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i If you need this information in another language or medium (audio, large print, etc) please contact the Customer Care Team on 0800 374 208 email: customercare@ salisbury.nhs.uk. You are entitled to a copy of any letter we write about you. Please ask if you want one when you come to the hospital. If you are unhappy with the advice you have been given by your GP, consultant, or another healthcare professional, you may ask for a second (or further) opinion. The evidence used in the preparation of this leaflet is available on request. Please email: patient.information@ salisbury.nhs.uk if you would like a reference list. 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. 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.) 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. 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) 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. 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. 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. For other STI’s eg Syphilis, or Trichomonas, other antibiotics will be given to you and the treatments explained. 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. 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. 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