Question:

A 34-year old man presented with a penile rash for two days. He gave a history of venereal exposure four days ago. He was otherwise well and enjoyed good past health.

Answer: C. Balanoposthitis

This man had balanoposthitis which refers to inflammation of the glans penis and prepuce. It can be classified according to aetiology, namely infective, irritant, traumatic and miscellaneous. Infection is the commonest cause, though balanoposthitis is often multifactorial.

Candidal balanoposthitis can follow intercourse with an infected sexual partner. However, infection may occur without sexual contact, usually in diabetic patients or patients taking oral antibiotics. It is more common in the uncircumcised. Clinically there may be diffuse erythema, a slightly scaling edge and eroded satellite pustules. Groin involvement may also occur. Microscopy and culture confirm the diagnosis. Recurrent candidal balanoposthitis may result in fissuring of the prepuce, fibrosis and sclerosis.

Other microorganisms that may lead to balanoposthitis include trichomonas, mycoplasma, chlamydia and anaerobes. Poor hygiene, retained soap or cleansing agents can cause irritant contact dermatitis of the glans penis and prepuce. Frictional trauma may result in localised erythema and oedema.

General advice on hygiene, avoidance of irritants, and gentle cleansing is important. The underlying cause should be treated if possible. Specific treatment is available for candidal balanoposthitis. Both partners should be treated concurrently if symptomatic. There are many topical anti-candidal drugs of the polyene or azole group. Oral itraconazole and fluconazole may be considered in severe cases. For recurrent balanoposthitis, diabetes mellitus needs to be excluded.