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Author: Dr Deborah Lee
Role: Associate Specialist in Sexual Health
Date written: October 2013
Last reviewed: May 2016
Review date: November 2016
Version: 1.0
Code: PI1152
Balanitis (1 of 3)
What is balanitis?
This is a condition that affects the end of the penis, which is called the
glans. Sometimes the foreskin may be affected as well. Sometimes
there is no abnormal appearance of the penis, but there may be a
discharge.
Symptoms may include soreness or irritation of the end of the penis,
redness, swelling, and/or a discharge.
Is it common?
Yes. In one study it affected approximately 1 in 10 men attending the
sexual health clinic.
Is it serious?
Usually it is not serious, but the symptoms may be unpleasant. Rarely,
there may be a more serious underlying cause, so it needs to be
checked out by your doctor, or in the sexual health clinic.
What causes it?
By understanding the cause, we can pinpoint treatment.
• Poor hygiene: sometimes difficulty retracting the foreskin, or
failing to clean under the foreskin can result in a build up of tissue
known as smegma. This can be irritating for the surrounding
tissue.
• Irritation e.g. due to soap, washing products, washing powders,
spermicides, or latex products such as condoms.
• Candida:
This infection is surprisingly common in men. It may be
associated with diabetes. In diabetic men, their female partners
should be seen, tested and treated.
• Aerobic infection: The most common of these is an organism
called gardnerella vaginalis. It may be sexually acquired so
the female partner should be screened. Other possibilities are
streptococcus group A or B.
• Anaerobic infection: this is commonly found in men who also
have an STI eg Non-Specific Urethritis. Most commonly these
bacteria are called bacteroides.
• Viral infection such as Herpes or HPV (wart virus infection):
Herpes frequently causes a bright red area on the penis, or is
Department of Sexual Health
01722 425120
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Balanitis (2 of 3)
associated with blisters or ulcers on the penis. HPV may cause a patchy area of redness
or soreness.
• Sexually transmitted infections (STI)
such as Chlamydia, TV, syphilis. Chlamydia may
cause greyish circular areas on the end of the penis. Other organisms like trichomonas
may cause redness and swelling. Syphilis can be associated with ulcers on the penis, both
early and later in the infection.
• Other (very rare) infections such as TB. This is a chronic inflammation on the end of the
penis, associated with ulceration.
• Common skin conditions such as eczema, psoriasis. If you have these skin conditions
elsewhere they can very commonly appear on the genitalia. This also includes seborrheic
dermatitis.
• Less common skin conditions such as balanitis xerotica obliterans (BXO), or premalignant
conditions. With BXO white plaques on the penis are characteristic. If there are small areas
of ulceration and other tests are negative, biopsy may be needed.
• Drugs such as antibiotics such as tetracyclines. Usually well defined red swollen or
ulcerated areas that appear soon after starting the antibiotic.
How is it treated?
We advise cleaning under the foreskin daily with luke-warm water, followed by gentle drying.
Soap or other irritants should not be used on the genitalia. Your doctor may prescribe you a soap
substitute.
We advise you not to use materials that contain irritants, for example, to stop using lubricants,
spermicides or perfumed washing products and to use only latex free condoms. The latter are
supplied by the clinic.
ˆˆ
For suspected candidal balanitis:
Use an antifungal cream e.g. Clotrimazole 1% twice a day until symptoms settle.
You may be given either a mild steroid cream, for example Hydrocortisone cream 1% to use
in addition, twice a day until symptoms settle. (Sometimes you may be given Clotrimazole HC
cream, which is a mixture of the two.)
ˆˆ
For suspected aerobic or anaerobic balanitis: You will be given some antibiotics:
Aerobic balanitis e.g. streptococcal, Amoxycillin 500mg four times a day for 7 days, or if you are
allergic to penicillin, Erythromycin 500mg four times a day for 7 days. Sometimes a mild steroid
cream such as 1% Hydrocortisone cream may also be prescribed.
ˆˆ
For gardnerella infection, and for anaerobic balanitis, you may be given
Metronidazole 400mg twice a day for seven days. When taking Metronidazole, you are
advised strongly not to drink alcohol as you may become very sick and vomit. Sometimes 1%
Hydrocortisone cream is also used.
Department of Sexual Health
01722 425120
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk
Balanitis (3 of 3)
ˆˆ
For viral infections e.g. Herpes: you may be given some antiviral tablets to take.
You are advised to have salt water baths twice a day, and to take regular pain killers such as
paracetamol and/or ibuprofen. Take care to wash you hands after handling the affected area, so
you do not transmit infection to your eye. If you are having difficulty passing urine, you could try
doing this in the bath. Sometimes local use of an anaesthetic gel called Instillagel may help you.
ˆˆ
For HPV (wart virus infection) - treatments differ and may include freezing with a cold
spray, or use of a special lotion, such as Warticon, or a cream preparation called Aldara. You
will be given specific instructions about use of these products.
ˆˆ
For STI’s eg Chlamydia, if your swab or urine test is positive you will be given
antibiotics to take. Usually this is Doxycycline 100mg to take twice a day for seven days. You
must finish the course. It is important not to have sex during treatment. Not even oral sex or
sex with a condom. While on Doxycycline you should avoid sunbathing as you may get a skin
reaction.
ˆˆ
For other STI’s eg Syphilis, or Trichomonas, other antibiotics will be given to you
and the treatments explained.
ˆˆ
Common skin conditions e.g eczema, psoriasis - these conditions respond to
treatment just as they do elsewhere on the skin.
• Eczema, avoid perfumed soaps. Use bland emollients as a soap substitute and
moisturiser e.g Emulsifying ointment. Use topical steroids e.g Hydrocortisone cream 1-2%,
several times a day if needed. Antibiotics may be needed if it becomes infected, and
antihistamines will help if it is itchy.
• Psoriasis, treatment is similar to eczema, except that topical steroids are used more
readily, commonly mixed with antifungal and antibacterial components eg Trimovate
cream, which can be used several times a day on the affected area.
ˆˆ
Less common skin conditions e.g BXO, or premalignant conditions: If the doctor
thinks the appearance of the penis needs further investigation, they will either arrange a biopsy
for you, or refer you to the dermatology or urology department. This is a simple procedure that
is done in the clinic setting, using injected local anaesthetic.
ˆˆ
Drugs e.g antibiotics such as tetracyclines: Stopping taking the drug usually results
in the abnormality on the penis disappearing within 6 weeks or so.
If any of the above conditions are failing to improve, or you have any concerns, you must seek
further help either from the clinic, or from your GP.
Department of Sexual Health
01722 425120
© Salisbury NHS Foundation Trust
Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ
www.salisbury.nhs.uk