Sexually transmitted infections (STIs) – Balanitis
Balanitis, or balanoposthitis, is inflammation of the head of the penis. The foreskin (the loose flap of skin that covers the head of the penis) is also often affected.
Balanitis is a common condition affecting both boys and men. It occurs more often in men who have not been circumcised.
Symptoms can include:
redness, swelling and soreness around the head of the penis or foreskin
a thick discharge under the foreskin
a rash on the penis
an unpleasant odour
pain when urinating
Some people may also have a tight foreskin that will not retract (pull back). This is called phimosis.
When to seek medical advice
Balanitis is not usually serious, but it can be a sign of another condition, such as a sexually transmitted infection (STI) or thrush (a type of fungal infection).
It's therefore important to visit your GP or a local sexual health or genitourinary medicine (GUM) clinic if you think you have balanitis.
You should also see your GP if your son has symptoms of balanitis.
What causes balanitis?
Skin irritation is the most common cause of balanitis in boys. This can occur because it's not always possible to pull back the foreskin fully at this age, leading to a build-up of a cheesy-looking substance called smegma that can irritate the skin.
Irritation by smegma is also a common cause of balanitis in uncircumcised men if the penis is not kept clean.
Other causes of balanitis include:
irritation caused by urine or substances such as soaps and shower gels (contact dermatitis)
thrush, which is more common in people with diabetes or who have recently taken antibiotics
a bacterial infection, usually caused by streptococcal bacteria
sexually transmitted infections (STIs), such as gonorrhoea, genital herpes and syphilis
skin conditions, such as atopic eczema, psoriasis, lichen sclerosus and lichen planus
in boys, repeatedly playing with their foreskin
In some cases, no cause can be found.
How balanitis is treated
Most cases of balanitis are easily managed with a combination of creams or ointments, good hygiene and avoiding substances that irritate the penis (see below).
This may include corticosteroid, antibiotic and antifungal creams and ointments, depending on what the underlying cause of the condition is.
These treatments will usually start to have an effect within a week and can be stopped after around two weeks, although in some people it does eventually come back after treatment.
A partial circumcision may sometimes be recommended for a small number of cases of recurring phimosis.
You can reduce your chances of developing balanitis by:
avoiding potential irritants, such as soaps, bubble baths and latex condoms
keeping your penis clean – you should wash it with water every day
avoiding STIs – use condoms whenever you have sex and don't share sex toys
Babies and young children who still wear nappies should have their nappies changed regularly because the warm and moist conditions can increase their risk of balanitis.
Your GP should be able to diagnose balanitis by examining your penis.
You may initially feel embarrassed about visiting your GP with the symptoms of balanitis, but it's important that you do because the symptoms could be a sign of a more serious underlying condition and you or your child may need prescription-only medication.
Seeing your GP
To determine what is causing balanitis, your GP will examine your (or your child’s) penis and ask a number of questions to help determine the cause. They may ask:
how often you clean your penis
whether you may have been exposed to irritants, such as soap or bubble bath
whether you have a history of skin conditions, such as atopic eczema
whether you may have damaged the head of your penis during sex
For children, your GP may ask whether you have noticed your child playing with their foreskin and, if your child is very young, they may want to know how often they have their nappy changed.
Further testing is usually only needed if the symptoms are particularly severe or do not clear with treatment. This usually involves taking a small sample of cells from the head of the penis (a swab) and testing them for infection.
Occasionally, your GP may arrange blood and urine tests to measure your blood sugar levels. This is to check whether you have developed diabetes, which may be making you more vulnerable to infection.
Referral to a specialist
In some cases, your GP may refer you to a specialist such as a dermatologist (skin specialist) or urologist (specialist in conditions affecting the urinary tract and genitals).
For example, you may be referred if your GP is not sure what is causing your condition, treatment isn't helping, or your GP thinks you could have an underlying condition.
If your GP thinks your symptoms could be caused by a sexually transmitted infection (STI), they may recommend getting tested at a sexual health clinic. Testing of your recent sexual partner(s) may also be arranged if appropriate.
If you or your child has balanitis, the recommended treatment will depend on what is causing the condition.
In all cases, you should keep your penis clean by washing it with warm water once a day.
You should also try to avoid potential irritants, such as soap, bubble bath and baby wipes. You may find it helpful to use an emollient as a soap substitute.
If your balanitis is the result of skin irritation and not an infection, you will usually be prescribed a topical corticosteroid (steroid cream or ointment).
Apply the cream to the head of your penis once a day until your symptoms have gone. Do not use the medication for more than 14 days in a row because this could lead to side effects, such as thinning of the skin.
If your balanitis is the result of a fungal infection, you will be prescribed either an antifungal cream to use several times a day for at least two weeks, or a single dose of the oral antifungal medication (tablet or capsule) fluconazole.
Side effects of antifungal creams can include a rash, itching and swelling. These creams can also damage latex condoms, so you should use an alternative form of contraception for at least five days after treatment stops.
Fluconazole is not recommended for children who are under 16 years old. It can also cause side effects, including nausea, vomiting, bloating, diarrhoea, and abdominal (tummy) pain.
If your symptoms are particularly troublesome, you may be prescribed a topical corticosteroid to use as well.
If a bacterial infection is the cause of your balanitis, you will be prescribed a seven-day course of an oral antibiotic (antibiotic tablets or capsules), such as flucloxacillin or metronidazole.
Common side effects of these types of antibiotics include a rash, nausea, vomiting and diarrhoea.
Again, if your symptoms are particularly troublesome, you may also be prescribed a topical corticosteroid.
The treatments listed above should start working within seven days. Contact your GP if your symptoms do not start improving by this time because you may require alternative treatment and you may need to see a specialist.
In rare cases, if you have phimosis (a tight foreskin) and you have repeat episodes of balanitis, you may be advised to have a partial circumcision (where some of the foreskin is removed).
Can I have sex during treatment?
If balanitis is not caused by an infection, it's usually fine to have sex before your treatment finishes.
However, you may want to avoid having sex until your symptoms improve because you may find it painful.
You should avoid having sex during treatment if your balanitis is caused by an STI or thrush, because there is a risk of passing the infection on.
Your GP or specialist can advise you about this.
You can usually reduce your chances of developing balanitis if you avoid potential irritants and infections, and keep your penis clean.
Possible irritants to avoid include:
soaps and bubble bath
You can buy emollients to use instead of soap and latex-free condoms made for sensitive skin.
To keep your penis clean, you should:
make sure the tip of your penis is completely dry and free of urine after urinating
carefully wash the head of your penis with water every day and gently clean under your foreskin
make sure you dry your penis thoroughly after bathing or showering
This advice also applies to children, although young boys may not yet be able to clean under their foreskin because it may not fully pull back. This should not be forced and should eventually become possible as they get older.
Babies and young children who still wear nappies may also be at a higher risk of balanitis due to the warm and moist conditions, so make sure you change your child's nappy regularly.
Sexually transmitted infections (STIs) can sometimes cause balanitis, so reducing your chances of picking up one of these infections may lower your risk of developing the condition.
STIs can often be prevented by using appropriate contraception and taking other precautions, such as:
using condoms every time you have vaginal or anal sex
using a condom to cover the penis, or a latex or plastic square (dam) to cover the female genitals, if you have oral sex
not sharing sex toys, or washing them and covering them with a new condom before anyone else uses them