What's happening and who's at risk
Fungi of the genus Candida are opportunistic: they are present in healthy people and cause inflammation only under suitable conditions. They require warmth, moisture and a nutrient medium rich in glucose. That is why candidal balanoposthitis especially often develops in poorly controlled diabetes mellitus - sugar in the urine and on the skin becomes ready food for fungi. The second common situation is suppression of normal bacterial flora after a course of antibiotics. In men with a narrow foreskin, moisture remains under it and smegma accumulates, which further supports inflammation.
- Diabetes mellitus and prediabetes
- Recent course of antibiotics
- Phimosis and cicatricial changes in the foreskin
- Obesity and excessive sweating
- Decreased immunity, taking glucocorticoids
- Unprotected contact with a partner who has an exacerbation of thrush
Symptoms
The disease usually begins with itching and a slight burning sensation on the head, followed by redness and swelling within a day or two. A white coating appears, similar to cottage cheese or sour milk, with a characteristic sour odor; under the coating the skin is bright red, sometimes with small erosions. Urination and sexual intercourse become painful. In a chronic course, severe inflammation goes away, but dryness, small cracks and tightness of the skin remain, and over time, a cicatricial narrowing of the foreskin may form.
- Itching and burning of the glans penis
- Redness and swelling of the glans and foreskin
- White cheesy coating with a sour odor
- Pain during urination and sexual intercourse
- Small cracks and erosions
- Chronic dryness and tightness of the skin
What can be confused with
Not every plaque and redness is candidiasis. A similar picture is given by allergic and irritant dermatitis from soap, latex or lubricants, psoriasis and lichen planus with damage to the head. Some sexually transmitted infections also begin with redness and discharge, so if there is a new partner, the examination is expanded. Persistent red plaques and non-healing erosions in older men require special attention: they must be shown to a dermatologist or urologist to exclude precancerous skin changes.
- Allergic and contact dermatitis
- Psoriasis, lichen planus
- Sexually transmitted infections
- Bacterial balanoposthitis
- Precancerous skin diseases of the penis
Diagnostics
In most cases, the diagnosis is obvious upon examination: typical plaque and redness do not require complex studies. It is confirmed by smear microscopy or PCR testing for candida; culture with sensitivity determination is needed for persistent and recurring episodes. It makes sense for almost every man with candidal balanoposthitis to check his blood glucose - newly diagnosed diabetes is detected this way quite often. If other infections are suspected, a urethral smear and appropriate tests are taken.
- Examination by a urologist or dermatologist
- Smear microscopy and PCR for candida
- Culture with sensitivity determination for relapses
- Blood glucose, if necessary - glycated hemoglobin
- Screening for sexually transmitted infections
Treatment and prevention
The basis of treatment is local antifungal agents in the form of a cream, which are applied to clean, dry skin in a course prescribed by a doctor. For severe inflammation, recurring episodes, or diabetes, a systemic antifungal drug is added. You should not use ointments with hormones on your own: they reduce itching, but support the proliferation of fungi. It is important to improve hygiene - wash the head with warm water without aggressive soap and dry it thoroughly, wear cotton underwear. A prerequisite for recovery is blood sugar control. For cicatricial phimosis with recurring inflammation, circumcision is discussed.
- Local antifungal creams as prescribed by a doctor
- Systemic antifungal drug for severe or recurrent disease
- Daily gentle hygiene and thorough drying of the skin
- Blood glucose control and diabetes management
- Examination and, if necessary, treatment of the partner
- Surgical treatment for cicatricial phimosis
