- Types of balanitis depending on the origin
- Symptoms and forms of balanitis
- Rare species of balanitis
Balanitis – inflammation of the glans penis. This area is characterized by heightened sensitivity and low degree of protection against pathogens; therefore, balanitis of polymicrobial etiology can occur in men of any age, regardless of whether intimate relationships exist in their lives.
Types of balanitis depending on the origin
Balanita in ICD 10 is assigned a code of 48.6. In men, the disease can be triggered by a wide range of factors:
- weakening of the immune system, the inability of the body to control the growth of colonies of microorganisms;
- narrowed or too long foreskin, short frenulum, which does not allow to completely expose the head;
- susceptibility to allergies (unpredictable reaction of the epithelium of the head to intimate lubricants or contact contraceptives);
- systemic, sexually transmitted diseases, against which there is inflammation of the head.
Balanitis is often preceded by postitis (inflammation of the foreskin) or is its consequence. The synchronous defeat of the foreskin and head is called balanoposthitis .
Primary balanitis arises as a reaction to the multiplication of infection from a preputial sac or microorganisms entering from outside, and a secondary one – a consequence of existing diseases.
Infectious balanitis develops mainly due to inadequate hygiene of the penis. In the preputial sac, formed by the foreskin around the head, smegma constantly accumulates – a light gray substance. It is mainly formed by secretions of the sebaceous glands of the foreskin, as well as cells of the dead epithelium, urine salts. All this is a favorable environment for the development of bacteria.
Preputial bag from nature endowed with its pathogenic microflora in it without any manifestations can live microorganisms, such as Staphylococcus aureus, propionic bacteria (provoking pimples on the skin), rod cells (Bacteroides) Melaninogenicus (inhabit in the intestine, gingival pockets, mouth, on the genital mucosa). Excessive multiplication of bacteria in the accumulated smegma causes inflammation of the head.
Frequent washing of the preputial sac with antiseptic agents can disrupt the microflora balance and give rise to the multiplication of pathogens.
Candida (fungal) balanitis is in second place in terms of development frequency . Candida mushrooms are part of conditionally pathogenic microflora, but their peculiarity is that uncontrolled reproduction can start suddenly: due to stress, hypothermia, brute force with alcohol, with a cold or taking antibiotics. Candidosis can be provoked by the abuse of sweets, sexual contact (and a woman can have normal tests). Fungal inflammation is easily distinguishable from other species by the presence of white cheesy lumps and flakes on the head, in the area of the coronoid groove, in the mouth of the urethra. They emanate a distinctive sour smell. The fungus often joins the already existing balanitis of another etiology.
Read: How does thrush manifest in men?
Balanitis can occur against the background of diseases that are transmitted predominantly through sex, for example:
- chlamydia . Chlamydia provoke the development of zirconium gobalanite, in which there are red oval spots on the head with clear boundaries;
- trichomoniasis . Trichomonas balanitis usually occurs with elongated foreskin. A frequent clinical sign is extensive erosion on the head, yellowish foamy purulent discharge from prepuce;
- gardnerellezny urethritis. Against this background, balanitis is manifested by gray urethral discharge and prepuce. With strong immunity, head symptoms almost do not appear and are suppressed for 2-3 days;
- mycoplasma urethritis. Mycoplasma balanitis is similar in manifestation to chlamydia;
- syphilis . A chancre (deep ulcer) may appear on the head , as well as a rash forming erosive foci;
- gonorrhea ( clap ). Gonorrheal balanitis is accompanied by urethritis , purulent secretions, fever, redness, swelling of the head;
- Herpes . Viral balanitis caused by a herpetic infection begins with a slight itch, redness, swelling of the head, and then clusters of bubbles with liquid form on its surface. After opening them, extensive surface erosion remains (erythematous form of balanitis).
Inflammation of the head can cause almost any of the genital infections, and opportunistic microflora leads to balanitis under favorable conditions of development.
In some cases, inflammation of the head of the penis occurs without the intervention of an outside microorganism. Balanitis of non-infectious origin can be caused by damage to the epithelium during frequent masturbation, active sex life, wearing too tight underwear. This is especially true for men with sensitive skin.
Sometimes there is a drug balanitis : with long-term antibiotic therapy (sulfonamides, tetracyclines), as well as taking salicylates, phenolphthalein, phenacetin, some sleeping pills.
Allergic balanitis is not only likely with contact contraceptives, lubricants and condoms. Inflammation can also develop in the types of tissue from which underwear is sewn. In some men, female vaginal discharge and even self-sperm cause irritation of the head.
Balanitis is often a companion of systemic diseases caused by autoimmune disorders. The causes of such pathologies lie in the malfunctioning of the immune system, destroying the body’s own tissues, which is why chronic dermatosis is progressing.
Inflammation of the head often occurs with the following diseases:
- systemic lupus erythematosus;
A characteristic of these pathologies is a violation of the processes of formation, renewal and regeneration of the skin, reduction of its protective barriers, failure in metabolic processes affect all types of epithelium, including the head of the penis. It is not by chance that balanitis recurs in 80% of men with diabetes mellitus: urine with a high concentration of glucose constantly irritates the head, and the barrier function of the epithelium is reduced. Characterized by increased bleeding when touched, the appearance of multiple cracks and ulcers.
Symptoms and forms of balanitis
The forms of manifestation of balanitis are not always determined by their etiology, largely depending on the general state of health of the patient.
The first symptom of incipient inflammation is a slight burning and itching of the head, accompanied by an insignificant redness and swelling. You can detect oozing thinning areas of the epithelium. Gradually, single and grouped red spots appear. This form is called catarrhal(irritative). The treatment started at this stage is usually effective and quick.
Far from all men at the first signs of balanitis turn to a urologist, therefore, the catarrhal stage often spills over into erosive , when weeping areas turn into swollen whitish formations from dead skin epithelium. Later, ulcers deepening with time remain in their place. Pathogens from the external environment easily penetrate into damaged skin and begin to actively develop, causing purulent balanitis . At this stage, the man feels a strong burning head, pain. Often marked purulent discharge from the urethra, general weakness, fever, an increase in the inguinal lymph nodes.
Ulcerative balanitis can take obliterating form (obliteration – narrowing, sealing of vessels and cavities), in which ulcers begin to scar. At the same time, the head of the penis becomes paler, becomes bumpy due to the atrophied areas, there is a feeling of tightness, especially when urinating.
Erosive foci, ulcers and pustules (vesicles with inflammatory contents) in case of relapses may be replaced by an atrophied epithelium ( atrophic balanitis ). The head is covered with whitish spots.
According to clinical manifestations, xerotic form of balanitis is also isolated , in which hollow nodules (papules), covered with crusts or scales, are formed on the head.
Lack of treatment can lead to the transition of inflammation in the gangrenous form : ulcerated head tissues begin to die off gradually. At this stage, there is already a threat to the whole organism, in some cases the penis amputation is necessary.
Acute and chronic balanitis
Acute balanitis develops quickly, showing all the main symptoms: itching, redness, swelling of the head, probably a rise in temperature, increased sweating. After a short time, rashes or ulcers appear on the skin of the head, possibly their suppuration. In acute balanitis, urgent medical intervention is necessary.
In the chronic form of the disease may go due to improper or incomplete treatment. Characteristic sluggish course with periodic relapses. Such an outcome is not uncommon for chlamydial and candidal types of inflammation. In some cases, the acute phase is absent, the symptoms are constant. For example, chronic hypertrophic balanitis is manifested by multiple small non-healing ulcerations on the head of the penis, gradually changing its shape.
Rare species of balanitis
Rare forms of damage to the head of the penis usually occur on the background of immune diseases that cause pathological changes in the skin. They are characterized by slow development and chronic course.
This type of balanitis, also called “scleroatrophic lichen”, develops in the presence of sclerotic lichen or Reiter’s syndrome. The first symptoms are itching and dryness in the region of the foreskin (elasticity is lost, breaks are frequent during intercourse). Gradually, a grayish sclerotic ring appears around the head, formed by the atrophied tissues of the foreskin. From it, the “bridges” of the connective tissue pass to the head and, gradually expanding, give it a white-blue tint. Over time, irreversible atrophy of the skin of the head occurs.
This type of balanitis is fraught with serious complications:
- narrowing of the foreskin and urethra, difficulty urinating;
- the appearance of cracks on the head, its wrinkling (indurativnaya form balanita);
- rebirth into a malignant form.
Timely applied treatment regimen stops the process.
The exact reason for the development of Zun balanitis is still unknown. It occurs in men after 50 years. Symptoms: clearly defined glossy orange-red and brownish patches appear on the head, painful sensations are absent at first, but over time, there is a burning sensation and pain.
In Behcet’s disease, the vascular walls are destroyed. The process takes place in the form of chronic ulcerative lesions of not only the head of the penis, but also the scrotum and mucous tissues of the oral cavity. Irregular ulcers tend to merge, forming extensive painful lesions.
This disease causes a precancerous lesion of the epithelium. On the head of the penis are formed from 1 to 3 knots of the jelly color. Their surface looks velvet or shiny, the borders are clear. There is an itch, discomfort, urination is sometimes difficult. The danger lies in the high probability of degeneration of formations into squamous cell carcinoma. At the same time, erosions, growths and blood crusts appear on the head.
Diagnosis begins with a visual inspection, then tests are assigned to assess the general condition of the body and identify the causative agent:
- urine and blood tests;
- urine bakposev;
- scraping and smear from the erosive surfaces of the head of the penis, smear from the urethra for bacterioscopic and bacteriological studies.
Accurately determine the type of viral infection can be using PCR diagnostics (polymerase chain reaction). A blood test for organ-specific antibodies helps to establish the autoimmune nature of balanitis (systemic dermatosis).
If there is a suspicion of a malignant course of the disease, then a small fragment of tissue is collected for histology (cell analysis). Histological examination of the biomaterial also makes it possible to determine the type of cell damage and determine the presence of systemic pathology, including xerotic obliterans balanitis.
Treatment of balanitis includes local effects, oral medication, injections, physiotherapy, and in some cases surgery. The doctor prescribes the scheme individually according to the results of the examination.
At home, to relieve the condition will be useful baths with antiseptics:
- furatsilin . You can purchase it as a ready-made solution or prepare it yourself: 2 tablets per cup of warm water;
- potassium permanganate (using a pale pink solution);
- Medicinal herbs : chamomile, oak bark, sage, plantain, succession. Recipe for this: 1-2 tablespoons of any of the herbs pour a glass of boiling water, wait for cooling;
- chlorophyllipt .
Baths and rinsing – addition to the main therapy prescribed by the doctor.
Versatile tool in various forms is balanitis ointment ” Triderm “, antibacterial, antifungal, anti-inflammatory effect on damaged skin of the head by a combination of gentamicin, clotrimazole and betamethasone. Levomekol ointment (lefometsetin + methyluracil) has a broad spectrum of activity : a strong antibiotic and at the same time effective restoration of damaged tissues.
For the treatment of candidal balanitis, antifungal agents are used: Clotrimazole , Miconazolecreams externally, capsules or Fluconazole injections . If an imidazole allergy occurs, Nystatin is discharged.
The complex treatment of balanitis includes broad-spectrum antibiotics: Cefazolin, Azithromycin, Ceftriaxone. With the defeat of anaerobic bacteria (for example, Melaninogenicus), Metronidazole and Co-Amoxiclav help well . The choice of drugs against aerobic bacteria (streptococcus, gardnerella, staphylococcus) depends on the result of the analysis of sensitivity to antibiotics.
When gonorrheal balanitis prescribed Cefixime, Ofloxacin, Ciprofloxacin . Trichomonas are treated by Metrogil, Trihopol . In case of herpetic, antiviral drugs with acyclovir are prescribed : Acivir, Virolex, Zovirax . A hydrocortisone cream of 1% is effective against the zircinar form of balanitis .
For severe itching, inflammation, as well as for autoimmune forms of balanitis, ointments Lorinden, Lokakorten, Lokoid, and prednisone ointment are used .
In the treatment of Zun balanitis, steroid preparations are used, in case of their ineffectiveness, 2% cream of fusidic acid is applied on the head for 8-16 weeks.
Independent use of antibiotics or antifungal agents can aggravate the course of the disease and complicate diagnosis, and the uncontrolled use of hormonal ointments will cause complications from the endocrine system.
Surgical methods for balanitis are used infrequently, mainly circumsizio operations — circumcision of the foreskin. The indications are various pathologies of the preputial sac (too long, narrow), frequent recurrences of inflammations of the head, and the presence of systemic diseases. Removing the foreskin solves the problem of smegma accumulation and bacteria multiplication.
For the treatment of obliterating balanitis, steroid preparations of local application are used: clobetasol propionate or betamethasone valerate. If necessary, surgical intervention is applied:
- restoration of the physiological lumen of the urethra (miatoplasty);
- restoration of normal patency of the urethra with cicatricial narrowing of the urethra (urethroplasty);
- laser vaporization (cauterization) of damaged areas of the head.
In cases of erythroplasia Keir in the non-launched cases, you can limit yourself to laser excision of the affected epithelium, using cytostatic ointments.
Balanitis is often complicated by phimosis and paraphimosis (narrowing of the foreskin and its infringement). It is also possible narrowing of the urethra, loss of sensitivity and scar deformity of the head, perforation of the foreskin.
Complicated gangrenous form of balanitis can lead to amputation of the penis and subsequent excretion of the urethra.
To prevent the development of most types of balanitis, it is enough to observe intimate hygiene, use barrier means of contraception during sexual intercourse, timely sanitize infectious foci in the body. After unprotected sex with an untested partner, it is better to err by washing the preputial sac, the head and urethra with Chlorhexidine .
In case of reddening of the skin of the head, you can take measures at home:
- rinse head and preputial bag;
- immerse the member in the bath with an antiseptic solution;
- lubricate the head with vaseline based cream;
- change underwear.
Most types of balanitis can be successfully treated for several days if the patient see a doctor in a timely manner. Modern medicine can effectively deal with the manifestations of systemic diseases, provided that the patient clearly follows the prescribed treatment regimen. However, even initially, a simple form of balanitis can lead to serious consequences, if treatment is not given due attention.