Diagnosis of balanitis

Inflammation of the glans penis is one of the unpleasant and to some extent dangerous diseases of a strong half of humanity. The disease called “balanitis” not only reduces the patient’s quality of life, it introduces its negative corrections to the relationship of sexual partners, reduces the patient’s self-esteem as a man, and impedes normal sex life. Professional diagnostics and treatment of balanitis help to avoid such problems and in most cases allow you to restore men's health.

Features of diagnosis of balanitis

The inflammatory process in the genital area, depending on the cause of its development and comorbidities, may have a different course. Hyperemia and edema of the penis tissues may have different severity. On the surface of the penis can be as small rashes, and ulcerative erosive foci, areas of necrosis and tissue atrophy. The urologist or andrologist notes all these signs during a physical examination of the patient.[1], [2]

This moment may seem inconvenient and extremely unpleasant to the patient, but it is very important for making a diagnosis, because external signs tell a lot about the type and form of balanitis. For example, inflamed wounds on the head of the penis indicate the erosive and ulcerative form of the disease, which in turn indicates the effect of infection on the tissues of the male organ. The infectious nature of the pathology is also confirmed by a congestion under the foreskin of the creamy secret of whitish or yellow-green color (purulent discharge and smegma). If a whitish, cheesy bloom is visible on the surface of the penis, the doctor will suspect Candida balanitis.[3]

For the inflammatory process, regardless of its etiology, hyperemia and edema of the tissues, which are visible to the naked eye, are characteristic. But about the symptoms such as itching, burning and pain, aggravated during walking and urination, the doctor can only learn from the words of the patient. You should not be afraid of the leading questions about when the symptoms first appeared and whether unprotected sexual intercourse was on the eve (most infections are sexually transmitted and pose a danger to the sexual partner), what kind of underwear the patient wears, or if he has had any allergies to creams or washing powders, etc.[4],

If a man turns to the doctor when the first signs of the disease appear, it is very difficult to determine from the existing symptoms whether there is infectious balanitis or whether it is a question of the effect of non-infectious irritants. Laboratory research helps to resolve this issue. By the way, they are also important when the symptoms clearly indicate the presence of an infection, because only tests make it possible to determine the causative agent of the disease or an infection that joined later and does not allow the inflammatory process to subside. And this, in turn, makes it possible to choose the right medicines for existing pathogens.

In order to identify the causative agent of balanitis, the doctor takes a smear from the patient's urethra and a scraping from the surface of the head. The study of the biomaterial is carried out by the method of polymerase chain reaction (CRP-analysis), which allows you to isolate the DNA of the pathogen. If sexually transmitted infections are detected, a consultation with a venereologist will be required.

When bacterial microflora is detected, which can only be treated with antibiotics, to exclude cases of antibiotic resistance, bacposiv is determined and the sensitivity of a particular pathogen to the traditionally used drugs is determined.

Additionally, the patient is offered to undergo tests for Wasserman's reaction (allows you to detect hidden proceeding syphilis), for hepatitis viruses and HIV infection, general and biochemical blood tests, urinalysis. To exclude or confirm the detrimental effect of diabetes, patients are prescribed a blood test for sugar.

If you suspect oncology, the doctor may prescribe a biopsy of the tissues of the penis and conduct a histological examination of the biopsy.

Balanitis is a disease that is easily diagnosed by doctors, even by external signs. It is much more difficult to identify the cause of the inflammatory process. Therefore, when balanitis of unspecified etiology, consultations of various doctors (traumatologist, rheumatologist, therapeutist, dermatovenereologist and even an oncologist), as well as additional instrumental studies may be required.

Instrumental diagnostics is assigned based on comorbidities and patient complaints. This may be an ultrasound examination of the urinary tract (ultrasound) or urethroscopy. As part of the diagnosis of pathology, an electrocardiogram, x-ray of the lungs and other studies can be prescribed, because the inflammatory process can be triggered by impaired blood circulation, i.e. Inadequate respiration and nutrition of the tissues of the glans penis caused by diseases of the cardiovascular and respiratory systems.

The head of the penis, as the main part of the human body, is covered with skin. The skin of the penis can respond not only to infections and injuries, rashes, redness and ulcers can occur for other reasons, for example, due to various systemic diseases. In order to differentiate balanitis from such pathologies and determine its type, differential diagnosis is carried out.[5]

For example, various skin manifestations are characteristic of sexually transmitted diseases:

• With genital herpes, blisters, sores and painful crusts can be found on the skin of the penis,
• in case of primary syphilis, painful ulcers, and in the case of secondary syphilis, volumetric warts and inflammatory foci of annular shape,
• with chancroid and venereal lymphogranuloma, ulcers also appear on the skin of the penis and there is an increase in the lymph nodes in the inguinal region,
• with gonorrhea on the skin of the phallus can be seen ulcers and pustules,
• trichomoniasis is manifested by the occurrence of erosive foci,
• papillomavirus can have manifestations in the form of rashes that are different in shape and size, reacting to acetic acid,
• with candidiasis, erythema, burning and severe itching in the intimate area are noted, a chewy patina with a sourish odor appears on the skin,
• infection with anaerobic gardnerella has its own characteristic - the unpleasant smell of spoiled fish, etc.

Skin manifestations in the region of the head of the genital organ can also be detected in case of pityriasis and lichen planus, allergic reactions, psoriasis, Behcet syndrome, seborrheic dermatitis, aphtosis. Differential diagnosis should be carried out with oncological diseases of the male organ (erythroplasia Keira, carcinoma, verrucous carcinoma, Paget's disease).

When conducting a comparative diagnosis, doctors rely on the patient's history, laboratory and instrumental studies. [6]If necessary, appoint special tests, for example, histological studies. After all, the quality of the diagnostics of balanitis will be determined, and the treatment and its effectiveness will depend on it.

Much attention is paid to comorbidities and complications of balanitis. For example, the disease often develops against the background of congenital phimosis (narrowing of the foreskin), but long-lasting inflammation and in itself can cause such a narrowing, i.e. Acquired phimosis. If nothing is done to eliminate inflammation, phimosis can give complications in the form of squeezing the urethra with modified foreskin (paraphimosis), resulting in serious problems with urination and erection, congestive processes and internal inflammation (cystitis, urethritis, prostatitis, etc..).

On the other hand, balanitis can develop as one of the complications of urethritis or another inflammatory disease of the urogenital system of an infectious nature. This is facilitated by discharge from the urethra, which contain bacterial particles.

Discharge from the preputial sac, characteristic of such a pathology as infectious balanitis, is also observed in the inflammation of the foreskin (post). And although the treatment of both diseases is similar, these pathologies should be differentiated to determine the focus of inflammation.