Severe Bacterial Balanitis in Circumcised Adult Males

Balanitis is the inflammation of the glans penis while balanoposthitis involves both the glans penis and prepuce and occurs only in uncircumcised males. Balanitis is more common in uncircumcised males due to the occlusive effect of the foreskin, which facilitates smegma retention and bacterial and fungal overgrowth. Therefore, balanitis is rare after circumcision and severe balanitis is even rarer. In patients with recurrent balanoposthitis, circumcision is indicated, and the presence of diabetes should be ruled out. Diabetes mellitus is a frequent predisposing factor for Candida balanoposthitis and has been associated with male genital lichen sclerosus, which in progressive stages leads to phimosis. Circumcision is also indicated in the treatment of lichen sclerosus associated with phimosis. Candida albicans stands as the primary culprit in cases of acute infectious balanoposthitis, with aerobic bacteria constituting the second most common etiological factor. Among these bacteria, streptococci particularly groups B and D and staphylococci, notably S. aureus, are prevalent. Mixed infections may also occur. The typical clinical manifestations involve erythema and oedema accompanied by itching and/or pain. In instances of painful, erosive streptococcal balanoposthitis, severe balanopreputial oedema with purulent exudate can be observed. Staphylococcus haemolyticus, a prominent member of the coagulase-negative staphylococci of the skin microbiota, causes infections in the male urogenital tract, such as urinary tract infections, chronic prostatitis and epididymo-orchitis. However, it had not been associated with balanitis. Enterococcus faecalis is part of the normal gastrointestinal microflora and is also a frequent cause of urinary tract infections and of chronic prostatitis. Enterococcus has been associated with mild balanoposthitis in adults and E. faecalis has been described to cause balanoposthitis in young children, but its association with severe balanitis .....