balanitis

Balanitis: description

Balanitis is an inflammation of the glans of the penis. Glans penis or glans is the thickening at the end of the penis. It is a very sensitive part of the male body because it is equipped with many sensitive nerves. In uncircumcised men, the glans is covered by the foreskin. In an erection, the foreskin usually retreats behind the glans penis. The inner leaf of the foreskin is located directly on the glans, so that an inflammation on the glans very often overlaps the foreskin. This is called Balanoposthitis. Recurrent and long-lasting episodes of glansitis are possible.

Balanitis is most common in uncircumcised men and almost equally in all age groups. However, depending on the age, the incidence of the different causes of glansitis is different. It is estimated that between three and eleven percent of men suffer from balanitis each year. However, most studies only looked at children and sexually active men.

Balanitis: symptoms

The main symptom of balanitis is a more or less painful red and inflamed glans. Inflamed are usually only the upper layers of skin and not the deep cavernosum of the glans. Those affected often report rashes and unclear changes to the glans. An itchy glans is also a common symptom.

As a rule, affected men also suffer from vaginal discharge. This discharge can be different colors and foul smelling. The consistency is often purulent. The retraction of the foreskin is usually difficult and painful. This may also be due to the fact that the glans swells (edema). This can make the urination problems and be painful. In severe cases, the control of the urine stream may be disturbed. Sometimes balanitis is even associated with impotence, albeit temporary.

Acute inflammation remains limited to the penis in most cases. Systemic signs of inflammation such as fever, malaise or even vomiting are atypical for balanitis. However, in some pre-existing conditions, balanitis can also cause severe systemic reactions. This is especially true for additional diseases that affect the immune system. Deep damage of the skin of the glans, even with bleeding, occurs only in advanced, severe disease.

Indications of the cause of balanitis

In addition, there are a number of balanitis signs that already provide clues to a possible trigger. Some are listed here by way of example:

• In case of an infection with the herpesvirus Forms a variety of grouped bubbles. The infection is usually accompanied by fever and swelling of the inguinal lymph nodes.
• An infection with the Human papillomavirus (HPV) triggers condylomata – cauliflower-like growths often found at the base of the glans.
• The Syphilisinfekton leads to a painful ulcer with a hard edge.
• Excessive redness or whitish discoloration with itching is evidence of a fungal infection.
• Balanitis in the context of Reiter’s syndromeIt is characterized by redness, which is delineated by a white margin, as well as by skin damage to the glans.
• The Balanitis plasmacellularis Zoon is a chronic glansitis of unknown cause. It is characterized by smooth, lacquer-like and red-brown spots.

Balanitis: causes and risk factors

There are a variety of causes that may be responsible for balanitis. Often there is also a combination of several causes. Thus, a mechanical irritation can promote an infection. In one third of all patients, no clear cause of glans inflammation can be identified.

The causes of balanitis are roughly divided into non-infectious and infectious causes. In addition, the acne inflammation may occur in the context of other diseases.

Non-infectious causes of balanitis

A common cause of inflammation of the glans is lack or exaggerated cleaning ( “Reinlichkeitsbalanitis”). In the absence of hygiene accumulates residual smegma – a yellowish-white mass of sebaceous gland secretions, skin cells and bacteria). This can lead to balanitis.

High levels of mechanical and chemical stress – such as disinfectants and excessive washing – can provoke balanitis.

In some cases, balanitis is also the result of one Irritation (irritation) or allergic reaction on medications, fragrances or (latex) condoms.

Infectious causes of balanitis

The two most common causes of balanitis are probably fungal and bacterial infections.

To bacterial causes Balanitis includes infections with staphylococci, enterococci, streptococci and also with Mycobacterium tuberculosis, the causative agent of tuberculosis. In addition, the bacterium Gardnerella vaginalis can lead to balanitis. This germ is more common trigger of bacterial vaginosis in women (vaginal inflammation). Men can become infected with ill bacteria and develop balanitis.

One through mushrooms Balanitis is also known as balanitis candidomycetika. Like bacterial infections, fungal infections can be either local or systemic (including the rest of the body).

Candida albicans, a yeast fungus, is the most common causative agent of a balanitis candidomycetika. Although the yeast fungus Candida albicans on the glans can be detected in about 15 percent of men, only a small part of it develops a balanitis. Uncircumcised men are more likely to get fungal balanitis than circumcised men. In most cases, the fungus transmits through sexual contact.

Another fungal infection, namely Malassezia furfur, is pityriasis versicolor (agaric). This form of skin fungus is very rare in Europe but common in tropical areas. It affects especially the back, shoulders, neck and chest, sometimes other parts of the body like the penis. Characteristic of this fungal infection are sharply defined, brownish and scaly lesions.

Other fungal infections are even less likely to affect the penis. Especially fungi that attach themselves to the groin can spread continuously to the penis.

The inflammation of the glans penis also occurs in the context of STDs on. Particularly noteworthy here are infections with herpesviruses and human papillomaviruses (HPV) – especially type 6 and 11. Specially HPV leads to protracted Balanitiden, which are not easy to defeat.

Other possible triggers include trichomonads, gonococci, Treponema pallidum (causative agent of syphilis) and Haemophilus ducreyi.

Balanitis in the context of other diseases

Various skin diseases can ease but also trigger balanitis. These include pemphigus vulgaris, seborrheic dermatitis and psoriasis.

Lichen sclerosus et atrophicancs can also be mentioned here. The chronic skin disease of unclear cause causes typical white plaques on the foreskin and the glans. This form of glansitis is referred to as balanitis xerotica obliterans. As the disease progresses, scars develop and the foreskin becomes thin. The scars lead to a narrowing of the foreskin. The disease can spread to the urethra.

As part of the Reiter’s disease, a non-infectious inflammation, about a quarter of those affected develop a balanitis. This disease is characterized by the three symptoms of arthritis, urethritis and conjunctivitis. It usually occurs one to four weeks after a urinary tract or gastrointestinal infection.

In older men between the ages of 50 and 80, the Balanitis plasmacellularis Zoon on. The cause of this form of glans inflammation is unclear. It comes to small bleeding and deposits of hemosiderin, an iron storage protein. In addition, immune cells infiltrate the tissue of the glans.

Rarely, inflammation of connective tissue strands can lead to the death of tissue and thus a dangerous Balanitis gangrenous trigger. It requires emergency treatment.

Balanitis as part of a cancer treatment

Rarely can the so-called BCG instillation lead to granulomatous balanitis in the treatment of bladder cancer. BCG is the abbreviation for a bacterial species. To prevent bladder cancer relapse, the bladder can be flushed with attenuated BCG bacteria. The bacteria trigger a local inflammation that activates the immune system. This should inhibit the further development of cancer cells.

Risk factors for balanitis

The main risk factor for balanitis is one bad intimate care, It is important to wash the penis and especially the glans daily with warm water and remove smegma. Failure to clean – but also too aggressive cleaning – can promote the development of balanitis.

Also a bad retractable, narrowed foreskin (Phimosis) favors a balanitis. In fact, it is easier for pathogens to settle on the glans and spread out. For this reason, circumcision seems to significantly reduce the risk of balanitis.

People with certain diseases Statistically, balanitis is more common than otherwise healthy people. This is especially true in diabetes mellitus. The sugar in the urine of diabetics presumably promotes the development of balanitis. Very often diabetics have a fungal infection as the cause of balanitis.

Severe obesity, as well as the chronic inflammatory bowel disease Crohn’s disease and ulcerative colitis are considered risk factors for acne inflammation.

Balanitis: examinations and diagnosis

If glans is suspected, men should go to the urologist. At the beginning of balanitis diagnostics, a detailed discussion with the patient is available Survey of the medical history (medical history), The doctor asks, for example:

• How intensive are you doing intimate care?
• Have you noticed any changes to the glans or the penis?
• Do you suffer from pain or itching?
• Do you have problems urinating or having sexual intercourse?
• Are you familiar with skin diseases or other diseases?

As part of the physical examination The lymph nodes, especially in the groin, and the glans must be examined. Even when looking at the glans penis, the doctor usually has redness and swelling. In addition, different colored discolorations are often observed. The foreskin should be examined closely. Often she is also affected by the inflammation. Also on a possible narrowing of the foreskin, the doctor will pay attention.

As already described in the symptoms, many causes of balanitis can be identified by typical, visible changes in the glans, such as grouped blisters in a herpes infection.

If infectious balanitis is suspected, it should nevertheless be used to detect the pathogen smear from the glans penis and the urethra entrance. This smear can be viewed under a microscope – possibly with the help of special stains. So mushrooms can be identified particularly well with a potassium hydroxide staining. In addition to a smear, one can be considered Culture to be able to grow existing pathogens and thereby identify better.

In very rare cases in Balanitis patients also the blood be examined for the pathogen or antibody to the pathogen. This may be useful for certain types of mushrooms. However, the blood test remains usually unclear and severe cases reserved.

A small Tissue sampling (biopsy) is considered in case of unclear and complicated balanitis. In an infectious balanitis, however, the findings of a biopsy are usually nonspecific. A biopsy in uncertain cases, however, can serve primarily to investigate the suspicion of a tumor or a skin disease. There are a number of diseases that resemble balanitis or are a complicated form of balanitis. These include a specific precancerous lesion (erythroplasia queyrat), penile carcinoma, the autoimmune vascular disease Behcet’s disease and an infectious or drug-induced rash (Steven Johnson syndrome).

If there are problems with urination, the doctor will examine the urethral output for signs of inflammation. He asks the patient whether the foreskin “inflates” when urinating. If there is evidence of involvement of the urinary tract, the doctor will also make an ultrasound scan of the bladder. This can prevent or confirm any obstruction of urine output.

It is also possible that a balanitis is due several causes at the same time has been triggered. This always means that even after a supposedly identified cause, it may be necessary to investigate further. Thus, even on a wart, caused by the human papillomavirus, even put another infection on it.

warning sign for a complicated course of balanitis are:

• Sign of blood poisoning (sepsis)
• a poorly controlled diabetes
• Inability to remove the foreskin
• Blockages when urinating

Balanitis: treatment

The treatment of glans inflammation depends on various factors: cause of inflammation, glans findings and general condition of the patient. Every balanitis therapy is based on a good and appropriate intimate care. This includes daily washing of the genital area with warm water and good drying. Camomile sitz baths can be used to support the therapy. In almost all infections, the partner should be treated, even if it shows no symptoms so far.

Local balanitis treatment usually sufficient

With an infectious glans inflammation usually a local (external) balanitis therapy is sufficient. Against bacteria is usually prescribed an ointment with the antibiotic metronidazole. It has a very wide spectrum of activity. Cotrimazole is used against fungi, which works against a variety of fungi. This is usually enough to defeat the infection. If no success can be seen after four weeks of anti-fungal therapy, the diagnosis should be reconsidered.

In the case of a balanitis of non-infectious nature, a local cortisone therapy with an ointment is usually tried first. Cortisone dampens the inflammation and thus usually improves the symptoms significantly. It should be noted, however, that the symptoms of cancer (precursors) can improve under cortisone, but reappear after discontinuation of the ointment.

If cortisone does not help, an ointment containing pimecrolimus, a stronger drug to calm the immune system, can also be used.

Systemic balanitis therapy with tablets

In certain situations, however, the medication must be taken as a tablet. This applies, for example, to diabetes mellitus (diabetes), severe alcoholism, chemotherapy, AIDS and prolonged use of cortisone. In addition, in these cases an increased risk of a recurrence of the infection must be expected.

surgery

Circumcision can be considered for repeated balanitis and narrowed foreskin. The foreskin of the penis is surgically removed. Circumcised men are usually less susceptible to infections. Especially with lichen sclerosus surgery is often performed to prevent a narrowing of the urethra.

Balanitis therapy in children

For children there are special therapy recommendations, which are to be observed. The parents or the child themselves should consistently perform daily intimate care with retracted foreskin and, if necessary, apply a cortisone-containing ointment twice a day.

If the foreskin is narrowed, it should be pushed back, if at all, only in consultation with the attending physician. This can be very painful and uncomfortable. For this reason, the use of local anesthetic with an ointment or the administration of analgesics (possibly also locally) may be considered.

Balanitis: disease course and prognosis

In most cases, balanitis treatment is permanently successful. If the therapy does not work, the choice of drug can be adjusted to better combat glans inflammation.

An untreated balanitis may rise along the urinary tract. Possible consequences are a urinary tract infection, a bladder or prostate inflammation. Urinary tract infections are rare in men and must be treated more consistently than in women.

If balanitis does not improve despite proper therapy, it may be indicative of a malignant process. In this case, a biopsy should be performed. In most cases it is then an erythroplasia Queyrat.

Rarely, precancerous lesions occur due to chronic inflammation of the glans.

In patients with weakened immune systems, especially infectious balanitis should be particularly observed. On the one hand, it is easily possible that the infection expands and seizes more parts of the body. On the other hand, balanitis can also be a first sign of an infection in the body. In addition, infections in a weakened immune system can also take significantly heavier courses than in healthy people and lead to severe skin damage with bleeding. Thus, persistent fungal balanitis can lead to painful inflammation of blood-draining vessels.

In rare cases, a foreskin constriction (phimosis) from a balanitis result.