Balanoposthitis

Balanoposthitis is a skin infection that affects your foreskin and the head (glans or prepuce) of your penis. It’s when you have an infection of the glans (balanitis) and an infection of the foreskin (posthitis) at the same time. It causes inflammation and pain. It can make peeing, orgasming and ejaculating uncomfortable.

Balanoposthitis (bal-eh-noh-pahs-thite-es) is a big word. But what does it mean?

• Balano-: Glans penis
• Posthe: Foreskin
• -itis: Inflammation

It usually isn’t serious. It most often isn’t a sexually transmitted infection (STI), and it isn’t generally contagious. It often goes away on its own or after treatment.

Balanoposthitis is a common condition. Between 12% and 20% of males who have foreskin get balanoposthitis at some point. Children most often get it between the ages of 2 and 5.

Symptoms of balanoposthitis

Balanoposthitis symptoms include:

• Pain and irritation on your foreskin and the head of your penis
• Tenderness
• Swelling
• Itching
• Foul-smelling discharge
• Discoloration (red, purple or slightly darker than your usual skin color) that may look like a rash
• Sores on the head of your penis

What is the main cause?

Not washing and drying your penis regularly is the main cause. This can allow bacteria and fungi to build up and cause inflammation. Some types of common bacteria that may cause balanoposthitis include:

• Streptococcus
• Haemophilus parainfluenzae
• Klebsiella
• Staphylococcus epidermidis

An overgrowth of fungi such as Candida albicans is the most common cause.

Other common balanoposthitis causes include:

• Scabies
• Psoriasis
• Eczema
• Dermatitis
• Allergies, including latex condoms, personal lubricants, spermicides, harsh soaps and corticosteroids

What STI causes it?

Healthcare providers don’t consider balanoposthitis an STI. But STIs may be a cause. Some STIs that may cause balanoposthitis include:

• Chlamydia
• Gonorrhea
• Human papillomavirus (HPV)
• Syphilis
• Trichomoniasis

Risk factors

Balanoposthitis typically affects males who still have their foreskin. If you had a circumcision, then you don’t still have foreskin.

You’re also at a higher risk of balanoposthitis if you:

• Have a lot of exposure to pee, like if you wear diapers or absorbent pads
• Don’t thoroughly wash and dry your penis and the area under your foreskin regularly
• Have diabetes
• Have a body mass index (BMI) greater than 25 (have overweight/obesity)
• Have an STI
• Have latex or certain chemical allergies
• Can’t pull back your foreskin

Complications

Untreated balanoposthitis can result in recurrent infections. A recurrent infection is when balanoposthitis goes away and comes back several times. Recurrent balanoposthitis may be a sign that you have diabetes.

Without treatment, it can also cause paraphimosis. This is when you can’t pull your foreskin back down over the head of your penis. It can cut off blood flow to the tip of your penis and cause a lot of pain. This is a medical emergency.

Can I have sex if I have it?

Healthcare providers don’t consider balanoposthitis an STI. But an STI may sometimes be the cause. You should avoid sexual intercourse until you know the cause.

Sex may also cause more irritation and discomfort. Avoiding sex and masturbation until it clears may help it go away faster.

Balanoposthitis can look like an STI, even if it’s not the cause. It’s a good idea to tell your partner(s) if you have balanoposthitis. If they have any questions, encourage them to talk to their provider before having sex. If you have sex while you have balanoposthitis, be sure to carefully wash and dry your penis afterward. Be sure to pull your foreskin back and clean underneath. Reapply any medications after washing.

How doctors diagnose balanoposthitis

Your healthcare provider will:

• Review your health history
• Ask about your symptoms
• Perform a physical exam of your penis

It’s often pretty easy to diagnose according to your symptoms and a physical exam. But they may recommend tests to determine its cause.

Tests that are used

Your healthcare provider may recommend the following tests to determine the cause of balanoposthitis:

• Skin test: Your provider will gently rub a cotton swab on your foreskin and glans. They’ll send the swab to a lab for analysis. This test helps identify bacteria, viruses and fungi.
• Urethral discharge swab: Your provider will carefully insert a cotton swab about 0.75 inches (2 cm) into your urethra. They’ll gently rotate the swab. They’ll send the swab to a lab for analysis. This test helps identify bacteria and viruses.
• Pee test: You’ll pee into a special cup. Your provider then sends your pee sample to a lab for analysis. This test helps identify bacteria and high sugar (glucose) levels. High glucose levels are a sign of diabetes.
• Glycated hemoglobin (A1c) blood test: This test helps detect prediabetes and diagnose diabetes. Your provider will withdraw a small amount of blood from a vein, usually in your arm. Or they may use an A1c machine. This machine only requires a small drop of blood from your fingertip. The results are available in a few minutes.

How is balanoposthitis treated?

Getting rid of balanoposthitis depends on its cause. Your treatment options may include:

• Antibiotics: Antibiotics can treat bacterial and viral infections. Common antibiotics include amoxicillin, clarithromycin and erythromycin.
• Antifungal creams: Providers use topical antifungal creams to treat fungal infections. Common creams include nystatin, clotrimazole, econazole, miconazole and sulconazole. Apply the cream to your foreskin and glans as prescribed by your provider.
• Antihistamines: Antihistamines can help if an allergic reaction causes balanoposthitis.
• Circumcision: If you get balanoposthitis a lot, your provider may recommend a minor procedure to remove your foreskin. They commonly recommend it if you can’t pull your foreskin back.
• Diabetes management: This may include managing your blood glucose levels, maintaining your blood cholesterol and triglyceride levels, managing your blood pressure, following a food plan and getting regular physical activity.
• Regularly bathing: Wash and dry your foreskin, the head of your penis and your genitals every day with soap and warm water.

When should I see my healthcare provider?

Talk to your healthcare provider if balanoposthitis causes problems peeing or ejaculating. You should also reach out if your discomfort or pain lasts longer than a week. It’s a good idea to schedule an STI test, too, if you think an STI is the cause.

During your appointment, you may wish to ask the following questions:

• What’s the cause?
• What tests do you recommend to confirm the cause?
• If I don’t have balanoposthitis, what other condition may I have?
• When is it safe for me to have sex?
• What’s the best way to keep my penis, foreskin and genitals clean?
• Is there a medication you can prescribe?
• Should I see a dermatologist, urologist or another specialist?

What can I expect if I have balanoposthitis?

The outlook for most people who have balanoposthitis is good. For many, symptoms go away within a week after regularly washing the area and treatment.

Balanoposthitis may come back if you don’t regularly clean the area. If you get it a lot, your provider may recommend circumcision.

Is there anything I can do to feel better?

You can help ease irritation, inflammation and discomfort by:

• Bathing every day: It’s especially important to wash under your foreskin and properly dry the whole area. Teach your children the importance of proper care for their penises.
• Avoiding harsh soaps and lotions: Use products with labels that read “fragrance-free,” “hypoallergenic” and “for sensitive skin.” Avoid soaps and lotions that contain perfumes, dyes and alcohol.
• Wearing loose underwear and pants: Tight underwear and pants trap heat and moisture around your groin. This can create the perfect environment for fungi to grow.
• Using mild laundry detergent: Use mild detergents to wash your clothes. It’s a good idea to use an extra rinse cycle to wash out all detergent, especially your underwear and pants.
• Staying dry: It’s important to keep the area dry after bathing and swimming. But you should also make sure your foreskin and the skin under your foreskin are dry after peeing.

Can balanoposthitis be prevented?

Bathing regularly is the best way to help prevent balanoposthitis. Carefully wash your foreskin, the skin underneath your foreskin and the head of your penis. It’s also important to thoroughly clean the rest of your penis and overall genital area.

It’s a good idea to wear condoms whenever you have sexual intercourse, as well. Wearing a condom can help prevent STIs that may cause balanoposthitis.