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. 1996 Jun;72(3):155–159. doi: 10.1136/sti.72.3.155

Balanitis and balanoposthitis: a review.

S Edwards 1
PMCID: PMC1195642  PMID: 8707315

Abstract

OBJECTIVES: To give an overview of the literature on balanitis, with a special emphasis on infective causes. METHOD: A data search was performed using the OVID CD plus Medline 1967-1995, using balanitis and balanoposthitis as textword search strategy. Specific subjects such as anaerobic infection, Zoon's balanitis were sought separately and subgroups combined. Original articles and abstracts were referenced to illustrate each condition. These were mainly English language articles, but included appropriate non-English language papers. CONCLUSIONS: Balanitis is a common condition among genitourinary medicine clinic attendees, the cause often remaining undiagnosed. Many cases are caused by infection, with candida being the most frequently diagnosed. However, gardnerella and anaerobic infections are common, and there are a wide variety of other rarer infective causes. In addition irritant balanitis is probably a contributing factor in many cases. Balanitis which persists and in which the cause remains unclear warrants biopsy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abdullah A. N., Drake S. M., Wade A. A., Walzman M. Balanitis (balanoposthitis) in patients attending a department of genitourinary medicine. Int J STD AIDS. 1992 Mar-Apr;3(2):128–129. doi: 10.1177/095646249200300211. [DOI] [PubMed] [Google Scholar]
  2. Arumainayagam J. T., Sumathipala A. H., Smallman L. A., Shahmanesh M. Flat condylomata of the penis presenting as patchy balanoposthitis. Genitourin Med. 1990 Aug;66(4):251–253. doi: 10.1136/sti.66.4.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Arumainayagam J. T., Sumathipala A. H. Value of performing biopsies in genitourinary clinics. Genitourin Med. 1990 Oct;66(5):407–407. doi: 10.1136/sti.66.5.407. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bainbridge D. R., Whitaker R. H., Shepheard B. G. Balanitis xerotica obliterans and urinary obstruction. Br J Urol. 1971 Aug;43(4):487–491. doi: 10.1111/j.1464-410x.1971.tb12073.x. [DOI] [PubMed] [Google Scholar]
  5. Bart R. S., Kopf A. W. Tumor conference No 18: squamous-cell carcinoma arising in balanitis xerotica obliterans. J Dermatol Surg Oncol. 1978 Aug;4(8):556–558. doi: 10.1111/j.1524-4725.1978.tb00500.x. [DOI] [PubMed] [Google Scholar]
  6. Beljaards R. C., van Dijk E., Hausman R. Is pseudoepitheliomatous, micaceous and keratotic balanitis synonymous with verrucous carcinoma? Br J Dermatol. 1987 Nov;117(5):641–646. doi: 10.1111/j.1365-2133.1987.tb07497.x. [DOI] [PubMed] [Google Scholar]
  7. Bernstein G., Forgaard D. M., Miller J. E. Carcinoma in situ of the glans penis and distal urethra. J Dermatol Surg Oncol. 1986 May;12(5):450–455. doi: 10.1111/j.1524-4725.1986.tb01934.x. [DOI] [PubMed] [Google Scholar]
  8. Bingham J. S. Carcinoma of the penis developed in lichen sclerosus et atrophicus. Br J Vener Dis. 1978 Oct;54(5):350–351. doi: 10.1136/sti.54.5.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Birley H. D., Luzzi G. A., Walker M. M., Ryait B., Taylor-Robinson D., Renton A. M. The association of human papillomavirus infection with balanoposthitis: a description of five cases with proposals for treatment. Int J STD AIDS. 1994 Mar-Apr;5(2):139–141. doi: 10.1177/095646249400500213. [DOI] [PubMed] [Google Scholar]
  10. Birley H. D., Walker M. M., Luzzi G. A., Bell R., Taylor-Robinson D., Byrne M., Renton A. M. Clinical features and management of recurrent balanitis; association with atopy and genital washing. Genitourin Med. 1993 Oct;69(5):400–403. doi: 10.1136/sti.69.5.400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Boon T. A. Sapphire probe laser surgery for localized carcinoma of the penis. Eur J Surg Oncol. 1988 Apr;14(2):193–195. [PubMed] [Google Scholar]
  12. Brook I. Balanitis caused by group B beta-hemolytic streptococci. Sex Transm Dis. 1980 Oct-Dec;7(4):195–196. doi: 10.1097/00007435-198010000-00012. [DOI] [PubMed] [Google Scholar]
  13. CATTERALL R. D., OATES J. K. Treatment of balanitis xerotica obliterans with hydrocortisone injections. Br J Vener Dis. 1962 Jun;38:75–77. doi: 10.1136/sti.38.2.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. COOKE R. A., RODRIGUE R. B. AMOEBIC BALANITIS. Med J Aust. 1964 Jan 25;1:114–116. [PubMed] [Google Scholar]
  15. Castle W. N., Wentzell J. M., Schwartz B. K., Clendenning W. E., Selikowitz S. M. Chronic balanitis owing to pemphigus vegetans. J Urol. 1987 Feb;137(2):289–291. doi: 10.1016/s0022-5347(17)43983-8. [DOI] [PubMed] [Google Scholar]
  16. Chalmers R. J., Burton P. A., Bennett R. F., Goring C. C., Smith P. J. Lichen sclerosus et atrophicus. A common and distinctive cause of phimosis in boys. Arch Dermatol. 1984 Aug;120(8):1025–1027. doi: 10.1001/archderm.120.8.1025. [DOI] [PubMed] [Google Scholar]
  17. Chaudhury D. S., Chaudhury M. A case report of gangrenous balanitis in progressive reaction in leprosy. Lepr Rev. 1966 Oct;37(4):225–226. doi: 10.5935/0305-7518.19660038. [DOI] [PubMed] [Google Scholar]
  18. Clarke J. Effects of obesity on sexual function. Br J Sex Med. 1976 Jun;3(3):8–9. [PubMed] [Google Scholar]
  19. Coldiron B. M., Jacobson C. Common penile lesions. Urol Clin North Am. 1988 Nov;15(4):671–685. [PubMed] [Google Scholar]
  20. Cree G. E., Willis A. T., Phillips K. D., Brazier J. S. Anaerobic balanoposthitis. Br Med J (Clin Res Ed) 1982 Mar 20;284(6319):859–860. doi: 10.1136/bmj.284.6319.859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Csonka G. W. Balanitis due to fixed eruption after Mandrax. Br J Vener Dis. 1973 Jun;49(3):316–317. doi: 10.1136/sti.49.3.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Csonka G. W., Rosedale N., Walkden L. Balanitis due to fixed drug eruption associated with tetracycline therapy. Br J Vener Dis. 1971 Feb;47(1):42–44. doi: 10.1136/sti.47.1.42. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. DUNKELBERG W. E., Jr, WOOLVIN S. C. HAEMOPHILUS VAGINALIS RELATIVE TO GONORRHEA AND MALE URETHRITIS. Mil Med. 1963 Nov;128:1098–1101. [PubMed] [Google Scholar]
  24. Davidson F. Yeasts and circumcision in the male. Br J Vener Dis. 1977 Apr;53(2):121–122. doi: 10.1136/sti.53.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Deliyanni V. A., Boniatsi L. S., Photinou A. S. Balanitis caused by group A beta-hemolytic Streptococcus in an 8-year-old boy. Pediatr Infect Dis J. 1989 Jan;8(1):61–62. doi: 10.1097/00006454-198901000-00020. [DOI] [PubMed] [Google Scholar]
  26. Dodds P. R., Chi T. N. Balanitis as a fixed drug eruption to tetracycline. J Urol. 1985 Jun;133(6):1044–1045. doi: 10.1016/s0022-5347(17)49372-4. [DOI] [PubMed] [Google Scholar]
  27. Drusin L. M., Wilkes B. M., Gingrich R. D. Streptococcal pyoderma of the penis following fellatio. Br J Vener Dis. 1975 Feb;51(1):61–62. doi: 10.1136/sti.51.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Duerden B. I. Black-pigmented gram-negative anaerobes in genito-urinary tract and pelvic infections. FEMS Immunol Med Microbiol. 1993 Mar;6(2-3):223–227. doi: 10.1111/j.1574-695X.1993.tb00331.x. [DOI] [PubMed] [Google Scholar]
  29. Dundas S. A., Laing R. W. Titanium balanitis with phimosis. Dermatologica. 1988;176(6):305–307. doi: 10.1159/000248741. [DOI] [PubMed] [Google Scholar]
  30. Editorial: What about the real problems? Br Med J. 1976 Jan 3;1(6000):1–1. [PMC free article] [PubMed] [Google Scholar]
  31. Estcourt C. S., Higgins S. P., Goorney B. P. Recurrent bullous balanitis: an unusual presentation of balanitis xerotica obliterans. Int J STD AIDS. 1994 Jan-Feb;5(1):58–59. doi: 10.1177/095646249400500114. [DOI] [PubMed] [Google Scholar]
  32. Finnerty E. E. Dermatitis artefacta of the genitals. Cutis. 1976 Aug;18(2):199–200. [PubMed] [Google Scholar]
  33. Fornasa C. V., Calabro A., Miglietta A., Tarantello M., Biasinutto C., Peserico A. Mild balanoposthitis. Genitourin Med. 1994 Oct;70(5):345–346. doi: 10.1136/sti.70.5.345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Goette D. K., Elgart M., DeVillez R. L. Erythroplasia of Queyrat. Treatment with topically applied fluorouracil. JAMA. 1975 Jun 2;232(9):934–937. doi: 10.1001/jama.232.9.934. [DOI] [PubMed] [Google Scholar]
  35. Griffiths M., Penna L. K., Tovey S. J. Aceto-white change of the glans penis associated with balanitis not human papillomavirus infection. Int J STD AIDS. 1991 May-Jun;2(3):211–212. doi: 10.1177/095646249100200315. [DOI] [PubMed] [Google Scholar]
  36. Guerrero-Vazquez J., Sebastian-Planes M., Olmedo-Sanlaureano S. Group A streptococcal proctitis and balanitis. Pediatr Infect Dis J. 1990 Mar;9(3):223–223. doi: 10.1097/00006454-199003000-00020. [DOI] [PubMed] [Google Scholar]
  37. Hillman R. J., Walker M. M., Harris J. R., Taylor-Robinson D. Penile dermatoses: a clinical and histopathological study. Genitourin Med. 1992 Jun;68(3):166–169. doi: 10.1136/sti.68.3.166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Jeyakumar W., Ganesh R., Mohanram M. S., Shanmugasundararaj A. Papulonecrotic tuberculids of the glans penis: case report. Genitourin Med. 1988 Apr;64(2):130–132. doi: 10.1136/sti.64.2.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Kanerva L., Kousa M., Niemi K. M., Lassus A., Juvakoski T., Lauharanta J. Ultrahistopathology of balanitis circinata. Br J Vener Dis. 1982 Jun;58(3):188–195. doi: 10.1136/sti.58.3.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Keat A. Reiter's syndrome and reactive arthritis in perspective. N Engl J Med. 1983 Dec 29;309(26):1606–1615. doi: 10.1056/NEJM198312293092604. [DOI] [PubMed] [Google Scholar]
  41. Kinghorn G. R., Jones B. M., Chowdhury F. H., Geary I. Balanoposthitis associated with Gardnerella vaginalis infection in men. Br J Vener Dis. 1982 Apr;58(2):127–129. doi: 10.1136/sti.58.2.127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Kinghorn G. R., Woolley P. D. Single-dose fluconazole in the treatment of Candida albicans balanoposthitis. Int J STD AIDS. 1990 Sep;1(5):366–367. doi: 10.1177/095646249000100516. [DOI] [PubMed] [Google Scholar]
  43. Kumar B., Sharma R., Rajagopalan M., Radotra B. D. Plasma cell balanitis: clinical and histopathological features--response to circumcision. Genitourin Med. 1995 Feb;71(1):32–34. doi: 10.1136/sti.71.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Kumar B., Sharma V. K. Papulonecrotic tuberculides on glans penis. Dermatologica. 1987;174(3):151–153. [PubMed] [Google Scholar]
  45. Kyriazi N. C., Costenbader C. L. Group A beta-hemolytic streptococcal balanitis: it may be more common than you think. Pediatrics. 1991 Jul;88(1):154–156. [PubMed] [Google Scholar]
  46. Lassus A., Tiilikainen A., Stubb S., Reunala T., Johansson E. Circinate erosive balanitis and HL-A 27. Acta Derm Venereol. 1975;55(3):199–201. [PubMed] [Google Scholar]
  47. Lejman K., Starzycki Z. Syphilitic balanitis of Follmann developing after the appearance of the primary chancre. A case report. Br J Vener Dis. 1975 Apr;51(2):138–140. doi: 10.1136/sti.51.2.138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Lucks D. A., Venezio F. R., Lakin C. M. Balanitis caused by group B streptococcus. J Urol. 1986 May;135(5):1015–1015. doi: 10.1016/s0022-5347(17)45963-5. [DOI] [PubMed] [Google Scholar]
  49. Lyttle P. H. Ulcerative colitis and balanoposthitis. Int J STD AIDS. 1994 Jan-Feb;5(1):72–73. doi: 10.1177/095646249400500120. [DOI] [PubMed] [Google Scholar]
  50. Manian F. A., Alford R. H. Nosocomial infectious balanoposthitis in neutropenic patients. South Med J. 1987 Jul;80(7):909–911. doi: 10.1097/00007611-198707000-00025. [DOI] [PubMed] [Google Scholar]
  51. Masfari A. N., Kinghorn G. R., Duerden B. I. Anaerobes in genitourinary infections in men. Br J Vener Dis. 1983 Aug;59(4):255–259. doi: 10.1136/sti.59.4.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Masfari A. N., Kinghorn G. R., Hafiz S., Barton I. G., Duerden B. I. Anaerobic bacteria and herpes simplex virus in genital ulceration. Genitourin Med. 1985 Apr;61(2):109–113. doi: 10.1136/sti.61.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Michalowski R. Balano-posthites à Trichomonas. A propos de 16 observations. Ann Dermatol Venereol. 1981;108(10):731–738. [PubMed] [Google Scholar]
  54. Mikhail G. R. Cancers, precancers, and pseudocancers on the male genitalia. A review of clinical appearances, histopathology, and management. J Dermatol Surg Oncol. 1980 Dec;6(12):1027–1035. doi: 10.1111/j.1524-4725.1980.tb01026.x. [DOI] [PubMed] [Google Scholar]
  55. Murray W. J., Fletcher M. S., Yates-Bell A. J., Pryor J. P., Darby A. J., Packham D. A. Plasma cell balinitis of Zoon. Br J Urol. 1986 Dec;58(6):689–691. doi: 10.1111/j.1464-410x.1986.tb05913.x. [DOI] [PubMed] [Google Scholar]
  56. Nia A. K., Smith E. L. Pityriasis versicolor of the glans penis. Br J Vener Dis. 1979 Jun;55(3):230–230. doi: 10.1136/sti.55.3.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Nishigori C., Taniguchi S., Hayakawa M., Imamura S. Penis tuberculides: papulonecrotic tuberculides on the glans penis. Dermatologica. 1986;172(2):93–97. doi: 10.1159/000249305. [DOI] [PubMed] [Google Scholar]
  58. Pattman R. S. Two unusual manifestations of infection with Staphylococcus aureus presenting to a clinic for sexually transmitted diseases. Br J Clin Pract. 1983 Jun;37(6):228-9, 231. [PubMed] [Google Scholar]
  59. Petersen L., Mommsen S., Pallisgaard G. Male genitourinary tuberculosis. Report of 12 cases and review of the literature. Scand J Urol Nephrol. 1993;27(3):425–428. doi: 10.3109/00365599309180460. [DOI] [PubMed] [Google Scholar]
  60. Peutherer J. F., Smith I. W., Robertson D. H. Necrotising balanitis due to a generalised primary infection with herpes simplex virus type 2. Br J Vener Dis. 1979 Feb;55(1):48–51. doi: 10.1136/sti.55.1.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Pheifer T. A., Forsyth P. S., Durfee M. A., Pollock H. M., Holmes K. K. Nonspecific vaginitis: role of Haemophilus vaginalis and treatment with metronidazole. N Engl J Med. 1978 Jun 29;298(26):1429–1434. doi: 10.1056/NEJM197806292982601. [DOI] [PubMed] [Google Scholar]
  62. Piot P., Duncan M., Van Dyck E., Ballard R. C. Ulcerative balanoposthitis associated with non-syphilitic spirochaetal infection. Genitourin Med. 1986 Feb;62(1):44–46. doi: 10.1136/sti.62.1.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Powers R. D., Rein M. F., Hayden F. G. Necrotizing balanitis due to herpes simplex type 1. JAMA. 1982 Jul 9;248(2):215–216. [PubMed] [Google Scholar]
  64. Poynter J. H., Levy J. Balanitis xerotica obliterans: effective treatment with topical and sublesional corticosteroids. Br J Urol. 1967 Aug;39(4):420–425. doi: 10.1111/j.1464-410x.1967.tb09823.x. [DOI] [PubMed] [Google Scholar]
  65. Read S. I., Abell E. Pseudoepitheliomatous, keratotic, and micaceous balanitis. Arch Dermatol. 1981 Jul;117(7):435–437. [PubMed] [Google Scholar]
  66. Rickwood A. M., Hemalatha V., Batcup G., Spitz L. Phimosis in boys. Br J Urol. 1980 Apr;52(2):147–150. doi: 10.1111/j.1464-410x.1980.tb02945.x. [DOI] [PubMed] [Google Scholar]
  67. STEVANOVIC D. V. Papulonecrotic tuberculids of glans penis. AMA Arch Derm. 1958 Dec;78(6):760–761. doi: 10.1001/archderm.1958.01560120080014. [DOI] [PubMed] [Google Scholar]
  68. Smith E. L. Pityriasis versicolor of the penis. Br J Vener Dis. 1978 Dec;54(6):441–441. doi: 10.1136/sti.54.6.441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Sonnex T. S., Dawber R. P., Ryan T. J., Ralfs I. G. Zoon's (plasma-cell) balanitis: treatment by circumcision. Br J Dermatol. 1982 May;106(5):585–588. doi: 10.1111/j.1365-2133.1982.tb04563.x. [DOI] [PubMed] [Google Scholar]
  70. Sonnex T. S., Ralfs I. G., Plaza de Lanza M., Dawber R. P. Treatment of erythroplasia of Queyrat with liquid nitrogen cryosurgery. Br J Dermatol. 1982 May;106(5):581–584. doi: 10.1111/j.1365-2133.1982.tb04562.x. [DOI] [PubMed] [Google Scholar]
  71. Souteyrand P., Wong E., MacDonald D. M. Zoon's balanitis (balanitis circumscripta plasmacellularis). Br J Dermatol. 1981 Aug;105(2):195–199. doi: 10.1111/j.1365-2133.1981.tb01205.x. [DOI] [PubMed] [Google Scholar]
  72. Thomas J. A., Antony A. J. Amoebiasis of the penis. Br J Urol. 1976 Aug;48(4):269–273. doi: 10.1111/j.1464-410x.1976.tb03017.x. [DOI] [PubMed] [Google Scholar]
  73. Vohra S., Badlani G. Balanitis and balanoposthitis. Urol Clin North Am. 1992 Feb;19(1):143–147. [PubMed] [Google Scholar]
  74. Wallin J., Forsgren A. Group B streptococci in venereal disease clinic patients. Br J Vener Dis. 1975 Dec;51(6):401–404. doi: 10.1136/sti.51.6.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Waugh M. A. Clinical presentation of candidal balanitis--its differential diagnosis and treatment. Chemotherapy. 1982;28 (Suppl 1):56–60. doi: 10.1159/000238154. [DOI] [PubMed] [Google Scholar]
  76. Waugh M. A., Evans E. G., Nayyar K. C., Fong R. Clotrimazole (Canesten) in the treatment of candidal balanitis in men. With incidental observations on diabetic candidal balanoposthitis. Br J Vener Dis. 1978 Jun;54(3):184–186. doi: 10.1136/sti.54.3.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Wijesurendra C. S., Singh G., Manuel A. R., Morris J. A. Balanoposthitis--an unusual feature of Crohn's disease? Int J STD AIDS. 1993 May-Jun;4(3):184–184. doi: 10.1177/095646249300400319. [DOI] [PubMed] [Google Scholar]
  78. Wikström A., von Krogh G., Hedblad M. A., Syrjänen S. Papillomavirus-associated balanoposthitis. Genitourin Med. 1994 Jun;70(3):175–181. doi: 10.1136/sti.70.3.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. ZOON J. J. Balanoposthite chronique circonscrite bénigne à plasmocytes. Dermatologica. 1952;105(1):1–7. [PubMed] [Google Scholar]
  80. de Vincenzi I., Mertens T. Male circumcision: a role in HIV prevention? AIDS. 1994 Feb;8(2):153–160. [PubMed] [Google Scholar]
  81. van Ulsen J., Stolz E., van Joost T., Geursen-Reitsma A. M. Allergy to spermicidal lubricant in a contraceptive. Contact Dermatitis. 1987 Aug;17(2):115–116. doi: 10.1111/j.1600-0536.1987.tb02678.x. [DOI] [PubMed] [Google Scholar]

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