Inflammation of the glans penis (Balanitis)

Balanitis is inflammation of the tip of the head of the penis (glans penis) caused by many things. Balanitis also causes inflammation of the skin covering the penis or on the penis that is not preputium.

Many causes of balanitis :

• Fungi infection.
• Bacterial infection.
• Sexually transmitted disease.
• Skin irritation.
• Skin disorders.

Balanitis can occur at any age. Cases that often occur in children aged < 4 years and adult men who do not prepuce.

Symptoms.

Symptoms of balanitis :

• Redness of the head of the penis.
• Whole red or red patches.
• Ulcers on the penis.
• Irritation.
• The penis feels hard, dry or stiff.
• The head of the penis is swollen.
• Pain.
• Sometimes a thick discharge from under the prepuce that smells due to anaerobic bacterial infection or streptococcus sp.
• Discomfort when urinating.
• It is difficult to withdraw the prepuce (phimosis).
• Impotence.
• Causes lymphoadenopathy.
• It is difficult to insert a Foley catheter.
• Itchy.
• Fever.
• Nausea.

Cause.

• Not keeping the genitals clean.
• Smegma : dirty fluid that forms under the skin of the tip of the penis.
• Sexually transmitted infections.
• Inflammation of the urethra.
• Genital herpes.
• Chlamydia.
• Gonorrhea.
• Non-sexual fungal infections of Candida sp. Candida sp is also a fungus that causes vaginal infections and vaginal discharge in women. Candida sp. Lives on the surface of the skin under normal conditions, but at times it can cause infection.

Infection is easier for someone with the conditions :

• Inflammation of the penis due to allergies or irritation.
• Diabetes : sugar in the urine can be a food source for bacteria if the remaining urine on the penis is not cleaned.
• Phimosis : a skin condition in which the prepuce cannot be drawn and the head of the penis cannot be cleaned.
• Allergies and irritants.

Causes of irritation on the head of the penis :

• Dead skin cells.
• Sweat.
• Urine.
• Several types of soaps and disinfectants.
• Excessive rubbing or washing of the head of the penis.
• Condom.
• Spermicide.
• Lubricate.
• Chemical compound.

Skin conditions that can cause balanitis :

• Skin cancer of the penis.
• Inflammation of the penis.

Risk factors :

• Diabetes mellitus.
• Use of oral antibiotics.
• Poor hygiene.
• Low endurance.
• Physical or chemical irritation to the head of the penis.

Microbes that cause balanitis :

• Candida sp
• Staphylococcus sp. 
• Streptococcus sp. 
• Gardnerella vaginalis 
• Trichomonas sp
• Borrelia vincentii 
• Treponema pallidum 
• Entamoeba histolytica 
• Many types of anaerobic bacteria
• Herpes virus
• Human Papilloma Virus

Diagnosis.

• Physical examination of redness and inflammation of the head of the penis.
• Collect samples to determine which microbes are causing infection and inflammation.
• Check blood sugar levels in diabetes patients.
• Referral to a genital skin specialist if balanitis is caused by a sexually transmitted disease.
• Referral to a dermatologist if the balanitis is caused by a skin disorder.
• Head biopsy to examine the skin structure through a microscope.
• Carry out a microbial culture of the balanitis infection fluid to determine the cause of infection.
• Serologic tests for syphilis.
• Checking the titer of the Human Papilloma Virus and HIV virus.
• Potassium hydroxide examination to determine the presence of candida sp.

Treatment.

• Treatment of balanitis caused by candida sp infection ➡ Anti-fungal creams and tablets (nystatin, clotriazole, fluconazole, miconazole and imadiazole).
• Treatment of balanitis caused by bacterial infection ➡ Antibiotics (penicillin, fluxoxacillin and erythromycin). For anaerobic battery infection metronidazole, coamixoclave, and clindamycin can be used.
• Treatment of balanitis caused by inflammation or allergies ➡ Steroid cream is used as an adjunct to balanitis caused by infection to reduce inflammation. Steroids should not be used without a doctor's advice because they will worsen the infection. 
• Treatment of recurrent balanitis with phimosis ➡ circumcision.

There are several ways to relieve symptoms of balanitis :

• Do not use soap on the genitals when inflammation occurs.
• Using a moisturizer as a substitute for soap to clean the genitals.
• Use warm water to clean the genitals.
• Take a bath using salt water.

Prevention.

Balanitis can be prevented by :

• Clean the penis regularly every day using soap.
• Use condoms for sensitive skin.
• Controlling diabetes conditions and other chronic diseases that impact balanitis.
• Lose weight if you are obese.

Complications.

Balanitis can cause other health problems, such as :

• Joint pain.
• Rash on the skin.
• Dry mouth.
• Swollen glands.
• Fever.
• Nausea.
• Tired.