Empirical Treatment for Infective Balanitis

ü  Balanitis is the inflammation of glans penis, while posthitis is inflammation of prepuce (foreskin). Since both areas are often affected, the term balanoposthitis is then used.

ü  Factors that can cause balanitis are listed in the table below:

Infectious	Dermatoses	Miscellaneous
Candida albicans	Lichen sclerosus (balanitis xerotica obliterans)	Trauma
Trichonomas vaginalis	Zoon’s balanitis	Irritant
Streptococci (Group A and B)	Psoriasis	Poor hygiene
Anaerobes	Circinate balanitis	Pre-malignant conditions: · Bowen’s disease · Bowenoid papulosis · Erythroplasia of Queyrat
Gardnerella vaginalis	Lichen planus
Staphylococcus aureus	Immuno-bullous disorders
Mycobacteria	Contact allergy
Entamoeba histolytica	Fixed drug eruption
Syphilis	Stevens-Johnson syndrome
Herpes simplex virus
Human papillomavirus

ü  Empirical treatment for balanitis:

	Candidal	Anaerobic	Aerobic
Clinical Presentations	§  Rash, with soreness and/or itch §  Blotchy erythema with small papules (may be eroded, or dry dull red areas with glazed appearance)	§  Foul smelling discharge, swelling and inflamed glands §  Preputial oedema, superficial erosions, inguinal adenitis	§  Non specific balanitis
First choice antibiotic	Clotrimazole 1% cream topically BD until symptoms settle	Metronidazole 400mg PO BD for 7 days	As per sensitivities
Second choice antibiotic	For severe symptoms: Fluconazole 150mg PO stat	Augmentin 375mg PO TDS for 7 days

References:
1. 2008 UK National Guideline on the Management of Balanoposthitis. http://www.bashh.org/documents/2062.pdf
2. NHS Grampian Medicines Management. Hospital empirical antibiotic therapy for adults. Infective balanitis. http://www.nhsgrampian.org/nhsgrampian/GJF_general_new.jsp?pContentID=5779&p_applic=CCC&pElementID=871&pMenuID=464&p_service=Content.show&