Diagnosis of balanitis

Inflammation of the glans penis is one of the unpleasant and to some extent dangerous diseases of the strong half of humanity. The disease called "balanitis" not only reduces the patient's quality of life, it makes its negative adjustments to the relationship of sexual partners, reduces the patient's self-esteem as a man, and interferes with normal sexual life. Professional diagnostics and treatment of balanitis help to avoid such problems and in most cases allow to restore men's health.

Features of balanitis diagnostics

The inflammatory process in the genital area, depending on the cause of its development and concomitant pathologies, can have different courses. Hyperemia and swelling of the penile tissues can have varying severity. On the surface of the penis, there may be both small rashes and ulcerative-erosive lesions, areas of necrosis and tissue atrophy. All these signs are noted by a urologist or andrologist during a physical examination of the patient. [ 1 ], [ 2 ]

This moment may seem inconvenient and extremely unpleasant to the patient, but it is very important for diagnosis, because external signs say a lot about the type and form of balanitis. For example, inflamed wounds on the head of the penis indicate an erosive-ulcerative form of the disease, which in turn indicates the effect of infection on the tissues of the male organ. The infectious nature of the pathology is also confirmed by the accumulation of a creamy secretion of a whitish or yellow-green color (purulent discharge and smegma) under the foreskin. If a whitish cheesy coating is visible on the surface of the penis, the doctor will suspect candidal balanitis. [ 3 ]

The inflammatory process, regardless of its etiology, is characterized by hyperemia and tissue swelling, which are visible to the naked eye. But the doctor can learn about symptoms such as itching, burning, and pain that intensifies during walking and urination only from the patient’s words. You should not be afraid of leading questions about when the symptoms first appeared and whether there was unprotected sexual intercourse the day before (most infections are sexually transmitted and pose a danger to the sexual partner), what kind of underwear the patient wears, whether he or she has had any allergies to creams and washing powders before, etc. [ 4 ]

If a man consults a doctor when the first signs of the disease appear, it is very difficult to determine from the existing symptoms whether it is infectious balanitis or the impact of non-infectious irritants. Laboratory tests help to resolve this issue. By the way, they are also important when the symptoms clearly indicate the presence of an infection, because only tests make it possible to determine the causative agent of the disease or an infection that has joined later and does not allow the inflammatory process to subside. And this in turn allows you to correctly select effective drugs for existing pathogens.

To identify the balanitis pathogen, the doctor takes a smear from the patient's urethra and a scraping from the surface of the head. The biomaterial is examined using the polymerase chain reaction (PCR) method, which allows the pathogen's DNA to be isolated. If sexually transmitted infections are detected, a consultation with a venereologist will be required.

When bacterial microflora is detected, the treatment of which is only possible with antibiotics, a bacterial culture is performed to exclude cases of antibiotic resistance and determine the sensitivity of a specific pathogen to traditionally used drugs.

Additionally, the patient is offered to take tests for the Wasserman reaction (allows to detect latent syphilis), for hepatitis viruses and HIV infection, a general and biochemical blood test, and a urine test. To exclude or confirm the harmful effects of diabetes, patients are prescribed a blood sugar test.

If cancer is suspected, the doctor may prescribe a biopsy of the penile tissue and a histological examination of the biopsy.

Balanitis is a disease that is easily diagnosed by doctors even by external signs. It is much more difficult to identify the cause of the inflammatory process. Therefore, in case of balanitis of unspecified etiology, consultations with different doctors (traumatologist, rheumatologist, therapist, dermatovenerologist and even oncologist) may be required, as well as additional instrumental studies.

Instrumental diagnostics are prescribed based on concomitant diseases and patient complaints. This may be an ultrasound examination of the urinary tract (ultrasound) or urethroscopy. As part of the diagnostics of the pathology, an electrocardiogram, chest X-ray and other studies may be prescribed, because the inflammatory process can be provoked by circulatory disorders, i.e. inadequate breathing and nutrition of the tissues of the head of the penis, caused by diseases of the cardiovascular and respiratory systems.

The head of the penis, like the main part of the human body, is covered with skin. The skin of the penis can react not only to infections and injuries, rashes, redness and ulcers can also occur for other reasons, for example, due to various systemic diseases. In order to differentiate balanitis from such pathologies and determine its type, differential diagnostics are carried out. [ 5 ]

For example, various skin manifestations are characteristic of sexually transmitted diseases:

• With genital herpes, blisters, ulcers and painful crusts may appear on the skin of the penis,
• in primary syphilis - painful ulcers, and in secondary syphilis - voluminous condylomas and ring-shaped inflammatory lesions,
• with chancroid and venereal lymphogranuloma, ulcers also appear on the skin of the penis and an increase in lymph nodes in the groin area is noted,
• with gonorrhea, ulcers and pustules are visible on the skin of the phallus,
• trichomoniasis is manifested by the appearance of erosive lesions,
• papillomavirus can manifest itself in the form of rashes of various shapes and sizes that react to acetic acid,
• with candidiasis, erythema, burning and severe itching in the intimate area are observed, a cheesy coating with a sour smell appears on the skin,
• Infection with the anaerobe gardnerella has its own characteristic sign - an unpleasant smell of spoiled fish, etc.

Skin manifestations in the area of the head of the penis can also be detected with versicolor and flat lichen, allergic reactions, psoriasis, Behcet's syndrome, seborrheic dermatitis, aphthosis. Differential diagnostics should also be carried out with oncological diseases of the male organ (erythroplasia of Queyrat, carcinoma, warty carcinoma, Paget's disease).

When conducting comparative diagnostics, doctors rely on the patient's medical history, laboratory and instrumental examination results. [ 6 ] If necessary, special tests are prescribed, such as histological examinations. After all, the quality of the balanitis diagnostics determines the subsequent treatment and its effectiveness.

Much attention is paid to concomitant diseases and complications of balanitis. For example, the disease quite often develops against the background of congenital phimosis (narrowing of the foreskin), but long-term inflammation itself can cause such narrowing, i.e. acquired phimosis. If nothing is done to eliminate the inflammation, phimosis can give complications in the form of compression of the urethra by the modified foreskin (paraphimosis), which results in serious problems with urination and erection, congestion and internal inflammation (cystitis, urethritis, prostatitis, etc.).

On the other hand, balanitis can develop as one of the complications of urethritis or other inflammatory diseases of the genitourinary system of an infectious nature. This is facilitated by discharge from the urethra, which contains bacterial particles.

Discharge from the prepuce, characteristic of such a pathology as infectious balanitis, is also observed with inflammation of the foreskin (posthitis). And although the treatment of both diseases is similar, these pathologies should be differentiated in order to determine the source of inflammation.