Balanitis

Symptoms include:

• rash
• inability to retract foreskin
• itch
• odour
• dyspareunia
• dysuria.

Signs include:

• erythema
• textural changes such as scaling or leukoplakia (pallor/plaques)
• purpura
• ulceration
• fissuring
• oedema
• odour
• phimosis.

If associated with a generalised condition, there may be systemic features, e.g:

• lymphadenopathy
• arthritis
• non-genital rash.

• Consider subpreputial swab for candida spp and bacterial culture in severe cases or where symptoms don’t resolve to general hygiene measures.
• If candidal infection is present, refer to GP to exclude diabetes.
• PCR for herpes simplex/syphilis if ulceration present (in addition to serology for syphilis).
• Testing for sexually transmitted infections if appropriate.
• Refer for biopsy if a pre-malignant or malignant condition is suspected.

Where a specific cause is identified, management should follow the relevant guideline.

General advice:

• Salt water bathing in addition to hygiene advice.
• Avoid soaps when inflammation is present. Soap substitutes include aqueous cream, E45, Dermol.
• Oil based creams may affect condom efficacy.
• Avoid possible irritants, e.g., baby wipes, shower gels, lubricants, hygiene sprays.
• Consider a trial of hypo-allergenic condoms if client uses condoms.
• If symptoms fail to resolve, consider referring on to senior GU colleague or dermatology for review. A trial of mild topical steroid maybe considered.

1. BASHH UK National Guideline on the management of balanoposthitis, 2008 2062.pdf (bashhguidelines.org) (accessed online May 2022 )
2. Patient Information Leaflet

West-of-Scotland-Balanitis-Leaflet-Final-3.1-August-21.pdf
West-of-Scotland-Genital-Hygiene-PIL-Final-3.1-August-2021.pdf