Some of the following are complaints presented by patients of balanitis [7]:

• Penile discharge
• Pain or difficulty with retraction of foreskin
• Impotence
• Difficulty urinating
• Tenderness and erythema of the glans penis
• Pruritus
• Foul smelling discharge

Systemic symptoms such as fever and nausea are rarely seen in patients.

Following physical examination the following findings may be noted:

• Erythema and edema
• Discharge
• Phimosis (uncommon)
• Signs of urinary obstruction 
• Lymphadenopathy

• Reiter Syndrome

  […] circinate erosive balanitis Balanitis, circinate: A form of skin inflammation around the penis in males with Reiter's syndrome. The skin around the shaft and tip (glans) penis can become inflamed and scale. [dermaamin.com]

  Circinate balanitis is the commonest cutaneous manifestation of reactive arthritis (Reiter syndrome), but can also occur independently. [ncbi.nlm.nih.gov]

  Balanitis circinata: erosive plaques with slightly raised edges on the glans due to a Reiter's syndrome. 1–4 weeks after urinary tract infection or intestinal infection patients may develop a Reiter's syndrome: fever, malaise, urethritis (95%), prostatitis [urology-textbook.com]

  Trichomonas vaginalis Herpes simplex virus Mycoplasma genitalium Inflammatory dermatoses: Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome). Bx - spongiform pustules, maybe chlamydia probe positive. [hopkinsguides.com]

  Reactive arthritis (formerly Reiter syndrome) is associated with inflammation around the head of the penis (circinate balanitis). [rxlist.com]

• Fever

  Aspirin or acetaminophen to relieve minor pain and fever. Activity Rest in bed if you have fever. Avoid sexual intercourse during treatment. Resume your normal activities when the infection is cured. Diet No special diet. [nmihi.com]

  When to seek medical advice Unless your child's healthcare provider advises otherwise, call the provider right away if: Your child has a fever (see Fever and children, below). The foreskin becomes trapped in a retracted position. [fairview.org]

• Cutaneous Manifestation

  Circinate balanitis is the commonest cutaneous manifestation of reactive arthritis (Reiter syndrome), but can also occur independently. [ncbi.nlm.nih.gov]

• Yellow Nails

  There was a whitish yellow nail-like lesion on the dorsum of the glans extending distally from the corona, which could be easily peeled off. [ijdvl.com]

• Genital Lesions

  *All persistent/undiagnosed genital lesions regardless of appearance must be evaluated for herpes Take home message: Predisposing factors include poor hygiene and over washing, over-the-counter (OTC) medications, as well as nonretraction of the foreskin [ncbi.nlm.nih.gov]

  Alberto Rosenblatt, Homero Gustavo de Campos Guidi and Walter Belda, Miscellaneous Benign Disorders, Male Genital Lesions, 10.1007/978-3-642-29017-6_14, (319-331), (2012). Pablo Boixeda, Lorea Bagazgoitia, João Borges da Costa and T. [doi.org]

  Some cases may follow prolonged or frequent intercourse or are associated with a genital lesion. However in the largest series reported, the majority were unexplained although the patients had coitus. [cirp.org]

  *All persistent/undiagnosed genital lesions regardless of appearance must be evaluated for herpes [Figure 1] Take home message: Predisposing factors include poor hygiene and over washing, over-the-counter (OTC) medications, as well as nonretraction of [ijstd.org]

  CASE REPORT Case 1: Male, 37 years old, uncircumcised, was referred to the STD Clinic with a 1 year history of genital lesions and no prior treatment. [scielo.br]

• Penile Lesion

  A middle-aged uncircumcised man presented with two long-standing erythematous prepucial penile lesions unresponsive to antibiotics. [ncbi.nlm.nih.gov]

  Although lesion biopsy and referral to a dermatologist is always a viable option, urologists can deliver excellent patient care when aware of the current knowledge of common penile lesions and recommended treatments. [scholars.northwestern.edu]

  Differentiating this lesion from similar lesions such as premalignant, infective and other inflammatory penile lesions is important. The current preferred treatment is circumcision and this disorder can be treated relatively easily by circumcision. [kci.go.kr]

• Penile Pain

  Men with suspected balanitis often complain of penile pain and redness. Physical examination revealing an inflamed and erythematous glans confirms the diagnosis of balanitis. [ncbi.nlm.nih.gov]

In uncomplicated cases of balanitis, laboratory studies are not always necessary but the following can be useful when appropriate [8]:

• Serum glucose test (as a part of the diabetes screening test)
• Culture of discharge
• Syphilis serology test
• Wet mount
• Potassium hydroxide (when dealing with Candida)
• HIV and human papilloma virus titers in some cases

Imaging studies that can be deployed include ultrasonography or bladder scan which will helps in detection of urinary obstruction following cases of severe balanitis. A biopsy carried out by a urologist is important in chronic cases.

In patients with balanitis but without the accompanying phimosis, the following are useful recommendations [9]:

• The foreskin must be gently retracted and soaked in warm water, cleaning the foreskin and the penis.
• In patients with mild balanitis xerotica and in pediatric cases, a 2-month trial of antifungals may be attempted. The patient or parent of the pediatric case should retract the foreskin gently and apply 0.05% betamethasone two times a day. This is applicable to children older than 3 years of age. It is more successful in males older than 10 years however, with a success rate of 65-95%. 
• Topical steroids will only bring about limited success especially in patients with moderate-to severe cases of balanitis xerotica obliterans. Using these in such cases often leads to the distal scarring of the foreskin. 
• In recurrent cases, 1% pimecromillus cream can be used instead of steroids. 
• In pediatric patients, bacitracin can be applied if bacterial infection is suspected. Neosporin should not be used. 
• In adult men with probable candida balanitis, topical clotrimazole should be used. 
• In complicated cases such as those with associated cellulitis, a culture of discharge should be obtained. Treatment should then be done empirically with the right antibiotics. 
• Fluticasone proprionate is effective in treatment of associated phimosis and the success rate is placed at 91.1% of cases. 

Patients with severe urinary obstruction as a complication of balanitis should get the following care:

• Surgical intervention should be performed by a urologist when possible
• Steroid cream and gentle retraction of the foreskin when phimosis isn’t excessively tight should be used before surgery is contemplated.
• Without damaging the glans penis, the foreskin should be dilated with the use of a clamp. Analgesia, local anaesthesia and sedation may be required in some instances. 
• A formal circumcision can be performed.

It is important to note that circumcision is not a preventative treatment of balanitis in males younger than 3 years of age [10].

Prognosis is largely dependent on the main causes of the condition and also the presence of any predisposing risk factors [6]. For instance, candidal balanitis often resolves rapidly with the right treatment but it is more than likely to recur in men with phimosis, poor genital hygiene and diabetes mellitus.

Balanitis as a result of contact irritants often gets resolved over a few days following removal of the provoking irritant or allergen. However, it may recur following future exposure.

There are many possible causes of this inflammation [2]. Some of them include irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens which may include bacteria, virus, fungus or sexually transmitted diseases (STDs). Diabetes has also been noted as a risk factor for balanitis especially when blood sugar is not properly controlled.

Below are the proven etiologic factors of balanitis:

• Poor levlels of hygiene
• Use of soap and other chemical causes of irritation
• Congestive heart failure
• Cirrhosis
• Nephrosis
• Allergies
• Severe obesity

The organisms and viruses that have been proven to cause balanitis, including the following:

Borrelia vincentii and Borrelia burgdorferi, trichomonal species, syphilis, Gardnerella vaginalis, human papillomavirus (HPV), chlamyida species, Neisseria gonorrhea and in people with diabetes, candidal species. 

In the United States, balanitis is a common condition which affects at least 3 to 11% of males [3]. There is however, no proof of mortality associated with balanitis. Morbidity on the other hand is associated with the complications of phimosis.

The condition is seen mostly in blacks and Hispanics. There is no clear reason for this but it may be related to the different rates of circumcision.

Balanitis can be seen in males at any age but etiologies vary depending on the age of the individual [4].

The males most affected by balanitis are those with poor personal hygiene [5]. Due to smegma and discharge around the glans penis, lack of aeration and irritation ensues and this leads to inflammation and edema. The main complications of balanitis include phimosis and cellulitis but these are relatively uncommon. Meatal stenosis accompanied by urinary retention is seen with balanitis in rare cases. Another rare occurrence is the buried penis syndrome as a result of balanitis.

Can balanitis be prevented? The risk of balanitis can be reduced with proper hygiene, but not all balanitis can be prevented depending on the underlying cause. [rxlist.com]

Prevent scarring - The only thing more important than fighting balanitis damage is to allow your glans to heal completely. This means preventing scar tissue formation - one of the biggest threats of balanitis. [suragel.com]

Balanitis refers to the inflammation of the glans penis [1]. When the condition affects the foreskin as well, it is known as balanoposthitis. Recurrent cases of balanitis may cause a complication known as phimosis. It most commonly occurs in uncircumcised men.

Balanitis is a condition where the head of the penis develops a sort of a wound. There are many causes of this condition but the most common causes are the use of irritating substances as well as sexually transmitted infections.

The condition can affect men of all ages but it can be easily treated with the use of special creams as long as there has not been any opportunistic complications or infections.