Monday, March 30, 2015

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&

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