Balanoposthitis is inflammation of the glans penis and foreskin in uncircumcised males. It is commonly caused by infections, particularly Candida albicans or other fungi. Other causes include viruses like HSV, bacteria like Gardnerella vaginalis, irritants, trauma, fixed drug eruptions, premalignant conditions, and various cutaneous and mucocutaneous diseases. Symptoms include papules, pustules, vesicles, erosions, edema, phimosis, and foul discharge. Diagnosis involves examination, tests like KOH mounts or cultures, and biopsies. Treatment involves hygiene, antibiotics, antifungals, corticosteroids, circumcision for severe

1. BALANOPOSTHITIS

2. DEFINITION
• Gk : ‘Balanos’ - Head of Penis / Glans
Lat : ‘Posthe’ - Foreskin / Prepuce
+ ‘itis’ – inflammation
Defined as the inflammation of the Glans Penis
and mucosal surface of the Prepuce, commonly
in uncircumcised males, with subpreputial
discharge and phimosis. 2% Incidence

3. AETIOLOGY
• INFECTIONS
Fungal
Candida albicans (MC – 20%)
Malassezia furfur (P. orbiculare)
Anaerobic Organisms
Corynebacterium diphtheriae
Fusospirochaetes

4. AETIOLOGY
• INFECTIONS
Spirochaetal
Treponema Pallidum
T. refrigens / phaegedenis / balanitidis /
vincenti
Viral
HSV (20%)
HPV
Mycobacterial
M. tuberculosis
M. leprae

5. AETIOLOGY
• INFECTIONS
Aerobic Org
Gardenella Vaginalis
Streptococcus sp
S. aureus
Calymmatobacterium granulomatis
Neisseria gonorrhoeae
Chlamydia trachomatis
Hemophilus ducreyi
Pseudomonas

6. AETIOLOGY
• INFECTIONS
Protozoal
Trichomonas vaginalis
Entamoeba histolytica
Parasitic
Scabies
Pediculosis
Creeping eruptions / CLM

7. AETIOLOGY
• IRRITANTS / ALLERGENS
Smegma
Soaps
Urine
Condoms
Spermicides
Podophyllin / Topicals
Lubricants

8. AETIOLOGY
• TRAUMATIC
Post-coital / Post-masturbation
Zip fastener laceration
Frictional trauma
Teeth bites
Excoriations

9. AETIOLOGY
• FIXED DRUG ERUPTIONS
Tetracyclines / Sulphonamides
Carbamazepines
Dapsone
Salicylates
Erythromycin
Metronidazole
Barbiturates

10. AETIOLOGY
PREMALIGNANT CONDITIONS
Erythroplasia of Qeuyrat (Bowen’s dis)
Leukoplakia
Extramammary Paget’s
MALIGNANT DISEASES
SCC / BCC
MELANOMAS

11. AETIOLOGY
• CUTANEOUS / MUCOCUTANEOUS DIS
Pemphigus
DH / EM / SJS / TEN
LP / Psoriasis
Behcet’s Disease
Aphthae
Porokeratosis of Mibelli
Herpes Zoster
Varicella Zoster

12. AETIOLOGY
• MISCELLANEOUS
Circinate Balanitis
Zoon’s Balanitis
Balanitis Xerotica Obliterans
(Lichen Sclerosus et Atrophicus)
Pseudoepitheliomatous micaceous and
keratotic balanitis of Civatte (PMKB)
FB-induced (Beads / Calculi)
Post Intravesical BCG (Granulomatous BP)

13. CLINICAL FEATURES
• Papules / Pustules or Vesicles (even Bullae)
with Erosions
• Prepucial Edema, Phimosis
• Thick, foul smelling subpreputial discharge
• Pain / Pruritis / Burning Micturition
• Painful LAN
• Extensive Ulceration
• Phaegedena

14. CLINICAL FEATURES
• Frenal tears / Edema / Pain (Traumatic)
• Vesicles / Bullae with Erosions (CD/FDE)

15. CLINICAL FEATURES
• Smooth erythematous scaly papules with
satellite pustules (Superadded inf)with peeling
of skin +/- Plaques of thrush / Maceration /
Erosions (Candida albicans)

16. CLINICAL FEATURES
• Small Gray-White vesicles on erythematous
base +/- Ulceration with Prostatitis / Urethritis
(Trichomonas Vaginalis)

17. CLINICAL FEATURES
• Superficial Erosions with Purulent Urethral
Discharge (Neisseria Gonorrhoea)

18. CLINICAL FEATURES
• Erosive indurated painless Chancre over
Prepuce with Phimosis – Doughy inflitrate /
Nodular Infiltrate / Diffuse Inflitrate)
(Follman’s Balanitis of Syphilis)

19. CLINICAL FEATURES
• Multiple painful shallow non-indurated ulcers
with undermined edges over prepuce / glans
+/- Phimosis (Chancroid)

20. CLINICAL FEATURES
• Annular erythematous moist plaques with
ulceration healing with fibrosis / scarring with
preceding Oral Ulcers / Ophthalmic inv
(Behcet’s Disease)

21. CLINICAL FEATURES
• Bright red micaceous scaly annular plaques
with cutaneous / nail / joint inv
(Penile Psoriasis)

22. CLINICAL FEATURES
• Painless, Serpiginous, geographic dermatitis of
Glans (uncirc) and Hyperkeratotic plaques (Cir)
(CIRCINATE BALANITIS of REITER’S DIS)

23. CLINICAL FEATURES
• Chronic inflamm followed by atrophic
sclerosis, depigmentation, induration, phimosi
s and Urethral Stricture
(Lichen Sclerosus et Atrophicans / BXO)

24. CLINICAL FEATURES
• Chronic benign circumscribed plasma cell
balanitis; shiny red velvety plaques with
Cayenne Pepper stippling (ZB)

25. COMPLICATIONS
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Recurrence / Chronicity
Phimosis / Paraphimosis
BXO
Prepucial Adhesions
Prepucial Perforation
Phagaedena
Scarring / pigmentation
Meatal Sricture
Lymphedema
Neoplasm

26. DIAGNOSIS
• Detalied History taking / Clinical Examination
• Confirm Diagnosis
KOH MOUNT (CANDIDA)
SUBPREPUTIAL SWAB for Culture (TRICH)
GS / ZN STAIN (MIXED INF)
PUS CULTURE / ABST (MIXED INF)
DGI MICROSCOPY (SPIRO)
TZANCK SMEAR (HSV)
ACETOWHITE TEST (HPV)
URETHRAL SWAB (GONO)
PATCH TESTS (CD)
SKIN BIOPSY

27. DIAGNOSIS
• LAB INV (SPECIFIC)
HIV
VDRL / RPR / TPI / FTA-ABS
BS F/PP
URINALYSIS / CULTURE
CBC

28. TREATMENT : GENERAL MEASURES
SUBPREPUCIAL IRRIGATION
NS / KMnO4 (1:10,000) / 1% Boric Acid
1% Lead Acetate / 0.6% MgSO4
CIRCUMCISION (Phimosis / ZB / Chronic / Intractable BP)
TREATMENT OF SEXUAL PARTNER(S)
MANAGEMENT OF SYSTEMIC DISEASE (HIV / DM / PSOR /
BEHCET’S)
PERSONAL HYGEINE

29. TREATMENT MEASURES : SPECIFIC
• ORAL and / or TOPICAL ANTIBIOTICS /
ANTIFUNGALS / ANTIVIRALS /
ANTHELMINTHICS
• TOPICAL CORTICOSTEROIDS (PSOR / LP / FDE /
ZB / BXO / CD)
• TOPICAL 5-FU 5% (PMKBoC / Bowen’s)
• MOHS MICROSURGERY
• SURGICAL MGMT (MEATOPLASTYTOMY, DORSAL SLIT, CIRCUMCISION)

30. THANK YOU