Balanitis: treatment, symptoms, causes and how long it lasts

The NHS says treatment for balanitis depends on what is causing it. A GP may prescribe a mild steroid cream or ointment, an antifungal cream or ointment, or antibiotics.

NICE CKS matches the treatment to the likely cause, as set out in the table.

The NHS suggests the following if you have balanitis.

• Wash your penis every day using just water or an emollient (moisturising treatment).

• Gently pull back your foreskin and wash the area with warm water, then dry gently.

• If you use condoms, choose condoms for sensitive skin.

• Wash your hands before peeing or touching your penis.

• Do not use soap or shower gel.

• If your child has balanitis, gently wash their penis every day with warm water and dry it gently, change nappies often, do not use soap, bubble bath or baby wipes, and do not pull their foreskin back if it is fixed in place.

With balanitis, the NHS says the head of the penis is usually swollen, itchy and sore. It usually looks red, although this may be less obvious on brown or black skin. Other symptoms can include:

• Pain when peeing.

• A thick discharge that comes from under the foreskin.

• Bleeding around the foreskin.

• An unpleasant smell.

• Difficulty pulling back the foreskin, though in young children it is normal to have a tight foreskin.

Balanitis means inflammation of the glans, the head of the penis. NICE CKS explains that posthitis describes inflammation of the foreskin and that in practice both areas are often affected, in which case the term balanoposthitis may be used. Its guidance uses balanitis to cover both.

It is a symptom with several possible causes, which is why the NHS advises seeing a GP rather than guessing the cause.

The NHS lists the following causes of balanitis.

• Not washing the penis properly.

• A very tight foreskin (phimosis) in some young boys, which means they cannot pull it back to clean under it.

• Thrush.

• A sexually transmitted infection (STI) such as gonorrhoea or chlamydia: if one is suspected you may be referred to a sexual health clinic.

• Substances such as soap, shower gels or condoms that may irritate the skin.

• Diabetes, because high levels of sugar in your pee can cause thrush.

NICE CKS lists a wider range of conditions that can present similarly and may co-exist: non-specific dermatitis with Candida albicans or bacterial infection; other infections such as anaerobes or sexually transmitted infections; inflammatory skin conditions such as irritant or allergic contact dermatitis, seborrhoeic dermatitis, psoriasis, lichen sclerosus, lichen planus or Zoon's balanitis; mechanical irritation and poor hygiene; and pre-malignant conditions (penile intraepithelial neoplasia).

This is why persistent or recurrent balanitis is looked at more closely. A lesion that does not heal, a lump or a patch that keeps changing is a reason to be checked without delay.

Balanitis itself is inflammation of the head of the penis rather than a single infection. The NHS lists a sexually transmitted infection such as gonorrhoea or chlamydia as one possible cause among several, along with thrush, irritation and poor hygiene. So whether it can be passed on depends on the cause.

If an STI is suspected the NHS says you may be referred to a sexual health clinic. NICE CKS says an STI screen should be arranged if clinically indicated, and sexual history is part of the assessment.

NICE CKS says most episodes will improve following accurate diagnosis and appropriate treatment of the underlying cause. The NHS does not give a fixed timescale because it depends on the cause. See a GP again if treatment has not worked.

If balanitis keeps coming back and medicine has not helped, the NHS says circumcision (surgery to remove the foreskin) may be considered.

NICE CKS says balanitis affects about 4% of uncircumcised boys between the ages of 2 and 5 years. The NHS says to see a GP if your child has a swollen, itchy, sore or red head of the penis, or if treatment has not worked.

The NHS notes that it is normal for young children to have a tight foreskin, and advises not pulling a child's foreskin back if it is fixed in place. For nappy care it advises changing nappies often and avoiding soap, bubble bath and baby wipes.

The NHS says a doctor or nurse will look at your penis and ask a few questions. If symptoms are severe they may suggest a blood test to check for conditions that can lead to balanitis, such as diabetes, and may wipe a cotton bud over the head of the penis to test for infections.

NICE CKS sets out that assessment includes asking about the onset and duration of symptoms, hygiene practices, exposure to irritants, allergens and new medicines, underlying skin conditions, sexual history and anything that suppresses the immune system. It says to consider swabs, an STI screen and blood tests for HbA1c and HIV if balanitis is severe or persistent.

The NHS says to see a GP if you or your child have symptoms of balanitis, or if you have balanitis and treatment has not worked. Adults can also go to a sexual health clinic, where the NHS says tests are often returned quicker than from GP surgeries.

NICE CKS advises referral to a specialist if there is diagnostic uncertainty, persistent or recurrent balanitis not responding to primary care treatment, persistent phimosis, suspected allergic contact dermatitis, lichen sclerosus or Zoon's balanitis, or a suspected pre-malignant or malignant lesion. Possible complications it lists include phimosis, paraphimosis, urinary symptoms from narrowing of the urethra opening, sexual dysfunction and penile malignancy.

Most people are assessed and treated by a GP or at a sexual health clinic, with referral to urology or dermatology if the problem persists, recurs or is unclear.

Some people prefer a private consultation, which can make assessment quicker. Whichever route you choose, the same approach applies: find the cause, treat it, and review if it does not settle.