcised men, the head is covered by the foreskin.

Most often, balanoposthitis and balanitis (inflammation of the head of the penis) occur in men, boys and boys with uncircumcised foreskin. Women do not have these diseases.

Depending on age, the frequency of various causes of balanoposthitis varies. In total, 11% of men on Earth develop this disease every year.

In one Japanese study, balanoposthitis was found in 9 (1.5%) of 603 uncircumcised Japanese boys aged 1 to 15 years, and a long-term Japanese study found that the incidence of balanoposthitis in Japan is 3 to 7% of cases per year.

However, most studies have only looked at children and sexually active men.

With balanoposthitis, reddening of the skin of the penis is observed, and ulcers and deep erosion have been seen in patients with progressive disease, often in combination with fungal infections (in immunocompromised people).

Balanoposthitis treatment

Usually, balanoposthitis is diagnosed during a physical examination, while the doctor examines the lymph nodes, especially in the groin, and the genitals.

• If infectious balanoposthitis is suspected, a swab is taken from the head of the penis and the opening of the urethra. Then these smears are examined under a microscope to find the causative agent of the disease.
• In very rare cases, The patient is sent for a blood test to find pathogens or antibodies against the pathogen.
• Biopsy is prescribed for severe balanoposthitis of an unclear cause. There are a number of diseases that resemble balanoposthitis, such as penile cancer, Behçet's disease, or Stevens-Johnson syndrome.
• The doctor will also examine the patient's urethra for signs of inflammation.. He will ask the patient if the foreskin "swells" during urination. If there is evidence of a urinary tract infection, the doctor will do an ultrasound of the bladder to confirm or disprove the presence of an obstruction to urine flow.

Frequently asked questions and answers on balanoposthitis

• Is balanoposthitis transmitted?
  No, the disease itself cannot be passed on to another man or woman. However, a fungal or bacterial infection that caused the development of the disease can be transmitted.
• Is it possible to have sex with balanoposthitis?
  You can, only in a condom, so as not to infect your partner with an infection that caused balanoposthitis. However, itching, pain and burning in the penis during sexual intercourse often "kill" the patient's sexual desire.
• Is balanoposthitis contagious?
  No.
• Is circumcision done with balanoposthitis?
  In the case of chronic balanoposthitis that does not respond to medical treatment, the urologist may recommend circumcision. This is a reliable means of getting rid of the disease.

Types of balanoposthitis

Physicians share the primary balanoposthitis, caused by a fungal infection, and the secondary, which has arisen due to injuries, infections and various skin diseases.

In addition to this classification Balanoposthitis is divided into types, each of which is characterized by its own pathogen and treatment features.

1. Candida fungal balanoposthitis- is considered the most common form of balanoposthitis. It is also called yeast balanoposthitis because it is caused by a type of candida yeast (usually Candida albicans). Many women have candida infections that they pass on to their male partners during sex.
2. Circinary balanoposthitis occurs due to streptococci or fungi Candida Albicans and usually there are no subjective sensations (pain, burning, etc.). Red spots with clear boundaries appear on the head of the penis and foreskin.
3. Simple balanoposthitis appears due to the fact that the accumulated smegma, which serves as a suitable environment for various microorganisms, has an irritating effect on the head of the penis and the inner leaf of the foreskin.
4. The presence of anaerobes on the glans penis, especially in uncircumcised men, leads to balanoposthitis. The most serious kind anaerobic balanoposthitis is erosive gangrenous balanoposthitis. Features of anaerobic infection: superficial erosion, fetid discharge, preputial edema, inguinal adenitis. With severe swelling, the penis takes on the characteristic shape of a bell tongue.
5. Aerobic bacterial balanoposthitis occurs during sexual contact with a woman in the vaginal microflora of which the gardnerella bacterium is present.
6. Cause acute balanoposthitis is a streptococcal or staphylococcal infection. Symptoms begin with mild discomfort in the foreskin and head of the penis. Over time, discomfort increases, redness, itching and swelling appear. One form of acute balanoposthitis is erosive balanoposthitis. Initially, white areas appear on the penis (where the epithelium has become dead). Some time later, the color of the areas changes to red, erosion appears with clear outlines.
7. Follicular balanoposthitis appears when urine or semen accumulates in the preputial sac. On palpation of the penis, small, dense nodules are felt. The foreskin and head are edematous, there is a release of purulent mucous secretion.
8. Chlamydial balanoposthitis does not affect the epithelium of the penis. The patient may not have subjective sensations. This type of balanoposthitis has clearly defined spots and is transmitted through sexual contact. Requires treatment of both partners.
   
   
9. Acute purulent balanoposthitis caused by either streptococci, staphylococci, or yeasts, or mixed causes. It can also be the result of diabetes mellitus, purulent urethritis or severe allergies. It is characterized by the appearance of purulent necrotic lesions on the head of the penis and foreskin, swelling and bright scarlet color of the affected skin.
10. Ulcerative balanoposthitis- a pathology in which the head of the penis and the foreskin are covered with a large number of sores. This complicates not only the process of urination, but also sex, since these actions cause severe pain. If you do not treat ulcerative balanoposthitis, you can "earn" inflammation of the inguinal lymph nodes.
11. Traumatic balanoposthitis- a consequence of wearing very tight underwear, mechanical damage to the skin of the penis (for example, by zippering trousers or as a result of masturbation). Symptoms - swelling and redness of the skin of the penis.
12. Adhesive (adhesive) balanoposthitis is a common illness in children. In this condition, it is not possible to remove the head of the penis from the foreskin. The patient is in pain, he has redness and swelling of the penis. Drug treatment does not always give the desired results, therefore, with adhesive balanoposthitis, the doctor may prescribe circumcision.
13. Chronic balanoposthitis- a long-term disease, accompanied by an alternation of "fading" of symptoms with acute periods. Sometimes it requires surgical intervention (circumcision).
14. Allergic balanoposthitis is the body's response to contact with an irritant, such as rubber or spermicidal lubricants. There is a wide range of clinical manifestations that range from mild redness to swelling of the entire penis.
15. Nonspecific balanoposthitis- it is characterized by gradually increasing swelling of the skin, leading to inflammatory phimosis and the release of pus from the preputial sac. Often occurs in patients with diabetes and alcoholics.
16. Irrital balanoposthitis- occurs due to neglect of personal hygiene, wearing tight swimming trunks, frequent masturbation and excessive sensitivity of the skin of the penis. Characteristic red stripes appear on the penis, the lymph nodes in the groin become inflamed.

Balanoposthitis: characteristic signs, disease code balanoposthitis according to ICD-10

Balanoposthitis ( ICD-10 - code N48.1) refers to "other diseases of the penis". Its main symptom is a more or less painful inflammation and discoloration of the glans penis and foreskin.

Inflammation usually affects only the upper layers of the skin, and not the deep cavernous bodies of the penis. Patients often report rash and itching on the glans and foreskin.

• Many patients experience fetid discharge from the penis.
• With a disease of balanoposthitis, the head swells (its swelling occurs), which makes urination painful.
• Sometimes balanoposthitis is associated with temporary impotence.
• Balanoposthitis is usually limited to the penis. Systemic signs of inflammation, such as fever with balanoposthitis, malaise, or vomiting, are not typical of this disease. In rare cases, improper treatment of balanoposthitis leads to a gangrenous condition, which is characterized by fever, necrotic purulent ulcers on the genitals and general intoxication of the body.

More about balanoposthitis

Balanoposthitis: causes and risk factors

There are many reasons that may be responsible for balanoposthitis. Often there is a combination of several causes, such as mechanical irritation of the penis and infection. In a third of patients, the cause of the disease is not clear.

The causes of balanoposthitis can be divided into non-infectious and infectious.

Balanoposthitis: non-infectious causes

• A common cause of inflammation of the glans penis and foreskin is insufficient or excessively frequent cleaning. With poor hygiene, smegma accumulates in the cavity of the foreskin (preputial sac), a yellowish-white mass consisting of fat, skin cells and bacteria. This can lead to balanitis in children and adults and balanoposthitis.
• Chemical and mechanical stress - the use of disinfectants and excessive washing can provoke an inflammatory process in the foreskin.
• In some cases, balanoposthitis occurs due to an allergic reaction to drugs, perfumes, or latex condoms.

Balanoposthitis: infectious causes

• The two most common causes of balanoposthitis are fungal and bacterial infections.
• Yeast-like fungi Candida albicans is the most common cause of candidal balanoposthitis. Uncircumcised men are more likely to become infected with fungal balanoposthitis than circumcised men. In most cases, fungi are transmitted through sexual contact.
• With bacterial balanoposthitis, the causes of occurrence in men include impase reviews of doctors due to staphylococci, enterococci, streptococci, as well as the causative agent of tuberculosis.

Attention

Inflammation of the glans penis and foreskin also occurs in the context of sexually transmitted diseases. So, the human papillomavirus causes chronic balanoposthitis, which is not easy to defeat.

The main risk factor for the development of balanoposthitis is poor personal hygiene.

• The narrowed foreskin (phimosis) that is poorly shifted from the head favors the appearance of balanitis and balanoposthitis. For this reason, circumcision reduces the risk of getting balanoposthitis.
• People with certain medical conditions are statistically more likely to have inflammation of the foreskin and glans. These diseases include diabetes mellitus, inflammatory bowel disease, Crohn's disease, obesity, and ulcerative colitis.

Balanoposthitis: the consequences of refusing treatment and the main complications

Most often, with the conservative treatment of balanoposthitis, the consequences for the patient are favorable.

• Treatment for infectious balanoposthitis may be topical (eg, clotrimazole ointment or potassium permanganate baths) or oral (eg, fluconazole), but both partners should be tested for infection. Women infected through sexual contact may develop vulvitis and other gynecological diseases.
• If after four weeks of antifungal treatment has not been successful, the diagnosis should be reassessed.
• With non-infectious balanoposthitis, an ointment with cortisone is prescribed at the initial stage. Cortisone reduces inflammation and reduces symptoms of the disease. If cortisone does not help, the urologist may recommend an ointment containing pimecrolimus, a powerful immunosuppressive and anti-inflammatory agent.
• For children, there are special treatment recommendations that must be strictly observed. Parents or the child should consistently perform daily intimate hygiene with the foreskin retracted and possibly apply cortisone ointment twice a day.
• If the foreskin is narrowing, it can be pushed back only after consulting with your doctor. This can be very painful and uncomfortable. For this reason, the use of local anesthesia (ointments or analgesics) should be considered. Recommendations for the care of the foreskin in young children can be found on the website of the famous pediatrician E.O. Komarovsky.
• Frequent recurrences of balanoposthitis and phimosis require circumcision - surgical removal of the foreskin of the penis. Circumcised men tend to be less susceptible to genital infections.

Neglecting the treatment of balanoposthitis is a sure step towards a urinary tract infection, bladder or prostate inflammation.

• In rare cases, the result of an inattentive attitude to the disease is phimosis.- narrowing of the foreskin ring, which makes it impossible to "pull" it from the head of the penis. And phimosis, in turn, sometimes leads to paraphimosis or infringement of the head of the penis. This requires surgical treatment.
• An unpleasant consequence of balanoposthitis (complication) is a decrease in the sensitivity of the glans penis. The weaker sensations during orgasm.
• A rare but possible complication is lymphagenitis.(inflammation of the blood vessels of the penis). In severe cases, it leads to gangrene of the penis.
• Allergic symptoms such as dermatitis, rashes, hives, and skin inflammation can lead to scarring. In turn, scar tissue on the penis can cause narrowing of the foreskin. This leads to the development of discomfort and difficulty with urination.
• With prolonged inflammation of the foreskin and head of the penis the formation of a malignant tumor is not excluded.

As a preventive measure, wash the penis daily with warm water, cleansing it of smegma and avoiding the use of scented or deodorizing products. Dry your penis completely after showering.