engleski

Aetiology and clinical variations of balanoposthitis

Background. Balanoposthitis is a rather demanding clinical entity including the broad range of aetiological factors and clinical variations. Therefore, the purpose of this survey was to analyze the clinical variations of balanoposthitis in the light of various aetiological factors. Patients and Methods. The retrospective analysis of data obtained from the STD and General Dermatovenereology Outpatient Clinics of University Department of Dermatology and Venereology, Zagreb University Hospital and Medical School of Zagreb University has been performed for the five-year period. The total of 599 patients with clinical findings of balanoposthitis (clearly visible signs of inflammation of the glans penis and the prepuce) attending our Clinics from the year 2003 to 2007 have been included in our study. In general, the results were based on medical history and clinical findings confirmed with the results of the mycological, histopathological and bacteriological (urethral swabs) examination whenever indicated (and/or available). Results. In 326 out of 599 patients, even with the slightest clinical suspicion of balanoposthitis of mycotic aetiology (Candida balanoposthitis), the mycological testing has been performed (direct microscopy and the cultivation on the modified Sabourad medium in the Reference Laboratory for Dermatological Mycology and Parasitology of the Ministry of Health and Social Welfare of Republic of Croatia in our Department). In 227 patients out of these 326, the result of the mycological testing was negative. However, in 99 patients out of 326, Candida spp. has been verified. In the rest of 263 out of the total of 599 patients the lesions were mostly clinically consistent with irritant balanitis (217) followed with: balanitis circumscripta plasmacellularis (Zoon balanitis) (16 patients), circinate balanitis (10 patients), lichen sclerosus et atrophicus (7 patients), lichen planus genitalis (4 patients) and inverse psoriasis (3 patients). In two patients circinate balanitis was found to be a part of Reiter’ s syndrome, the other two patients were HLA B 27+, DR+ positive, but the other criteria have not been fulfilled to establish the diagnosis of Reiter’ s syndrome, whereas in the rest of 6 patients there were no signs of Reiter’ s syndrome. In 8 patients with clinical features of irritant balanitis, serotypes D-K Chlamydia trachomatis have been isolated from urethral swabs ; Ureaplasma urealyticum in 10 patients ; Mycoplasma hominis in 6 patients and Trichomonas vaginalis in 4 patients. In 9 patients considering medical history and clinical findings a Latex allergy has been suspected, but the allergological testing has not been performed due to the patients’ poor compliance. In 6 patients the artefact dermatitis of the genital region has been seriously suspected. Discussion and Conclusion: It can be thus concluded that different aetiological agents can induce similar clinical findings in balanoposthitis, as well as the single aetiological agent of balanoposthitis can induce different clinical features. Moreover, we observed that a certain number of patients with clinical findings of balanoposthitis were referred to as STIs, but these lesions have been finally proven as purely dermatological disorder(s). Under the name of “ irritant balanitis” many other entities might be misdiagnosed, thus the proper and very careful manner of taking history, precise clinical examination, rational laboratory testing and combined “ dermatovenereological” approach are required in order to solve the complexity of this problem.

Balanoposthitis; HPV; aetiology; genital dermatology

nije evidentirano