Papillomavirus-associated balanoposthitis. (33/37)

OBJECTIVE: To assess whether there might be an association between genital papillomavirus infection (GPVI) and balanoposthitis. DESIGN: Retrospective HPV DNA examination of biopsy specimens from 23 men suffering from balanoposthitis and exhibiting acetowhite lesions that were penoscopically and histologically concurrent with HPV infection. SETTING: The STD clinics at Karolinska Hospital and South Hospital, Stockholm, Sweden. PARTICIPANTS: Randomly selected men attending with long-lasting and/or recurrent penile symptoms and exhibiting a clinical picture of balanoposthitis, who revealed a penoscopical and histopathological picture of epidermal lesions that were concordant with accepted criteria for typical or conspicuous GPVI. Asymptomatic controls were selected retrospectively on the basis of identical penoscopy and histology criteria. RESULTS: A history of previous condylomata was obtained in eight (35%) of 23 men. At penoscopic evaluation tiny condylomatous lesions were observed in five (22%) patients. The in situ hybridisation (ISH) assay using specific probes for the HPV types 6/11, 16/18, 31/33 and 42 was positive in 13/23 (56%) of the patient samples, but in only 26% of the 19 control samples. In patient biopsies the oncogenic HPV types 16/18 and/or 31/33 were found in 7/13 samples, whereas HPV 6/11 and/or 42 were present in another six cases. PCR performed on the ten ISH negative patient biopsies, were negative in all cases. CONCLUSION: Symptoms included redness, itching, burning, tenderness, dyspareunia, fissuring and in two cases penile oedema and inguinal adenopathy. All patients fulfilled penoscopical and histopathological criteria for HPV infection. We demonstrate some tentative evidence that HPV might be associated with long-lasting balanoposthitis, although our data still are circumstantial for a causative association. The results also elucidate the diversity in clinical presentation of GPVI.  (+info)

Clinical features and management of recurrent balanitis; association with atopy and genital washing. (34/37)

OBJECTIVE: To evaluate clinical features and diagnostic investigations in patients with recurrent or unresponsive balanitis in order to institute rational management. DESIGN: Forty-three patients presenting to a genitourinary medicine clinic with recurrent or persistent balanitis were studied. All patients were asked whether they had a history of atopic illness and about their practice of genital washing. All patients were investigated by taking a swab specimen from the preputial area for bacterial and viral culture and 30 underwent biopsy of the affected skin. Follow-up was between three and six months. SETTING: Outpatient genitourinary medicine clinic, St Mary's Hospital, London, UK. RESULTS: In 31 (72%) of the patients a diagnosis of irritant dermatitis was made. In comparison with the remaining patients, they had a greater lifetime incidence of atopic illness and more frequent daily genital washing with soap. For 28 (90%) of these patients, use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily. For the remaining 12 patients, a variety of diagnoses were made. Biopsy proved a well tolerated and diagnostic investigation, but the isolation of microbial pathogens from preputial swabs was irrelevant to management. CONCLUSION: A history of atopic illness and of the practice of penile washing are important aspects in the evaluation of patients with recurrent balanitis. Biopsy is an important investigation in the condition when it does not seem to be caused by irritant dermatitis.  (+info)

Candidal balano-posthitis: a study of diagnostic methods. (35/37)

OBJECTIVES: To compare microscopy with culture for diagnosing candidal balanoposthitis and to document which diagnostic methods are used in genitourinary medicine clinics in Great Britain. DESIGN: (a) Penile material for microscopy and fungal culture were obtained from men with balano-posthitis. A "plain-slide" method of collecting material for microscopy was compared with a novel "adhesive-tape" method of sampling. (b) Questionnaires were sent to all genitourinary medicine clinics in Great Britain. SETTING: The Department of Genitourinary Medicine, Addenbrooke's Hospital, Cambridge, England. MAIN OUTCOME MEASURES: The sensitivity and specificity of microscopy using culture as the "gold standard" for diagnosis. RESULTS: Candida was isolated from 35% of 450 men with balano-posthitis attending the clinic over a three year period. The sensitivity of microscopy compared with culture was 12% ("plain-slide" method of material collection) and 65% ("adhesive-tape" method) (p < 0.0001). The respective specificities were 95% and 81%. The positive predictive values for the two methods of material collection were 50% ("plain-slide" method) and 75% ("adhesive-tape" method). The respective negative predictive values were 71% and 72%. 60% of 250 genitourinary medicine clinics returned questionnaires. 13% routinely diagnosed candidal balanoposthitis by appearance only and 34% sometimes relied only on clinical appearance. Culture was used by 78% and microscopy by 69% of clinics. Material for microscopy was most commonly collected by using a cotton-wool tipped swab and the Gram stain was the favoured method for microscopy. CONCLUSION: Candida is a common cause of balano-posthitis. Diagnosis by microscopy has a low sensitivity and varies with the method used for collecting material. Although up to one third of genitourinary medicine clinics may rely solely on clinical appearance for diagnosis most continue to use microscopy and culture.  (+info)

Comparison of the efficacy and safety of oral fluconazole and topical clotrimazole in patients with candida balanitis. (36/37)

One hundred fifty seven men with candidal balanitis were entered in a randomised, open-label parallel-group multicentre study comparing efficacy and safety of a single oral 150-mg fluconazole-dose with clotrimazole applied topically twice daily for 7 days. Of 64 fluconazole and 68 clotrimazole treated patients who were evaluable at short term follow up, 92% and 91% respectively were clinically cured or improved. Candida albicans was eradicated in 78% and 83% of patients respectively. Median time to relief of erythema was 6 days for fluconazole and 7 days for clotrimazole. Twelve of 15 patients who had received previous topical therapy for balanitis said they preferred oral therapy. At the one month follow up visit, 24/36 and 29/33 patients in the two groups were clinically cured or improved. Nine in the fluconazole group experienced a relapse; 6 of these 9 patients reported previous episodes of this infection during the past year. Two patients in the clotrimazole group had a relapse; neither had a history of previous episodes. Mycological eradication was noted in 26/36 and 25/33 patients in the two groups. Both treatment regimens were well tolerated. Thus a single 150 mg dose of fluconazole was comparable in efficacy and safety to clotrimazole cream applied topically for 7 days when administered to patients with balanitis.  (+info)

Balanitis and balanoposthitis: a review. (37/37)

OBJECTIVES: To give an overview of the literature on balanitis, with a special emphasis on infective causes. METHOD: A data search was performed using the OVID CD plus Medline 1967-1995, using balanitis and balanoposthitis as textword search strategy. Specific subjects such as anaerobic infection, Zoon's balanitis were sought separately and subgroups combined. Original articles and abstracts were referenced to illustrate each condition. These were mainly English language articles, but included appropriate non-English language papers. CONCLUSIONS: Balanitis is a common condition among genitourinary medicine clinic attendees, the cause often remaining undiagnosed. Many cases are caused by infection, with candida being the most frequently diagnosed. However, gardnerella and anaerobic infections are common, and there are a wide variety of other rarer infective causes. In addition irritant balanitis is probably a contributing factor in many cases. Balanitis which persists and in which the cause remains unclear warrants biopsy.  (+info)