Balanitis

Age: ‍ years old

Gender: male



HISTORY:

Presents with a ‍-‍day history of penile ‍painswellingrednessdischarge

Symptoms include:

‍penile pain

‍swelling

‍redness

‍irritation

‍itching

‍foul-smelling discharge

‍difficulty retracting foreskin

‍painful urination

‍sores on the glans

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍lymph node enlargement in the groin



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍poor hygiene

‍use of irritants like soaps or lotions

‍tight or synthetic clothing

‍multiple sexual partners

no history of: ‍balanitis, ‍circumcision, ‍sexually transmitted infections, ‍diabetes, ‍HIV, ‍immunodeficiency, ‍eczema

no use of: ‍recent antibiotics





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Balanitis ‍likelysuspectedpossible

DDx: candidal balanitis, bacterial balanoposthite, circinate balanitis (associated with reactive arthritis), Zoon's balanitis (plasma cell balanitis), contact dermatitis, allergic reaction, psoriasis, lichen planus, lichen sclerosus, genital herpes, human papillomavirus (HPV), syphilis, scabies, fixed drug eruption, phimosis, sexually transmitted infections, mechanical irritation, poor hygiene, diabetes mellitus





PLAN:

Investigations:

- Swab for bacterial culture

- Swab for fungal culture

- STI screening

- Blood work: ‍Glucose, ‍HbA1C

- Patch testing

Treatments:

- ‍Topical antifungals

- ‍Topical steroids

- ‍Oral antifungals

- ‍Oral antibiotics

- ‍Analgesics

- Good hygiene practices

- Avoidance of irritants (soaps, lotions, latex condoms if allergic)

- Circumcision

Further care:

- Referral to dermatologist

- Referral to urologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms do not improve or worsen, or if new symptoms such as discharge or ulceration develop