Types of balanoposthitis

Types of balanoposthitis are divided into several groups, each of which is determined by the source of infection.

So, the most common and frequently encountered types of balanoposthitis are:

1. Simple
2. Chronic
3. Erosive
4. Purulent
5. Obliterating
6. Xerotic
7. Candidal
8. Circinate
9. Fungal
10. Zuna
11. Spicy
12. Gardnerella
13. Chlamydial
14. Yeast
15. Trichomonas
16. Sticky
17. Annular
18. Ulcerative
19. Allergic
20. Traumatic
21. Bacterial
22. Non-specific
23. Recurrent
24. Gangrenous
25. Herpetic
26. Catarrhal
27. Irritant
28. Follicular
29. Adhesive

Balanoposthitis can be acute or chronic. The main forms of acute inflammation are:

• Simple balanoposthitis - the patient develops redness, which develops into erosive wounds and is accompanied by purulent discharge.
• Gangrenous balanoposthitis - complicated by phimosis, characterized by abundant non-healing ulcers. The wounds scar and heal poorly.
• Erosive balanoposthitis - a layer of dead white epithelium appears on the head of the penis due to abundant discharge. After this, bloody erosive wounds appear, which have a rim of maceration.

As for chronic balanoposthitis, as a rule, the inflammation is caused by sexually transmitted diseases. It can appear due to herpes or mycosis. The main forms of chronic balanoposthitis: •

• Candidal.
• Fungal.
• Circinate.
• Allergic.
• Purulent balanoposthitis.

Purulent balanoposthitis is one of the most severe forms of this disease. Purulent balanoposthitis is characterized by inflammation of the glans penis and the inner layer of the foreskin. In addition, the patient develops purulent discharge. This form of the disease occurs due to the action of yeast fungi, streptococcal and staphylococcal microorganisms. The disease can occur with diabetes mellitus, purulent urethritis or allergic reactions.

The main symptoms of the disease are itching, burning, swelling of the head of the penis. Patients complain of pain in the groin. In exceptional cases, the disease negatively affects the general well-being, causing an increase in temperature and general weakness.

Treatment of purulent balanoposthitis begins with diagnostics and testing. Without timely treatment, ulcers appear on the penis, causing pain when urinating and walking. In addition, lymphangitis (inflammation of the lymphatic vessels, which causes the appearance of red stripes on the back of the penis) may begin. Advanced lymphadenitis can lead to gangrene of the penis. Treatment is carried out using antibacterial and antifungal drugs, ointments and solutions. If balanoposthitis has led to phimosis, the urologist performs circumcision, which involves excision of the foreskin, where pathogenic microorganisms accumulate.

Circinate balanoposthitis

Circinate balanoposthitis is characterized by spots that appear on the head of the penis and have clear outlines. As a rule, this form of balanoposthitis appears with chlamydial infections or is a symptom of Reiter's syndrome. Symptoms characteristic of circinate balanoposthitis: inflamed head and foreskin without roughness and subjective signs. With further development of the disease, white-gray spots, swelling, necrosis of the epidermis and an increase in the stratum corneum appear on the head.

With circinate balanoposthitis, the patient may develop gangrenous ulcers. If the disease has not taken an advanced form, then treatment involves observing the rules of intimate hygiene and washing the penis in a solution of potassium permanganate and medicinal herbs. In addition to hygiene measures, the urologist prescribes treatment to eliminate the cause of the disease. The patient may be prescribed antifungal agents, antibiotics and vitamin preparations.

Allergic balanoposthitis

Allergic balanoposthitis is an inflammatory disease that occurs due to exposure to an allergen or genital allergy. The disease has symptoms characteristic of all forms of balanoposthitis. The patient complains of itching, pain and burning, redness and swelling of the foreskin and head of the penis. But if spots, blisters and superficial erosions appear, allergic balanoposthitis can be accurately diagnosed.

The main factors of allergic balanoposthitis:

• Latex allergy – condoms are made of latex, so cases of latex allergy are very common. The only way to prevent an allergic reaction and subsequently balanoposthitis is to take antihistamines before using condoms.
• Consumption of allergens – since all waste products pass through the urethra, consumption of foods that cause allergies can cause allergic balanoposthitis.
• Local concentrates - to prevent unwanted pregnancy, women use concentrates in the form of ointments, vaginal tablets, suppositories, gels and other forms of release, which are popular due to the ease of use. Before release, the drugs are tested for allergic reactions in women, but this procedure is not provided for men. That is, sexual intercourse without a condom with a partner who uses local concentrates can cause allergic balanoposthitis.

Regardless of the cause of allergic balanoposthitis, treatment should be comprehensive. Drugs and treatment procedures are selected according to the stage of development of balanoposthitis and the characteristics of the patient's body. But do not forget that any treatment will be ineffective if the allergen is present in the body.

[ 1 ], [ 2 ], [ 3 ]

Anaerobic balanoposthitis

Anaerobic balanoposthitis is an inflammation of the prepuce, the foreskin of the glans penis. The disease is caused by anaerobic gram-negative bacteria. The main causes of anaerobic balanoposthitis are Gardnerella vaginalis bacteria. The disease has several forms - mild and erosive.

• Mild form - with this form of balanoposthitis, a sticky coating appears in the area of the coronary groove of the head of the penis, an unpleasant fishy smell and mild erythema of the foreskin and head of the penis.
• Erosive form – accompanied by mild symptoms, causes purulent erosions and plaque with a specific odor.

Anaerobic balanoposthitis is diagnosed based on clinical signs and laboratory data. Thus, to establish the etiologic agent of anaerobic inflammation, polymerase chain reaction and sowing of vaginosis-associated bacteria are used. Treatment is carried out using antibacterial drugs Metronidazole and Clandamycin, both systemically and locally.

[ 4 ], [ 5 ]

Chlamydial balanoposthitis

Chlamydial balanoposthitis most often manifests and proceeds as a circinate infectious and inflammatory disease. Balanoposthitis affects the head of the penis and has clearly defined lesions. There are no subjective symptoms of chlamydial balanoposthitis. Chlamydia does not affect the epithelium of the foreskin and head of the penis.

Chlamydial balanoposthitis is extremely rare, patients suffer from chlamydial balanitis much more often, since chlamydia actively affects the head of the penis, and not the foreskin. The foci of inflammation are clearly defined, which allows for an accurate diagnosis.

Chlamydial balanoposthitis usually occurs in men with Reiter's disease. The predisposing factor for the disease is congenital phimosis and narrowness of the foreskin, non-compliance with hygiene rules and abuse of hygiene products. Chlamydial balanoposthitis is sexually transmitted, so both partners undergo treatment. Oral medications and immunomodulators are used for treatment.

[6]

Balanoposthitis in diabetes mellitus

Balanoposthitis in diabetes occurs in 80% of patients. The inflammatory and infectious disease caused by diabetes mellitus refers to secondary balanoposthitis. Treatment of this form of the disease is long-term, since balanoposthitis is quite persistent and poorly amenable to therapy. The inflammation has a polymicrobial etiology and appears with mixed infectious microorganisms: yeast fungi, streptococci, staphylococci, symbiosis. The disease can also be caused by a monoinfection, for example, gardnerella.

Balanoposthitis in diabetes occurs due to metabolic disorders that accompany diabetes. Symptoms of the disease are accompanied by increased bleeding of the head of the penis, the appearance of ulcers, hyperemia, cracks and ulcers with the development of cicatricial and adhesive processes. The nature of the symptoms depends on the age of the patient and the duration of diabetes.

Treatment consists of selecting antidiabetic drugs that help stabilize and eliminate the inflammatory process. Surgical circumcision of the foreskin can be used for treatment. But this method of treatment can only be used if the blood sugar level is normal.

[7], [8], [9], [10], [11]

Adhesive balanoposthitis

Adhesive balanoposthitis is the most common infectious and inflammatory disease, which most often occurs in young boys. The task of parents is to monitor compliance with hygiene rules. In some cases, the disease appears due to congenital or acquired developmental defects. In adults, balanoposthitis occurs less often, and, as a rule, is the cause of other inflammatory diseases.

The symptoms of adhesive balanoposthitis in adults are accompanied by bloody wounds on the head of the penis and peculiar discharge. Due to the advanced symptoms of balanoposthitis, treatment can be radical and involves circumcision, that is, excision of the foreskin. The adhesive form causes phimosis and narrowing of the foreskin of the penis, so surgery is an effective method of treating balanoposthitis and its consequences.

[12], [13], [14], [15]

Herpetic balanoposthitis

Herpetic balanoposthitis is one of the most common types of balanoposthitis. The clinical picture of this type of inflammatory and infectious disease is characterized by a vesicular rash, so, as a rule, it is not difficult to diagnose. Herpetic inflammation often recurs, causing a rash, hyperemia and swelling of the glans penis. Such symptoms occur in the initial stages of the disease, later the rash is replaced by blisters and herpetic balanoposthitis turns into an erythematous form of genital herpes. In this case, the disease makes the glans penis hypersensitive to irritants and takes a chronic form.

Herpetic balanoposthitis has two forms - atypical erythematous and irritant postherpetic. The task of the urologist is to accurately diagnose the form of balanoposthitis, since the treatment depends on it. Antiherpetic and corticosteroid ointments are used for treatment. The treatment is long-term, but it helps prevent relapses of balanoposthitis.

Trichomonas balanoposthitis

Trichomonas balanoposthitis is a secondary infectious and inflammatory disease that occurs against the background of trichomonas urethritis. As a rule, the inflammation affects the skin of the glans penis. The clinical picture of trichomonas balanoposthitis is practically no different from the inflammatory process of another origin. But with this form of the disease, a foamy purulent liquid of yellow or white color with a very unpleasant odor begins to be released from the preputial sac.

To diagnose balanoposthitis, the urologist prescribes tests and smears that allow to detect trichomonads. The main symptoms are hyperemia of the head and foreskin of the penis, the appearance of red spots. To distinguish the primary form of this disease from the secondary, the patient takes a urine test (after washing the preputial sac). If the test results do not reveal inflammatory elements, then this indicates primary trichomonas balanoposthitis.

Bacterial balanoposthitis

Bacterial balanoposthitis is an inflammation of the external genitalia, usually in men. In the bacterial form of the disease, both the head of the penis and the tissue of the foreskin are affected. The disease is caused by a bacterial infection. Most often, bacterial balanoposthitis is diagnosed in boys under three years of age. This is due to the fact that from birth, the head of the penis is covered by the foreskin, and it does not always open on its own, which causes problems with hygiene. As a result, harmful microorganisms accumulate under the skin, which provoke the appearance of bacterial balanoposthitis.

The first symptom of the disease is severe itching of the genitals. In addition to itching, the inflammation causes redness and swelling of the penis, pain when urinating, and, if neglected, inflammation of the inguinal lymph nodes. Treatment at the early stages does not take much time and is not difficult. The patient is prescribed a course of antibacterial drugs, ointments and solutions for washing. Intimate hygiene is mandatory. In severe cases of bacterial balanoposthitis, the only treatment method is surgical excision of the foreskin.

[ 16 ], [ 17 ]

Gardnerella balanoposthitis

Gardnerella balanoposthitis is an inflammatory process caused by the bacterium gardnerella. With this form of inflammation, both the head of the penis and the foreskin are affected. To diagnose the disease, the urologist prescribes tests. As a rule, the tests show a high concentration of anaerobic microorganisms and a low content of lactobacilli. Due to the rapid proliferation of bacteria, the microflora of the genitals begins to change.

Most often, gardnerella balanoposthitis is a secondary disease that occurs against the background of gardnerella urethritis. The main symptoms of the lesion are: itching and burning of the genitals, pain when urinating, gray discharge with an unpleasant odor. The causes of this form of inflammation have not been fully studied. Thus, the appearance of the disease can be caused by disturbances in the functioning of the body, hormonal factors, endocrine diseases and other causes.

The disease must be treated without fail, since without medical assistance, advanced gardnerella balanoposthitis can lead to infertility, bartholinitis, chronic prostatitis or urethral syndrome.

Follicular balanoposthitis

Follicular balanoposthitis is an infectious disease that most often occurs due to stagnation of sperm or urine in the prepuce. The peculiarity of the follicular form is that the patient has small but dense nodules. The patient develops mucopurulent secretion, swelling of the head and foreskin of the penis is observed. Inflammation can affect the entire urethra and lead to the development of urethritis.

Treatment of the follicular form of balanoposthitis involves curettage, i.e. scraping and cauterization of the follicles. If the disease is at an early stage of development, the patient's preputial sac is washed using antiseptic solutions, antibiotics and ointments are prescribed.

[ 18 ], [ 19 ], [ 20 ]

Xerotic balanoposthitis

Xerotic balanoposthitis (lichen sclerosus) is a chronic inflammatory lesion of the genitals in both men and women. The disease is very rare. The main factors that provoke the appearance of xerotic balanoposthitis:

• Autoimmune diseases and hormonal disorders – thyroid disease, alopecia, diabetes, impaired absorption of sex hormones by tissues.
• Genetic predisposition – scientists have proven that this form of balanoposthitis is hereditary and can be transmitted from mother to daughter.
• Viral and infectious agents.
• Local factors – mechanical damage to the skin due to wearing tight underwear and constant friction of the genitals.

The symptoms of the disease, at the initial stages of its development, do not differ from other forms of balanoposthitis. The first sign of inflammation is skin atrophy and the appearance of whitish spots on the head and foreskin of the penis. The main symptom of xerotic balanoposthitis is a whitish sclerotic ring. Subsequent stages of the disease cause the formation of scars and thickening of the skin of the foreskin. Because of this, it becomes impossible to open the head of the penis, as cicatricial phimosis is formed. Tears may also appear.

Treatment of this form of balanoposthitis depends on the stage of the inflammatory process. Thus, with cicatricial changes in the genitals, the process of narrowing of the urethra, disturbance of urine outflow and urination can begin. As a result, complications of balanoposthitis will lead to urolithiasis, renal failure and infectious lesions of the urinary tract.

There are two types of treatment for xerotic balanoposthitis. The first method is conservative treatment using ointments with glucocorticoid hormones. The second method is circumcision, i.e. surgical excision.

Non-specific balanoposthitis

Non-specific balanoposthitis is a form of inflammatory disease that is similar to other types of balanoposthitis in its symptoms and treatment methods. The peculiarity of non-specific balanoposthitis is that the patient has increasing swelling of the tissues on the head of the penis and foreskin. It is swelling that is the first sign of non-specific balanoposthitis, which allows differentiating this form of the disease from others. But in addition to swelling, the patient suffers from severe itching, burning, pain when urinating and hyperemia of the skin.

An advanced form of non-specific balanoposthitis can lead to the development of pathological phimosis, the only way to treat which is surgical intervention. The non-specific form of inflammation is not caused by bacterial and infectious pathogens, but is an accompanying symptom of diabetes mellitus and very often appears in patients with chronic alcoholism. In this case, the head of the penis is very painful and swollen, so it is difficult for the patient to open it. Another important symptom of non-specific inflammation is the release of liquid pus in large quantities from the preputial sac.

Treatment involves eliminating the cause of the disease. If the primary pathological condition is completely cured, the symptoms of balanoposthitis will disappear. Ignoring the symptoms and unwillingness to treat the inflammation lead to balanoposthitis becoming chronic and recurrent. The only advantage of non-specific balanoposthitis is that it is not transmitted during sexual intercourse.

Catarrhal balanoposthitis

Catarrhal balanoposthitis is a simple form of infectious and inflammatory disease. As a rule, this type of inflammation appears due to the effect of decomposing smegma on the skin of the genital organ. Catarrhal balanoposthitis is caused by the decomposition of the secretion of the inguinal glands in the prepuce. The disease occurs due to the action of staphylococcal and streptococcal microorganisms, E. coli and smegma bacilli. Trauma to the head of the penis can also lead to catarrhal inflammation. This can happen due to wearing tight underwear or during sexual intercourse due to increased dryness of the woman's vagina.

The main symptoms of the catarrhal form of balanoposthitis are itching, burning, swelling and hyperemia of the head and foreskin of the penis. At the same time, attempts to move the foreskin and open the head cause pain and become impossible. Without medical care and treatment, the symptoms worsen, and purulent discharge with an unpleasant odor appears, and some patients have a fever of up to 39 degrees.

Treatment of catarrhal balanoposthitis does not take much time and consists of washing and bathing the penis, lubricating the head with medications. If the symptoms of inflammation are aggravated by high temperature and purulent discharge, the patient is prescribed a course of antibiotics.

Irritant balanoposthitis

Irritant balanoposthitis is an inflammatory process that occurs due to stagnation of physiological fluids in the prepuce (the skin covering the head of the penis). As a rule, the disease is caused by stagnant urine residues, smegma and its decay products. Due to poor personal hygiene, the patient develops irritant balanoposthitis. The most common factor that provokes the development of the disease is trichomonas and gonorrhea urethritis, diabetes mellitus. External irritants, such as: congenital phimosis, excessive masturbation, frequent contact of the head of the penis with soap, can also cause irritant balanoposthitis.

This form of inflammation does not refer to infectious inflammatory processes, but it is possible that an infection will appear as the disease progresses. The main pathogens of infection are staphylococci, herpes, streptococci, yeast fungi, E. coli and others. The first symptom of this form of balanoposthitis is red skin on the genitals, as well as spongy skin. Swelling appears on the head and foreskin, and purulent fluid with an unpleasant odor is released from the preputial sac.

Inflammation causes enlargement of the lymph nodes in the groin, pain, burning, and sloughing of the epithelium. In advanced cases of irritant balanoposthitis, the patient develops multiple ulcers. Treatment is usually conservative, but if the disease has led to phimosis, then excision of the foreskin is necessary.