Balanitis

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Read the full PCH Emergency Department disclaimer

Aim

To guide staff with the assessment and management of balanitis.

Definition

Balanitis is an irritation and inflammation of the foreskin and glans, often associated with poor hygiene. There is usually an infective component to the condition, and there may be an associated nappy rash.

Assessment

Mild to severe swelling of the foreskin and glans
Erythema

Investigations

No investigations are required

Differential diagnoses

Paraphimosis

Management

If the patient is able to void urine

Oral antibiotics - cefalexin or trimethoprim with sulphamethoxazole (co-trimoxazole) - ChAMP monographs
Mupirocin 2% ointment if bacterial infection is suspected, topically 2 or 3 times a day for 5-10 days.³
Twice daily salt baths.
Referral to Surgical Outpatients only if recurrent episodes.

If the patient is unable to void urine

Provide adequate analgesia
Attempt voiding in a warm bath
Refer to paediatric surgical team
If the bladder is full, consider 'in-out' urinary catheterisation to empty bladder. Try to avoid an indwelling catheter if possible
IV or oral antibiotics as recommended by the surgical team
Twice daily salt baths.

Medications

Analgesia - ED guideline
Antibiotics - ED guideline

Referrals and follow-up

Urgent paediatric surgical referral if:

Urinary retention
Paraphimosis

Outpatient paediatric surgical referral if:

Recurrent severe episodes of balanitis.

References

Morris BJ, Krieger, JN, Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision. Int J Prev Med. 2017; 8: 32.
Tews M, Singer J, Balanitis and balanoposthitis in children and adolescents: Management. Up to Date Last updated Oct 2019. Cited 10 November 2021. Available from: Balanitis and balanoposthitis in children and adolescents: Management - UpToDate (health.wa.gov.au)
AMH Children’s Dosing Companion (2021) Australian Medicines Handbook Pty Ltd. Modified: July 2021; Cited 9 November 2021
Textbook of Paediatric Emergency Medicine 3rd Edition Cameron P, Browne GJ, Mitra B, et al (2018) Publisher: Elesevier Edition updated.
Nelson Textbook of Pediatrics: 21st Edition Robert M. Kliegman, St Geme JW, Blum MJ et al. 2020 Publisher: Elsevier

Endorsed by:	Drugs and Therapeutics Committee	Date:	Dec 2021
		Review date:	Nov 2024

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