Persistent Balanitis: Symptoms and Treatment Options

Balanitis cannot be cured?

Hello, Doctor.
Let me provide some basic information.
I have no history of genital diseases and have not engaged in sexual intercourse since the onset of my symptoms.
Prior to the onset, I experienced a problem where the skin at the meatus was torn and bled after exercise, but it healed without major issues.
I have never undergone circumcision, but I can easily retract my foreskin.
Although I haven't checked my blood sugar for a while, my weight, dietary habits, and daily routine have not changed significantly, and there is no family history of diabetes.
I have been consistently exercising.
Around the end of last year, I developed balanitis.
The initial symptoms included white, foul-smelling discharge in the coronal sulcus, and after an erection, there were flaky skin remnants on the surface of the glans, resembling a network.
After a period of no improvement, I sought medical attention.
The doctor diagnosed it as balanitis and prescribed Meikang cream for me to apply.
Initially, there was improvement, and during a follow-up visit, the doctor noted significant improvement and advised me to stop applying the cream.
However, within a few days, the symptoms recurred.
I continued to apply the medication, but it no longer affected the condition, which became intermittent, with periods of improvement and worsening.
The frequency and symptoms after applying the cream remained similar to when I was consistently using it.
Following the doctor's advice to maintain local hygiene and keep the area dry, I have developed a habit of cleaning myself thoroughly after using the restroom.
Therefore, there is currently minimal smegma, but there is still a smell reminiscent of fermentation or decay.
The current symptoms differ slightly from the initial ones; after an erection, the coronal area of the glans has folds (which did not occur before).
In severe cases, there are subtle, patchy red spots on the glans, and after an erection, there are flaky remnants of skin.
Occasionally, there is an itch, but it is infrequent and not severe.
The coronal sulcus is now a bright red color, whereas it used to be similar to the surrounding skin color.
Despite maintaining abstinence for over a month, the symptoms continue to recur at my usual frequency.
I have researched many articles, but none closely resemble my issue, only mentioning that recurrence is common after onset.
I have taken all preventive measures possible, but there has been no improvement.
The hospital only provided me with another tube of Meikang cream.
Therefore, I would like to ask the doctor if my current symptoms are normal or if there is still an issue.
Did I miss anything in my description, or do the doctors think my symptoms are mild? The doctor I consulted at the time advised me to continue applying the cream twice a day, but it has been over six months since the onset, and although the symptoms are not severe, there are no signs of recovery.
I appreciate your help in clarifying my concerns.
Thank you.

ericlee, 20~29 year old female. Ask Date: 2018/08/07

Dr. Du Mingyi reply Urology

Maintaining cleanliness and dryness is essential.
If there are recurrent inflammations, consider circumcision.

Reply Date: 2018/08/07

More Info

Persistent balanitis, or inflammation of the glans penis, can be a challenging condition to manage, especially when symptoms persist despite treatment. Based on your description, it seems you have been experiencing recurrent symptoms of balanitis, including white, foul-smelling discharge, skin peeling, and redness, particularly in the coronal sulcus area.

Understanding Balanitis
Balanitis can be caused by various factors, including infections (bacterial, fungal, or viral), irritants (such as soaps or lotions), and underlying medical conditions (like diabetes). Given that you have not had sexual intercourse and have no significant medical history, it is essential to consider other potential causes.
1. Infection: The presence of foul-smelling discharge and skin changes suggests a possible infection, which could be fungal (like Candida) or bacterial. The fact that you have had some improvement with topical treatments indicates that there may be an infectious component that responds to these medications.

2. Irritation: Mechanical irritation from activities such as exercise or friction can exacerbate symptoms. Maintaining cleanliness and dryness is crucial, as moisture can promote the growth of pathogens.

3. Underlying Conditions: While you mentioned that you do not have a family history of diabetes and maintain a healthy lifestyle, it might still be worth checking your blood sugar levels, as uncontrolled diabetes can lead to recurrent infections.

Treatment Options
1. Topical Treatments: You mentioned using a topical cream (Miconazole) which is effective for fungal infections. If the symptoms persist, it might be beneficial to consult your doctor about switching to a stronger antifungal or considering a combination treatment that targets both fungal and bacterial infections.

2. Oral Medications: In cases where topical treatments are insufficient, oral antifungal or antibiotic medications may be necessary. This approach can help address any underlying infections that are not responding to topical therapy.

3. Hygiene Practices: Continue to maintain good hygiene by cleaning the area gently with mild soap and water, ensuring it is thoroughly dried afterward. Avoid irritants such as scented soaps or lotions that could exacerbate the condition.

4. Follow-Up Care: Since you have been experiencing these symptoms for over six months without significant improvement, it is crucial to follow up with your healthcare provider. They may consider performing a culture of the discharge to identify the specific pathogen involved, which can guide more targeted treatment.

5. Consider Referral: If your symptoms do not improve with standard treatments, it may be worthwhile to seek a referral to a dermatologist or urologist who specializes in genital skin conditions. They can provide a more comprehensive evaluation and explore other potential causes or treatments.

Conclusion
Your symptoms are not uncommon in cases of persistent balanitis, but the lack of improvement over an extended period suggests that further evaluation and possibly a change in treatment strategy are warranted. It is essential to communicate openly with your healthcare provider about your ongoing symptoms and concerns. They can help determine if additional tests or treatments are necessary to address your condition effectively. Remember, persistent symptoms should not be ignored, and seeking further medical advice is always a prudent step.

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