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Visual Diagnosis

Case: A 6-month-old boy whose tip of his penis has been swollen for one day is brought in by his mother for. She noticed that he cries when he urinates, and she suspects that he may be in pain when he voids. There is no history of trauma or new exposures.

Acute appendicitis ultrasound in a 13-year-old-boy

Diagnosis:

This patient has balanopothitis.

Balanoposthitis is inflammation of the glans penis and foreskin in an uncircumcised male. Inflammation is usually caused by poor hygiene, although risks of bacterial, viral, or candida infections may develop in individuals with underlying medical issues, sexually transmitted diseases, or diabetes mellitus. Treatment includes encouraging proper hygiene to genitalia and frequent diaper changes in children. Topical antibiotics, topical antifungals, and topical low-potency steroids should also be considered for treatment. Circumcision is usually not warranted.

Clinical Practice Pearls:

  • Balanoposthitis is commonly confused with balanitis, which is the inflammation of the glans penis, not involving the foreskin.

  • Consider diabetes, sexually transmitted diseases, or other underlying medical concerns in individuals with recurrent balanoposthitis or balanitis.
  • Although diagnosis is usually clinical, potassium hydroxide slide prep or skin culture may assist in the diagnosis and guide proper treatment.
  • Obtain urinalysis to evaluate for suspected urinary tract infection in patients with dysuria.

Additional Reading:

  • Lisboa C, Ferreira A, Resende C, et al. Infectious balanoposthitis: management, clinical, and laboratory features. Int J Dermtol. 2009. 48(2):121-124.

  • Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med. 1996. 72(3):155-159.

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