Author: Stingrays BV, Urologist, andrologist. Experience since 1996.
November, 2018.
Balanoposthitis - a pathological condition which has a negative effect on the penis, causing inflammation of the foreskin and the glans penis.
Foreskin - "preputial bag" - is a movable fold of skin that covers the head of the penis and goes beyond it. It is this inner side most subject to inflammation, as forming a closed cavity ( "bag").
According to WHO statistics, 11% of calls men to the urologist associated with balanoposthitis, this diagnosis is almost 50% of all penile skin diseases.
Causes
Since the foreskin removed during circumcision, balanoposthitis affects only the "uncircumcised" men. It can occur at any age.
The disease has many causes, but most actively contribute to its development:
- poor hygiene,
- compacted narrowed foreskin.
A number of factors can increase the risk of disease. People with balanoposthitis, often reveals one of several reasons:
infection
One of the most frequent causes of balanoposthitis. Although in itself is not a balanoposthitis venereal pathology, some microorganisms, sexually transmitted infections, may contribute to its occurrence:
- ascomycetes
- chlamydia
- gonorrhea (causative agent - gonococcus)
- herpes simplex
- Human Papilloma Virus (HPV)
- primary or secondary syphilis
- Trichomonas.
ascomycetes
Another common cause of balanoposthitis. Candida - type of fungus that is normally found in small amounts in the human body.
noninfectious processes
They may also increase the risk of balanoposthitis. Some of these conditions include:
- chronic balanitis (permanent inflammation of the foreskin)
- eczema
- injuries and accidents
- irritation caused by rubbing or scratching
- irritation from chemicals
- diabetes mellitus (due to permanent irritation foreskin urine high glucose)
- receiving antibiotics (causing imbalance mikrfolory contributes exit fungi - Candida at the forefront of the prepuce zone)
- local allergic reaction, including antibiotics reception
- psoriasis
- reactive arthritis
- compacted narrowed foreskin.
Household irritants can also lead to balanoposthitis. For example, exposure to chlorine in the pool can cause irritation of the penis.
In other cases, balanoposthitis appears after a few days after intercourse may be the result of friction or the use of a latex condom.
Kinds
Based on the causes, identify different types of balanoposthitis:
- Candida or fungal (called "Candida" fungus)
- allergic
- autoimmune (when the foreskin becomes inflamed and torn away due to unbalancing immunity in his own body)
- infection, when the cause of the disease are different viruses or bacteria - infectious agents:
- bacterial:
- chlamydial (called "chlamydia" bacteria)
- staphylococcal,
- Anaerobic (caused by bacteria that can live without air in the prepuce)
- gardnerelleznoy (called Gardnerella)
- Trichomonas (pathogen - Trichomonas).
- virus, including herpes (caused by the herpes virus)
- non-specific, occurs in patients with diabetes or alcohol abuse (under the influence glucose and alcohol released in the urine, the foreskin is so inflamed that develops a rough its restriction - kraurosis)
Depending on the nature of the disease, balanoposthitis can be divided into:
- Erosive (with small sores), as a sub - tsirtsinarny (with multiple ulcers bright red in color);
- ulcer - can occur during treatment with steroids pathologies of joints, for example, systemic diseases - produces large sores on the foreskin and head of the penis;
- follicularis - to form small bubbles inflammatory;
- xerotica - when the chronic form of inflammation of the foreskin leads to its coarsening and compaction;
- sluggish - term applies to chronic slow stream balanoposthitis no symptoms;
- recurrent - when the background of chronic course there is a surge of disease exacerbation, poorly treatable.
stage balanoposthitis
Also, depending on the stage of the disease, are distinguished:
- catarrhal balanoposthitis (slight inflammation of the glans and foreskin);
- purulent (more serious inflammation with formation of pus);
- gangrenous (critical step fraught with contamination of blood and the whole body).
Symptoms of acute and chronic forms
Signs of balanoposthitis appear near the glans penis and the foreskin may vary from mild to severe.
Manifestations balanoposthitis can hinder urination and sexual intercourse.
Common symptoms include:
- pain, sensitivity and irritation;
- thickening and roughening of the foreskin, skin reinforcement pattern (lichenification);
- discolored or "shiny" skin;
- itching or burning;
- very dry skin of the foreskin and the glans;
- unusual discharge;
- unpleasant smell from the penis and discharge;
- narrowed compacted foreskin (phimosis);
- erosion or damage to the skin.
The symptoms of the chronic form
During the chronic balanoposthitis, symptoms will be as follows:
- moderate swelling of the glans penis;
- constantly renewed attack on the head;
- discomfort;
- redness and irritation of the glans penis, prepuce, from time to time passing.
In later stages of chronic balanoposthitis or developing acute process may occur such phenomena as:
- swelling and tenderness of the penis;
- redness;
- cloudy urine with a dash of purulent discharge;
- pus from under the foreskin, in some cases - blood;
- increase in body temperature.
In extremely severe cases of balanoposthitis, a transition of the disease in the form of necrotic - gangrene, which is manifested:
- ulceration of the foreskin and the glans;
- blackening foreskin and head (proper formation of necrotic tissue);
- increase of pain and pyrexia to 39C or higher;
- food poisoning symptoms necrosis decay: muscle weakness, thirst, lower blood pressure, disturbance of consciousness.
The combination of symptoms usually depends on the cause balanoposthitis. For example, a process called yeast infection can include symptoms such as itching, burning and white spot around the glans and foreskin.
What can be confused balanopostit
Differential diagnosis should be made with the following diseases:
- sclerosing deprive
- psoriasis (skin disease)
- cancer of the penis
- paraphimosis (infringement of the penis constricted foreskin)
- kavernitom penis (inflammation of the internal structures of the penis)
- Reiter's disease (rheumatic disease in combination with an annular lesions penis)
- Zun disease (redness of the head of the penis with the formation of pink shiny patches and "weeping" of the surface that occurs in older men)
- erythroplasia Keira
- furuncle, abscess (purulent inflammatory cavity) of the corpus cavernosum and the penis
- cellulitis of the corpus cavernosum and the penis.
Phimosis, balanitis and balanoposthitis
Speaking of balanoposthitis, often confuse it with two similar diseases: phimosis and balanitis. All three diseases, one way or another, affect the penis. However, every pathological condition affects a different part of it.
- Phimosis (N 47 ICD-10) - a condition that makes it difficult to extract the head of the penis as a result of the narrowing of the foreskin.
- Balanitis (N 48.6 ICD-10) - an inflammation of the glans penis.
- Balanoposthitis (N 48.1 ICD-10) - an inflammation as the glans penis and the foreskin.
Phimosis may occur along with balanitis and balanoposthitis. In many cases, it is both a symptom and a cause. For example, the presence of phimosis provokes irritation of the glans penis and the foreskin. Once this irritation occurs, such things as pain and swelling can impede head out of the leaves of the foreskin.
What doctor treats
If you experience irritation around the head of the penis or foreskin, should consult a doctor who specializes in urology (urologist) or skin disorders (dermatologist, venereal diseases).
Hardly pathology will pass without treatment, although in rare cases it is possible. Most probably, without light treatment catarrhal stage will go or chronic, or purulent and then dangerously gangrene.
balanoposthitis treatment
Balanoposthitis lends itself quite well treatment, provided that the remedial measures taken in time.
The attending physician will start with the fact that you will ask about your symptoms and examine your penis. Doctors may take a swab from the head of the penis, prepuce for examination under a microscope, or for sowing on microorganisms. Possible to determine the sensitivity of a microorganism to sow specific antibacterial agents.
Depending on the symptoms, may require different tests, such as blood test overall, on sugar, HIV, syphilis, urinalysis, foreskin biopsy (taking a piece of tissue on microscopic study).
balanoposthitis treatment consists of:
- exterior washing
- baths and lotions,
- admission antibacterials
- antibiotics administered intramuscularly and / or intravenously.
Address (depending on the sensitivity of the results of sowing) antibiotics gives a better result than the thumb (blind) their use.
In allergic and autoimmune forms prescribe antihistamines and hormones - glucocorticoids.
Various ointments in the treatment balanoposthitis substantially compromised, as in 60% of cases occur undesired reactions at an ointment base.
In viral infections may require antiviral and immune drugs.
From empirical antiseptic for topical use (as trays, washes, wraps) are proven solutions
- bigluconate chlorhexidine 0.05%,
- miramistina,
- furatsilina,
- weak solution of potassium permanganate.
It is undesirable to use hydrogen peroxide solution, because of its aggressiveness significantly to the delicate skin of the foreskin. Good, combined with chemical solutions are aqueous herbal extracts of chamomile, succession, celandine, sage, oak bark, which are not as irritating to the skin and contribute to the restoration of normal microflora prepuce.
Time average of such therapy may range from one to two weeks.
In the case of treatment failure "blindly", should make a smear on the diagnosis of a particular type of pathogen, then is assigned as a topical antibiotic therapy, orally or by injection, depending on the severity of the process, given pathological microorganism.
Thus, against pathogens such as Staphylococcus and Streptococcus effective antibiotics group of synthetic penicillins.
If fungal infections are effective special antifungal cream: clotrimazole, miconazole and econazole, add tablet drugs - Diflucan (fluconazole).
In identifying the herpes simplex virus in the course of therapy administered Acyclovir, Valacyclovir.
Important! Sexual partners are also subject to treatment and examination.
Treatment of balanitis and balanoposthitis, basically, no different, as part of an organ, stricken by these processes are in close contact. In chronic, intractable cases with frequent relapses, as well as complications of acute process, surgical treatment.
Operation at a balanoposthitis
Surgical treatment balanoposthitis is circular circumcision (circumcision).
Indications for surgical intervention is
- ineffectiveness of conservative therapy,
- frequent relapses,
- balanoposthitis combination with phimosis and redundant prepuce.
As is the operation
Circumcision operation (cutting) is performed under general or conduction anesthesia and takes up to 30 minutes. At the hospital, these patients are usually short-lived - a few days. Sutures are removed on day 5-7. In a hospital or clinic, to remove seams is carried observation processing seams "zelyonkoj". If necessary, appoint baths with potassium permanganate, in the case of inflammation may prescribe antibiotics.
rehabilitation period - 2-3 weeks. This period excludes sex, swimming in fresh water and sea water, baths and saunas, reception of alcohol and spicy food.
Prevention balanoposthitis
The prevention is crucial hygiene prepuce, the glans penis.
Timely treatment of phimosis (narrowing of the foreskin) and "excessive" foreskin.
Prompt treatment of infections, sexually transmitted diseases.
Literary reference:
"Guidelines on the treatment balanoposthitis number 47 of 2017". Health Department of the city of Moscow with assistance of the Moscow scientific - practical center of dermatology and cosmetology. Edited by NN Potekaeva, KI Zabirova, AE Gushchin, VI Kissin et al.
