Sandbox:Balanitis
Synonyms and keywords: Balanoposthitis

# Overview
Balanitis is inflammation of glans penis. When inflammation involves the foreskin and prepuce, it is termed as balanoposthitis. Based on the etiology, balanitis can be mainly categorized into infectious, inflammatory dermatoses, and penile carcinoma in situ. Patients with balanitis may present with asymptomatic or symptomatic lesions with itch or pain in the genital region. Risk factors, pathogenesis, clinical presentation, diagnosis and management varies depending on etiology.

# Historical Perspective
Balanitis is an ancient disease,The term Balanitis is derived from a Greek term balanos or acorn.

# Classification
There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:
- Infectious
- Inflammatory dermatoses
- Penile carcinoma in situ

# Pathophysiology
Pathophysiology of Infectious balanitis varies from pathogen to pathogen:

# Causes
Causes of balanitis are:
Causes of Infectious balanitis include:

# Differentiating diagnosis

# Epidemiology and Demographics
- There are no comprehensive studies studying the incidence and prevalence in general population. A recent study has shown that balanitis commonly occurs in around 10% of the patient population visiting the STD clinic, with infectious etiology responsible for around 50% of the cases.
- Candida is the most common cause being responsible for 30-35% cases with infectious etiology.

# Risk Factors
Pathophysiology of Infectious balanitis varies from pathogen to pathogen:

# Screening
There is no established clinical guidelines for screening patients for balanitis.

# Natural History, Complications and Prognosis

## Natural history
If left untreated, Infectious balanitis may result in complications, which include pain, phimosis, and urinary retention.

## Complications
Complication of Infectious balanitis include:
- Pain
- Erosions
- Fissures
- Phimosis
- Paraphimosis
- Painful erection
- Reduced urinary flow
- Urinary retention

## Prognosis
Prognosis is usually good with treatment.

## Natural history
Bowenoid papulosis
If left untreated, papules may increase, or decrease, or disappear with time, or  progress  into squamous cell carcinoma(Studies have reported risk of progression of bowenoid papulosis to squamous cell carcinoma at 2.6%).

### Erythroplasia of Queyrat
If left untreated, Erythroplasia of Queyrat may progress into invasive Squamous cell carcinoma, with an incidence ranging from 10% to 33%.

### Bowen's Disease
If left untreated, Bowen's disease may progress into invasive Squamous cell carcinoma(Incidence of Bowen's disease to develop into invasive squamous cell carcinoma is 3% to 5% for cutaneous and 10% for genital lesions). The malignant potential of Bowen's disease is increased when its existence is compounded by concomitant disease such as HPV infection, Lichen sclerosis or Lichen planus, or in patients with poor genital hygiene and smokers.

## Complications
Complication of penile carcinoma in situ include:
- Pain
- Transformation into invasive squamous cell carcinoma

## Prognosis
The prognosis is usually good with treatment.

# Diagnosis
Diagnostic Criteria |  History and Symptoms |  Physical Examination |  Laboratory Findings | X-ray|CT-Scan| MRI|  Other Diagnostic Studies

# Treatment
Medical Therapy | Primary Prevention  | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies