Due to many men neglecting hygiene and having excessively long foreskin, infections of the foreskin and glans can occur. Balanitis poses significant risks; if left untreated long-term, it may lead to male infertility. Therefore, prompt medical examination and treatment are essential.
What tests are required for balanitis?
1. Secretion examination
Samples from the affected glans or foreskin are examined microscopically or cultured. Candida may be identified, indicating candidal balanitis; trichomonads may be detected in secretions for trichomonal balanitis.
2. Direct Microscopic Examination
Scrape skin scales from the surface lesions on the glans penis, corona sulcus, or foreskin as specimens for examination.
3. Isolation and Culture
For patients with negative smear results, Candida culture is required. Under sterile conditions, inoculate the specimen onto Sabouraud's agar. Incubate the agar at 37°C for 24-48 hours. Observation of abundant creamy-white colonies indicates a preliminary diagnosis of Candida infection.
4. Staining Tests
Gram staining yields higher positive rates than direct microscopy. Gram-stained specimens show spores and pseudohyphae as blue; Congo red and PAS staining reveal spores and pseudohyphae as red.
Symptoms of Balanitis
1.Micaceous and Keratinizing Pseudopapillomatous Balanitis
The glans exhibits infiltrated thickening, hyperkeratosis, and micaceous crusting. The affected area loses normal elasticity, eventually atrophying over time. Histopathology reveals hyperkeratinized stratum spinosum with elongated thickened epidermal processes forming pseudopapillomatous hyperplasia.
2. Acute Superficial Balanitis
Manifests as edema, erythema, exudation, and erosion. Secondary infection produces purulent discharge, prone to ulceration with subjective pain.
3. Annular Erosive Balanitis
Inflammatory lesions on the glans and foreskin appear annular or ring-shaped, with cheesy smegma. Over time, these may ulcerate into shallow sores. If the annular pattern is lost, differentiation from superficial balanitis becomes difficult. This condition may occur independently or as a mucosal manifestation of Reiter's syndrome.
4. Plasmacytic Balanitis
More common in middle-aged men, presenting as single or multiple chronic inflammatory lesions that persist for a long time. These lesions appear plaque-like, with a smooth, desquamating, or moist surface. Infiltration is relatively prominent, with clear borders that are not easily ulcerated. Small, pepper-like spots may be visible on the surface, making it difficult to distinguish from proliferative erythema of the glans.