Sexually Transmitted Diseases - I. I. Mavrov 2005

Non-Venereal Inflammatory Diseases of the Reproductive Organs
Balanitis and Balanoposthitis

The most frequent non-venereological diseases in men are balanitis and balanoposthitis. Inflammation of The surface of the glans Penis is called balanitis, and inflammation of the corona of the glans is called posthitis, while their simultaneous inflammation is termed balanoposthitis.

Balanitis and balanoposthitis can be primary or secondary. Primary balanoposthitis usually develops in individuals who neglect personal hygiene or have phimosis, leading to a significant accumulation of smegma in the preputial sac, which causes mechanical and, upon decomposition, chemical irritation. Under these conditions, various microorganisms proliferate easily, resulting in inflammation. The disease may also be triggered by other external factors (e.g., medications). Secondary balanoposthitis can be a consequence of urethritis, diabetes, allergic conditions, and other diseases.

Primary Balanitis and Balanoposthitis

Erosive circinate balanitis (Balanitis erosiva circularis) is a relatively rare condition caused by a fusospirochetal infection and Vincent's spirochete. Erosive, pustuloulcerative, and gangrenous forms are known. Laboratory examination reveals pure cultures of Fusobacterium fusiforme (Plaut-Vincent fusiform bacterium) and the spirochete Borrelia vincentii. Erosive circinate balanitis has been reproduced experimentally by transmitting the infection to the genitalia using secretions from patients with Plaut-Vincent angina or Vincent's gingivostomatitis. The disease occurs spontaneously or 36–48 hours after sexual intercourse. Its course can be severe, especially in ulcerated and gangrenous forms, but it is relatively mild in superficial erosive lesions (see insert XIV, 1–3).

Fusospirochetosis affects the external genitalia in women much less frequently. This condition manifests as erosive-ulcerative and necrotic vulvitis. The Skin folds of the labia may also become involved in the process.

Diagnosis. First of all, a hard chancre must be excluded. The main distinguishing feature is the (usual) absence of regional lymphadenitis in erosive circinate balanitis. It is particularly important to differentiate treponemes and Vincent's spirochetes in the discharge. Often, the diagnosis can only be confirmed using serological tests.

Erosive circinate balanitis should also be differentiated from soft chancre (Chancroid), which can clinically closely resemble its ulcerated and gangrenous forms. In soft chancre, the causative agent is difficult to detect, whereas the fusospirochetal Symbiosis is relatively easily identified.

Genital diphtheria should also be kept in mind. This infection can simulate certain forms of Vincent's balanitis in boys without causing Impairment of the general condition or the severe toxic phenomena characteristic of diphtheritic angina.

Treatment. In severe cases, Antibiotics are prescribed, and if a secondary infection develops, combining them with sulfa drugs is recommended. Locally, irrigation and compresses with antiseptic solutions are used.

Gangrenous balanitis (balanitis gangraenosa) is a form of erosive circinate balanitis characterized by multiple ulcers of varying depth covered with a dense purulent coating. It is accompanied by lymphadenitis and fever; sometimes it occurs against the Background of a low-grade fever. In severe cases, the process ends with Gangrene of the glans penis and part of the preputial sac. Transmission, as a rule, occurs sexually.

Anaerobic microorganisms, spirochetes, and various cocci are detected in the discharge. In severe cases, the prognosis is unfavorable due to the rapid progression and tissue necrosis, the risk of Hemorrhage, and the deformation of the glans penis following treatment.

Differential diagnosis is carried out with phagedenization of Hard and Soft chancres (gangrenous progression involving the entire area of the chancre inward and outward, as well as surrounding Tissues), and fulminant Fournier's gangrene.

Treatment. Antibiotics and sulfanilamides are prescribed. Locally, acidic antiseptics are indicated: hydrogen peroxide, potassium permanganate, and swabbing lesions with a 1–2% silver nitrate solution.

Given the possibility of a dual infection (combined with Syphilis or soft chancre), epidemiological surveillance, laboratory testing, and other measures must be organized to detect or rule out Sexually Transmitted Infections.

Ulceropustular balanitis (balanitis pustuloulcerosa), or Castellani's balanitis, is a condition characterized by small purulent pustules on the glans penis that transform into deep ulcers with a purulent coating. The course is acute. Frequent relapses are noted. The Etiology AND Pathogenesis are not established, though a coccal infection is presumed to be the cause. It must be differentiated from soft chancre and Herpes simplex virus infection.

Treatment: topically — compresses or cauterization of lesions with carbolic acid diluted 1:10, and swabbing with a rivanol solution (1:1000).

Medicated balanoposthitis (balanoposthitis medicamentosa) occurs As a result of using various medications (alcohol, corrosive sublimate solution, salol, concentrated potassium permanganate solutions, silver nitrate solution, etc.) for Contraception, the Prevention of venereal diseases, etc. Depending on the drugs used, the lesions may have a catarrhal character, and The Development of ulcerative or even gangrenous balanoposthitis is possible.

More difficult to diagnose are drug-induced types of balanitis resulting from systemic (oral) administration of medications. For example, erythemapigmented balanitis, which occurs after taking antipyrine or phenolphthalein, is characterized by bullous and erosive eruptions (see inserts XIV, 5–6; XVI, 1). Upon re-administration of antipyrine (sometimes even many years after the first exposure), a relapse of this same form of balanitis is observed, specifically in the exact same Location.

Balanitis caused by external factors (balanitis artefacta) can be triggered by mechanical, physical, chemical, and other influences. Of particular note are cases of balanitis induced intentionally for simulation through the local application of various agents, including certain plants (e.g., spurge sap, green fig fruit juice, etc.). Simple balanoposthitis (balanoposthitis simplex) is an inflammation of the skin of the glans penis and the inner layer of the preputial corona. It arises from exposure to excessive irritants (mechanical, chemical), infection by various Bacteria or Fungi, and typically poor personal hygiene. It is characterized by edema, hyperemia, sometimes epidermal maceration, soreness of the glans and corona, and purulent discharge. Pathogenetic factors may include retention of smegma or urine, and phimosis.

Treatment. In mild cases, careful exposure of the glans, thorough removal of smegma and pus from the preputial sac and corona, and washing with soap and Water or mild antiseptic solutions (rivanol, 0.5% silver nitrate, or potassium permanganate solution) are indicated. This Procedure should be repeated 3–4 times a day, after which the glans must be reduced to avoid paraphimosis. If phimosis is severe, circumcision is indicated.

Secondary Balanitis and Balanoposthitis

Secondary balanitis can be triggered by various causes and accompany a wide range of diseases. Inflammatory phenomena in the area of the glans penis may be the consequence of a herpetic infection, Scabies, syphilis, soft chancre, and others.

Keratotic ulcerated balanitis (balanitis keratotica exulcerans) is a rare condition. It is observed in elderly men on the glans penis as a lax, pink, wart-like lesion with an infiltrated crateriform ulcer. The lesion resembles erythroplasia combined with penile Sarcoma. It develops slowly. Differential diagnosis is conducted with Bowen's disease, Queyrat's Erythroplasia, and carcinoma. Histology reveals hyperkeratosis, papillomatosis, lymphoplasmacytic infiltration, and an ulceronecrotic process. Data on a malignant course are absent.

Diabetic balanoposthitis (balanoposthitis diabetica) is an inflammation that develops in Diabetes Mellitus due to irritation of the skin of the glans penis and corona by sugar-containing urine and infection by Yeast-like fungi of the genus Candida. It can be acute or chronic. In the acute form, the inner surface of the corona and the skin of the glans are intensely hyperemic, bleeding, and patchily covered with ulcers accompanied by abundant purulent discharge. Relapses are frequent. In the chronic course, dryness, glossiness, and desquamation of the mucous membrane of the glans are noted, while the skin of the corona remains edematous and inflamed. This form of balanoposthitis is so characteristic that in A number of cases it leads to the initial diagnosis of diabetes. Balanoposthitis in diabetic patients resolves very rapidly once sugar disappears from the urine.

Gonococcal balanoposthitis (balanoposthitis gonococcica) is an inflammation of the glans penis and corona that typically accompanies acute recent Gonorrhea with profuse urethral discharge, especially in individuals with congenital phimosis. The inflammation is catarrhal in nature, or occasionally takes the form of erosive circinate balanitis. Treatment of gonorrhea leads to the regression of balanoposthitis symptoms.

Balanoposthitis xerotica obliterans is a distinct inflammatory, atrophic, and sclerosing form of balanoposthitis. It occurs relatively rarely and may develop spontaneously. Its etiology and pathogenesis remain unclear. It is observed in elderly and, less frequently, in young men who are not sexually active. The underlying condition is a progressive scleroatrophic process (see Insert XVI, 2).

Clinical presentation. The skin of the glans corona is thickened and indurated, leading to non-inflammatory phimosis. Erosions, fissures, and atrophic patches appear upon it. Adhesions form between the glans penis and the inner leaf of the preputial corona. Sexual intercourse becomes painful. Malignant transformation is occasionally observed. Therefore, such patients require regular clinical follow-up and dispensary monitoring.

Treatment. Vitamin E, unithiol, bucarban (0.125 g twice daily), and potassium iodide phonophoresis are prescribed; topically, ointments containing Hormones (synestrol, progesterone, testosterone) are applied.