Balanoposthitis is known to be an inflammatory disease of the glans penis and the inner layer of the foreskin. Anatomically, these two formations are located side by side, their surfaces are in contact, however, in some cases, an isolated inflammation of the glans penis - balanitis, or the foreskin - postitis may occur. In clinical practice, the classification of balanoposthitis according to the etiological factor and clinical course of the disease is most often used. Thus, based on the etiology, infectious and non-infectious balanoposthitis are distinguished. Non-infectious forms are quite rare and can be allergic, radiation or autoimmune (for example, in psoriasis).
According to the clinical guidelines of the European Association of Urology, the most common infectious pathogens are fungi of the genus Candida, streptococci, anaerobic microorganisms, staphylococci, Trichomonas, mycoplasma, as well as herpes virus and human papillomavirus. The recommendations also highlight balanoposthitis associated with inflammatory dermatoses: eczema, lichen sclerosus, psoriasis, etc. In such cases, both urologists and dermatovenerologists can be involve in treatment. On the etiological basis, several types of balanoposthitis are distinguished here:
fungal - caused by fungi, mainly candidal;
viral - caused by the herpes virus or human papillomavirus;
trichomonas – associated with trichomoniasis caused by protozoa (Trichomonas vaginalis);
chlamydial - provoked by Chlamydia trachomatis;
nonspecific - bacterial, caused by opportunistic intestinal microflora (staphylococci, streptococci, Escherichia coli);
•anaerobic - often associated with Gardnerella vaginalis, can be caused by bacteriaд Bacteroides fragilis, Melaninogenicus; Fusobacterium;
•associated with gonorrhea, primary or secondary syphilis.
Treatment of balanoposthitis in such cases is etiological. If the pathogenic microorganism is correctly identified, the prognosis is usually favorable. It should be noted that balanoposthitis deserves special attention as the debut of diabetes mellitus. Usually, with this combination, balanoposthitis is infectious, often associated with candidiasis, sometimes complicated by cicatricial phimosis. Thus, the urologist is often the first specialist to diagnose diabetes. With the correction of diabetes mellitus, the symptoms of balanoposthitis, are normally resolved.
In most clinical cases, acute balanoposthitis is observed.
Less common is chronic, usually associated with cicatricial changes in the foreskin and phimosis.
Acute balanoposthitis, in turn, is divided into several types:
catarrhal, or simple - manifested by redness in the area of the pathological focus, swelling and soreness;
erosive and ulcerative - in this case, deep defects occur due to severe purulent inflammation;
gangrenous - necrosis of the tissues of the glans penis and foreskin is observed.
In December 2012, the Order of the Ministry of Health of the Russian Federation No. 1684n "On the approval of the standard of specialized medical care for phimosis, balanoposthitis, balanitis, ulcer and leukoplakia of the penis and other inflammatory diseases of the penis" was issued. Also, in accordance with Article 37 of the Federal Law of November 21, 2011 No. 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation", it was ordered to approve the standards of specialized medical care for such diseases. According to the order of the Ministry of Health, patients with these types of pathology are provided with specialized medical care on a permanent basis, on a scheduled basis. The average approved treatment period is five days. In 100% of cases, according to the Order, such patients need a personal examination by a urologist. Thus, the main role in the treatment of these diseases is given to the doctors of the urological specialty. Also, in the fall of 2018, updated European guidelines for the treatment of balanitis and balanoposthitis were released. According to them, in the treatment of nonspecific balanoposthitis, preference should be given to circumcisio. In other cases, antibacterial drugs, steroids and laser resection are used.
Sources: Andrey Mikhailovich Smernitsky. "Diseases of the penis" urologist, employee of the Central Polyclinic of JSC "Russian Railways",17.05.2019 https://www.uroweb.ru/