GPAtlas🧭 When to suspect
Balanitis is inflammation of the glans penis.
• When the foreskin (prepuce) is also inflamed the correct term is balanoposthitis, though “balanitis” is used loosely for both.
• Balanitis is common, affecting roughly 3–11% of males in their lifetime.
• Balanitis occurs almost exclusively in the uncircumcised, where the warm, occluded sub-preputial space favours irritation and infection.
Work out the cause (irritant, candidal, bacterial, anaerobic, or an underlying dermatosis), and never miss the dangerous mimics:
• The two surgical emergencies (paraphimosis and necrotising fasciitis).
• The premalignant/malignant lesions (lichen sclerosus and penile cancer).
Most cases are simply irritant dermatitis or Candida, and most settle with hygiene measures and a short course of topical treatment.
Recognising the pattern guides treatment more than any test. The appearances below are the high-yield discriminators.
| Cause/type | Clinical clue – what you see |
|---|---|
| Irritant or contact dermatitis | • The commonest cause • Soreness and itch after soap, shower gel, bubble bath, baby wipes, latex condoms or lubricant |
| Candida | • Itchy blotchy erythema with small red satellite papules, or dry dull-red patches • Suspect diabetes if recurrent |
| Anaerobic (incl. Gardnerella) | Foul-smelling sub-preputial discharge with oedema and tender inguinal nodes. |
| Aerobic/bacterial (Group A/B strep, S. aureus) | • Uniform erythema and oedema • May be erosive, painful and purulent |
| Herpes simplex (HSV) | • Grouped vesicles on an erythematous base that rupture into painful shallow grey ulcers • Often recurrent |
| Lichen sclerosus (BXO) | • White, atrophic, scarred glans/foreskin, often with phimosis • Premalignant |
| Zoon’s (plasma cell) balanitis | • Shiny, well-defined, glistening orange-red patch • Now regarded as part of the male lichen sclerosus spectrum |
| Psoriasis or circinate balanitis | • Well-demarcated scaly or moist plaques • Look for psoriasis elsewhere or reactive arthritis |
| Penile intraepithelial neoplasia or squamous cell carcinoma (SCC) | A persistent, fixed, indurated plaque, ulcer or mass that does not settle with treatment. |
Raise suspicion particularly in uncircumcised men, those with phimosis or poor hygiene, and where there is diabetes mellitus, obesity or immunocompromise. In an older man with a non-resolving lesion, keep malignancy in mind.
Source: European balanoposthitis guideline · DermNet
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