BA — Key Facts & Diagnosis

Clinical description

Balanitis and balanoposthitis are inflammation of the glans penis and/or foreskin.

• Main symptoms: redness, swelling, itching, burning, pain of the glans penis/foreskin. ± discharge, ± unpleasant odour.
• Mostly caused by poor hygiene / tight foreskin (phimosis) → non-specific bacterial or fungal infection.
• Non-STI causes (most common): Candida, Staphylococcus, Streptococcus, Gardnerella, E. coli.
• STI causes: Candida, HSV-2, syphilis, chancroid, LGV, granuloma inguinale.
• Recommend circumcision if foreskin is not easily retractable (after BA is fully healed).

Treatment

If genital ulcers/sores present: treat as GUD. If ulcers absent: treat for candidiasis. Educate: wash glans and under foreskin daily with mild soap.

Standard treatment (no ulcers)

• Clotrimazole 1% cream BD for 7 days OR gentian violet 1% solution OD for 7 days.

If not improved after 3–7 days

• Metronidazole 2000 mg oral stat.
• Treat partner: clotrimazole 500 mg vaginal pessary stat.
• Re-educate: wash daily with mild soap.

Routine partner treatment is not usually needed unless BA fails to improve or re-occurs.

At every visit

HIV & ART status

• Ascertain HIV + ART status from health passport or self-report.
• Offer new HIV test for all unless previously diagnosed. Do not use coercion.
• New positive: active referral for ART initiation.
• New negative: refer/offer PrEP, VMMC, consistent condom use.
• Known positive: reinforce ART adherence or refer for re-initiation.

Hepatitis B

• Offer HBV rapid test for all patients born before 2002.
• HBsAg negative: refer for HBV vaccination unless previously completed 3 doses.
• HBsAg positive: refer for clinical and treatment assessment.

Syphilis screening

• Offer syphilis rapid test for concurrent asymptomatic syphilis (except in GUD/ARI where it does not influence treatment decisions).

Risk reduction & condoms

• Risk reduction counselling. Promote and dispense condoms.
• Promote VMMC for all non-circumcised men. Schedule appointment in 2 weeks.