A descriptive study of the clinical and etiological profile of balanoposthitis

Abstract

Background: Balanoposthitis is defined as an inflammatory condition of glans penis and prepuce. There are wide variety of etiologies including both infectious and noninfectious conditions. This study attempts to throw light on information regarding clinical and microbiological aspects of balanoposthitis.

Objectives: To study various clinical patterns, etiologies, and predisposing factors of balanoposthitis.

Methodology: A descriptive study was undertaken on 106 cases who presented to sexually transmitted disease (STD) clinic with balanoposthitis between November 2017 and April 2019. A detailed history, physical examination, and investigations like KOH mount, leishman staining, gram staining, dark field microscopy, cultures, and other investigations were done wherever indicated. The data collected was tabulated and analyzed.

Results: In our study, infectious etiology was the most common and was found in 77.36% cases. About 13.41% of cases with infectious balanoposthitis had multiple etiological agents. Noninfectious etiology was found in 22.64% cases. The most common infectious cause of balanoposthitis was candida, noted in 59.76% cases, followed by herpes simplex virus (19.51%), human papilloma virus (13.41%), and scabies (8.54%). Among noninfectious etiologies, adverse drug reaction (4.72% of total cases) was the most common, followed by lichen planus (3.77%) and psoriasis (3.77%). There was significantly higher incidence of phimosis in diabetic patients with candidal balanoposthitis.

Conclusion: Identifying the etiology facilitates early treatment and hence reduces the infectivity and transmission of disease and also the disease complications like phimosis. In addition, multiple infectious etiologies should always be kept in mind while evaluating STDs.

Keywords: Balanoposthitis; candidal; genital warts; herpes genitalis.

Figure 1

Candidal balanoposthitis. (a) Radial fissuring of prepuce. (b) KOH showing abundant pseudohyphae with spores. (c) Methylene blue staining showing psudohyphae with budding spores. (d) Culture showing growth of Candida albicans

Figure 2

Herpes genitalis. (a) Erosive ulcers with polycyclic margins. (b) Tzanck smear showing multinucleated giant cells

Figure 3

Genital warts

Figure 4

Scabies. (a) Excoriated papules over glans penis and prepuce. (b) Scabies mite visualized on scraping and microscopy

Figure 5

Gonorrhea. (a) clinical picture showing urethral discharge. (b) Gram stain showing intracellular diplococci

Figure 6

Noninfectious balanoposthitis. (a) Adverse drug reaction showing erosions over glans penis and prepuce. (b) Adverse drug reaction in the same patient showing erosions over lips. (c) Genital lichen planus. (d) Genital psoriasis