Balanitis / Balanoposthitis — বাংলা ক্লিনিক্যাল নোট
Balanitis = glans penis/penile head-এর inflammation।
Posthitis = foreskin/prepuce-এর inflammation।
Balanoposthitis = glans + foreskin দুটোই inflamed; uncircumcised male-এ বেশি দেখা যায়। IUSTI 2022 guideline অনুযায়ী balanoposthitis infection, dermatoses এবং premalignant penile skin disease—সবকিছুর কারণে হতে পারে।
Clinical note: নিচের dose মূলত প্রাপ্তবয়স্ক পুরুষের জন্য। শিশু, diabetes, immunosuppression, pregnancy-related partner issue, ulcer/STI suspicion, urinary retention, phimosis/paraphimosis হলে physician/urologist/dermatologist review দরকার।
1) Cause / Etiology & Pathophysiology — কারণগুলো
A. Infective causes
1. Candida balanitis — সবচেয়ে common infective cause
Candida সাধারণত warm, moist, occluded preputial sac-এ grow করে। Diabetes mellitus, recent antibiotic use, immunosuppression, obesity, poor hygiene, tight foreskin/phimosis থাকলে ঝুঁকি বাড়ে। Candida balanitis-এ erythema, itching, burning, white curdy discharge থাকতে পারে। Diabetes Candida balanitis-এর independent risk factor হিসেবে reported।
2. Aerobic bacterial infection
Staphylococcus aureus, Streptococcus spp. ইত্যাদি bacteria glans/foreskin-এ redness, swelling, pus/discharge, fissuring করতে পারে। severe হলে cellulitis/lymphangitis হতে পারে। MSD Manual infectious causes-এর মধ্যে candidiasis, chlamydial/gonococcal urethritis, HSV, syphilis, scabies, trichomoniasis ইত্যাদি উল্লেখ করে।
3. Anaerobic infection
Bad smell, erosions, discharge, tenderness—এগুলো anaerobic balanoposthitis-এ বেশি দেখা যায়। IUSTI guideline anaerobic infection-এ metronidazole 400 mg twice daily × 1 week regimen দিয়েছে।
4. STI-related causes
HSV genital herpes, syphilis, gonorrhoea/chlamydia urethritis, trichomoniasis, HPV wart, molluscum contagiosum, scabies—সবগুলো genital inflammation/ulcer/papule/discharge দিয়ে present করতে পারে। CDC STI guideline genital herpes, gonorrhoea, chlamydia ও syphilis-এর diagnostic/treatment regimen দেয়।
1) Cause গুলো বিস্তারিত
1. Poor hygiene / smegma জমা
- Foreskin-এর নিচে dead skin cell, sweat, urine drop, semen residue ও secretion জমে smegma তৈরি হয়।
- এই smegma moist environment তৈরি করে; bacteria/fungus সহজে grow করে।
- এতে glans ও foreskin irritated হয়ে redness, itching, bad smell, discharge হয়।
- Phimosis থাকলে foreskin পিছনে নেওয়া যায় না, তাই পরিষ্কার করা কঠিন হয়; MSD Manual বলেছে phimosis hygiene interfere করে এবং subpreputial secretion infected হয়ে inflammation করতে পারে।
2. Phimosis / tight foreskin
- Foreskin tight হলে glans expose করা যায় না।
- Urine, smegma ও sweat trapped থাকে।
- Repeated infection হলে foreskin আরও tight হয়—এটা আবার infection বাড়ায়; অর্থাৎ vicious cycle তৈরি হয়।
- Long-term chronic balanoposthitis phimosis, paraphimosis ও cancer risk-এর সাথে related হতে পারে।
3. Candida fungal infection
- Candida balanitis-এ glans লাল, itchy, sore হয়।
- Diabetes mellitus, older age, recent antibiotic use, immunosuppression, poor hygiene, moist foreskin—এগুলো risk বাড়ায়।
- IUSTI guideline Candida balanoposthitis-এ erythematous rash with soreness/itch, small papules, erosion বা dry glazed red area উল্লেখ করেছে; diabetes ও older age risk factor।
Mechanism:
Diabetes-এ urine/skin secretion-এ glucose বেশি থাকতে পারে, immunity কমে, moist area থাকে—Candida grow করে inflammation করে।
4. Bacterial infection
Aerobic bacteria
- Staphylococcus spp., Streptococcus spp., Group A Streptococcus balanoposthitis করতে পারে।
- সাধারণত বেশি pain, swelling, pus, crusting, fissure দেখা যায়।
- Severe হলে cellulitis বা lymphangitis হতে পারে।
Anaerobic bacteria
- Foreskin-এর নিচে oxygen কম থাকে; তাই anaerobic bacteria grow করতে পারে।
- Bad smell, erosive lesion, dirty discharge—এগুলো বেশি suggestive।
IUSTI guideline infective balanoposthitis-এ Candida, Staphylococcus, Streptococcus, anaerobes, HSV, HPV, syphilis, chlamydia ও trichomonas উল্লেখ করেছে।
5. STI-related causes
Sexually transmitted infection থেকেও balanitis/balanoposthitis হতে পারে।
- HSV genital herpes: painful vesicle বা ulcer
- Syphilis: painless ulcer/chancre, lymph node
- Gonorrhoea/Chlamydia urethritis: urethral discharge, dysuria
- Trichomonas: irritation, discharge
- HPV: genital wart
- Scabies/Molluscum: itchy papule/skin lesion
MSD Manual infectious causes হিসেবে candidiasis, chlamydial urethritis, gonococcal urethritis, HSV, molluscum, scabies, syphilis ও trichomoniasis উল্লেখ করেছে।
6. Irritant / allergic contact dermatitis
- Harsh soap, Dettol/Savlon, antiseptic wash, perfumed gel, lubricant, spermicide, latex condom, detergent—এসব glans-এর thin skin irritate করে।
- বেশি washing করলেও natural protective oil নষ্ট হয়ে irritation হয়।
- IUSTI guideline poor hygiene-এর পাশাপাশি over-washing, non-retraction of foreskin, soap irritant, diabetes—predisposing factor হিসেবে উল্লেখ করেছে।
7. Skin disease / inflammatory dermatoses
এগুলো infection নয়, কিন্তু দেখতে balanitis-এর মতো লাগে।
- Psoriasis: well-demarcated red shiny plaque
- Lichen sclerosus / BXO: white, tight, scarred foreskin; meatal narrowing হতে পারে
- Lichen planus: violaceous/erosive lesion
- Zoon’s balanitis: shiny red-orange moist plaque; older uncircumcised male-এ বেশি
- Seborrheic dermatitis / eczema: redness, scaling, itching
- Fixed drug eruption: কোনো drug খাওয়ার পর একই জায়গায় dusky red/black patch বারবার হয়
MSD Manual noninfectious causes হিসেবে contact dermatitis, fixed drug eruption, lichen planus, psoriasis, reactive arthritis, seborrheic dermatitis ও balanitis xerotica obliterans উল্লেখ করেছে।
8. Premalignant / malignant condition
- সব balanitis simple infection না।
- Persistent red velvety plaque, non-healing ulcer, bleeding, hard lesion, irregular growth থাকলে penile intraepithelial neoplasia বা penile cancer exclude করতে হবে।
- IUSTI guideline বলেছে balanoposthitis presentation premalignancy থেকেও হতে পারে এবং uncertain persistent lesion-এ biopsy দরকার হতে পারে।
B. Non-infective causes
1. Irritant/contact dermatitis
Excessive washing, harsh soap, antiseptic, Dettol/Savlon, perfumed gel, lubricant, spermicide, latex condom allergy—এগুলো irritant/allergic balanitis করতে পারে।
2. Dermatological diseases
Psoriasis, lichen sclerosus/BXO, lichen planus, Zoon’s balanitis, seborrhoeic dermatitis, eczema, fixed drug eruption—এগুলো recurrent বা chronic balanitis-এর common non-infective cause। MSD Manual noninfectious causes হিসেবে contact dermatitis, fixed drug eruption, lichen planus, psoriasis, reactive arthritis, seborrhoeic dermatitis, balanitis xerotica obliterans উল্লেখ করে।
3. Premalignant/malignant lesions
Persistent red velvety plaque, non-healing ulcer, bleeding, induration, pigmentation change, irregular growth—Penile intraepithelial neoplasia বা squamous cell carcinoma exclude করতে হবে। IUSTI guideline atypical/persistent disease-এ specialist opinion including biopsy recommend করে।
2) Symptoms / Clinical Features — লক্ষণগুলো
- Glans/foreskin লাল হওয়া, burning, itching, irritation
- Pain/tenderness, sexual intercourse-এ pain
- Foreskin ফুলে যাওয়া, tight হয়ে যাওয়া, retract করতে কষ্ট
- White curdy discharge — Candida suggestive
- Foul-smelling discharge/erosion — anaerobic বা mixed infection suggestive
- Pus/crusting, fissure, superficial ulcer — bacterial/STI/dermatosis হতে পারে
- Dysuria বা urethral discharge — urethritis/STI consider
- Vesicle → painful ulcer — HSV consider
- Painless chancre/ulcer + lymph node — syphilis consider
- Recurrent episode — diabetes, phimosis, dermatitis, lichen sclerosus, poor hygiene evaluate
- Inguinal lymph node swelling থাকতে পারে; MSD Manual pain, irritation, subpreputial discharge, phimosis, superficial ulceration ও inguinal adenopathy উল্লেখ করে।
2) Symptoms গুলো বিস্তারিত
A. Common symptoms
1. Redness / লাল হয়ে যাওয়া
- Glans ও foreskin লাল হয়।
- Candida হলে blotchy red rash, small papules, dry glazed red area থাকতে পারে।
- Dermatitis হলে diffuse red irritation হয়।
- Psoriasis/Zoon’s হলে shiny plaque-এর মতো দেখা যায়।
2. Itching / চুলকানি
- Candida ও dermatitis-এ itching বেশি common।
- Fungal infection-এ চুলকানির সাথে burning ও soreness থাকতে পারে।
- Scabies হলে রাতে itching বেশি হয় এবং partner/family member-এরও itching থাকতে পারে।
3. Burning sensation / জ্বালাপোড়া
- Urine touch করলে জ্বালা বাড়তে পারে।
- Soap/antiseptic reaction, Candida, bacterial infection, ulcer—সব ক্ষেত্রেই burning হতে পারে।
4. Pain / soreness
- Glans touch করলে ব্যথা লাগে।
- Intercourse বা masturbation করলে pain বাড়ে।
- Bacterial infection, fissure, ulcer, HSV-তে pain বেশি হতে পারে।
- MSD Manual balanitis/balanoposthitis-এ pain, irritation ও subpreputial discharge উল্লেখ করেছে।
5. Foreskin swelling / foreskin ফুলে যাওয়া
- Inflammation হলে foreskin oedematous হয়।
- Swelling বেশি হলে foreskin পিছনে নেওয়া কঠিন হয়।
- Tight foreskin থাকলে phimosis worsen করতে পারে।
6. Discharge / foreskin-এর নিচে স্রাব
- White curdy discharge → Candida suggestive
- Yellow/pus-like discharge → bacterial infection suggestive
- Foul-smelling discharge → anaerobic infection suggestive
- Urethral discharge থাকলে gonorrhoea/chlamydia urethritis ভাবতে হবে।
7. Bad smell / দুর্গন্ধ
- Smegma জমা, poor hygiene, anaerobic bacterial infection-এ বেশি হয়।
- শুধু smell থাকলেই STI না; কিন্তু discharge, ulcer, dysuria থাকলে STI test দরকার।
8. Ulcer / erosion / ঘা
- Superficial erosion Candida, dermatitis, bacterial infection-এ হতে পারে।
- Painful grouped vesicle/ulcer → HSV suspect
- Painless firm ulcer → syphilis suspect
- Non-healing ulcer → premalignant/malignant lesion exclude করতে হবে।
MSD Manual superficial ulceration ও inguinal adenopathy হতে পারে বলে উল্লেখ করেছে।
9. Fissure / skin crack
- Foreskin বা glans-এর skin crack হতে পারে।
- Candida, eczema, tight foreskin, repeated inflammation-এ fissure হয়।
- Fissure থাকলে intercourse বা foreskin retract করার সময় pain ও bleeding হতে পারে।
10. Dysuria / প্রস্রাবে জ্বালা
- Glans inflamed থাকলে urine touch করলেই জ্বালা হতে পারে।
- Urethral discharge বা deep burning থাকলে urethritis/STI consider করতে হবে।
- Meatal narrowing থাকলে urine stream thin/weak হতে পারে; lichen sclerosus-এ হতে পারে।
11. Pain during sex
- Inflamed glans friction সহ্য করতে পারে না।
- Fissure, dryness, swelling, tight foreskin থাকলে intercourse painful হয়।
- Recurrent balanitis sexual avoidance বা anxiety তৈরি করতে পারে।
12. Inguinal lymph node swelling
- Infection বা ulcerative STI থাকলে groin lymph node ফুলতে পারে।
- Painful node bacterial/HSV-তে হতে পারে।
- Painless node syphilis বা malignancy suspicion-এ evaluate করা দরকার।
) Cause অনুযায়ী symptom pattern
Candida pattern
- Itching বেশি
- Red rash
- Soreness/burning
- White curdy discharge
- Small red papule বা erosion
- Diabetes/recent antibiotic history থাকতে পারে
IUSTI Candida balanoposthitis-এ soreness/itch, blotchy erythema, small papules, erosion এবং dry glazed red area উল্লেখ করেছে।
Bacterial pattern
- Pain বেশি
- Swelling
- Pus-like discharge
- Crusting
- Fissure
- Bad smell থাকতে পারে
- Severe হলে fever/cellulitis হতে পারে
Anaerobic pattern
- Foul smell prominent
- Dirty discharge
- Erosion
- Tenderness
- Foreskin-এর নিচে wet/macerated area
Irritant/contact dermatitis pattern
- Soap/condom/lubricant ব্যবহারের পর শুরু
- Diffuse redness
- Burning বেশি
- Itching থাকতে পারে
- Usually pus/discharge কম
- Skin dry/cracked হতে পারে
HSV pattern
- Painful vesicle → ulcer
- Burning/tingling আগে হতে পারে
- Recurrent episode হতে পারে
- Groin node painful হতে পারে
Syphilis pattern
- Usually painless ulcer
- Firm edge
- Groin lymph node
- Pain কম হলেও risky sexual exposure থাকলে test জরুরি
Lichen sclerosus pattern
- White patch
- Foreskin tight
- Skin scarred/wrinkled
- Painful fissure
- Urine stream narrow হতে পারে
- Recurrent balanitis-এর মতো present করতে পারে
Psoriasis / Zoon’s / chronic dermatoses pattern
- Long-lasting red plaque
- Itching কম বা মাঝারি
- Antibiotic/antifungal দিলে পুরোপুরি ভালো হয় না
- বারবার ফিরে আসে
- Dermatology evaluation দরকার
Premalignant/malignant suspicious pattern
- ৪ সপ্তাহের বেশি persistent lesion
- Non-healing ulcer
- Bleeding
- Hard/indurated area
- Irregular growth
- Red velvety plaque
- Pain না থাকলেও serious হতে পারে
4) মনে রাখার সহজ shortcut
Itch + white discharge = Candida ভাবুন
Pus + pain + swelling = bacterial ভাবুন
Bad smell + erosion = anaerobic ভাবুন
Soap/condom-এর পর burning = irritant/allergy ভাবুন
Painful ulcer = HSV ভাবুন
Painless ulcer = syphilis ভাবুন
White tight foreskin = lichen sclerosus ভাবুন
Persistent hard/bleeding/non-healing lesion = cancer exclude করুন
Overview / Summary
Balanitis/balanoposthitis-এর cause তিন ভাগে ভাবলে সহজ: infection, irritant/allergic/skin disease, এবং premalignant/malignant lesion। Main symptoms হলো redness, itching, burning, pain, swelling, discharge, bad smell, ulcer, fissure, dysuria ও painful sex। Recurrent বা persistent case-এ শুধু antifungal দিয়ে বারবার treat না করে diabetes, STI, phimosis, dermatoses ও malignancy exclude করতে হবে।
Actionable Plan / Steps
- Symptoms দেখে cause pattern identify করুন।
- Discharge/ulcer/STI risk থাকলে swab/NAAT/serology করুন।
- Recurrent Candida-like balanitis হলে FBS/HbA1c করুন।
- Persistent lesion >4 weeks, ulcer, bleeding, hard plaque হলে biopsy/referral করুন।
- Tight foreskin বা repeated balanoposthitis হলে urology review করুন।
3) Clinical Diagnosis & Specific Investigations
Clinical diagnosis
Diagnosis মূলত history + genital examination। History-তে জানতে হবে: onset, itching/burning/pain, discharge, ulcer, dysuria, sexual exposure, condom/lubricant use, soap/antiseptic use, diabetes, recent antibiotics, immunosuppression, recurrent episode, foreskin retractability। Examination-এ glans, prepuce, urethral meatus, inguinal nodes, scrotal/perianal skin, oral/skin lesions দেখা উচিত। MSD Manual history/physical exam এবং selective microbiological testing recommend করে।
Specific investigations
| Situation | Investigation |
| First episode, mild Candida-like | Often clinical; recurrent/severe হলে test |
| Candida suspicion | Subpreputial swab/KOH microscopy, fungal culture if recurrent |
| Pus/discharge/cellulitis | Swab for Gram stain, culture & sensitivity |
| Dysuria/urethral discharge/STI risk | First-catch urine or urethral swab NAAT for N. gonorrhoeae + C. trachomatis |
| Vesicle/ulcer | HSV PCR from lesion; syphilis serology |
| Painless ulcer/rash/lymph node | RPR/VDRL + TPHA/TPPA; HIV test |
| Recurrent Candida/balanitis | Fasting blood glucose, HbA1c; consider HIV if risk |
| Chronic/persistent/atypical lesion | Dermatology/urology referral + biopsy |
| Suspected allergic dermatitis | Patch test |
| Phimosis/voiding problem | Urology assessment; urine R/E ± culture |
MSD Manual specifically fasting glucose and HbA1c testing mentions করে, especially infectious/noninfectious cause evaluate করার সময়।
4) Differential Diagnosis — কী কী রোগের সাথে মিল থাকতে পারে
| Disease | Clue |
| Candida balanitis | Itching, red glans, white curdy discharge, diabetes/recent antibiotic |
| Bacterial balanitis | Purulent discharge, crust, fissure, cellulitis |
| HSV genital herpes | Painful vesicle/ulcer, recurrence |
| Syphilis | Usually painless ulcer/chancre, lymph node |
| Genital wart/HPV | Verrucous papule/wart |
| Scabies | Severe nocturnal itching, burrows, partner itching |
| Psoriasis/circinate balanitis | Well-demarcated red plaque, other psoriasis/reactive arthritis signs |
| Lichen sclerosus/BXO | White sclerotic patch, tight foreskin, meatal narrowing |
| Zoon’s balanitis | Older uncircumcised male, shiny red/orange plaque |
| Fixed drug eruption | Same site recurrent dusky patch after drug |
| Penile intraepithelial neoplasia/SCC | Persistent red velvety plaque, ulcer, bleeding, induration |
5) Complications — জটিলতা
- Phimosis: foreskin tight হয়ে glans expose করতে না পারা
- Paraphimosis: retracted foreskin আটকে গিয়ে glans ফুলে যাওয়া—urological emergency
- Recurrent infection: diabetes/phimosis/poor hygiene থাকলে বারবার হয়
- Meatal stenosis/urethral stricture: especially lichen sclerosus/BXO
- Cellulitis/lymphangitis: bacterial infection ছড়িয়ে গেলে
- Painful sex/sexual dysfunction
- Scarring/fissuring
- Penile premalignancy/malignancy miss হওয়া: persistent lesion biopsy না করলে delay হতে পারে। IUSTI guideline atypical/persistent disease-এ biopsy/specialist opinion advise করে।
6) Treatment / Management — Guideline-based
General treatment — সব patient-এর জন্য
- Glans/foreskin gentle lukewarm water বা normal saline দিয়ে পরিষ্কার; harsh soap/antiseptic/perfume avoid
- Foreskin জোর করে টানবেন না
- ভালোভাবে dry রাখবেন
- Tight underwear, friction, sweating কমাবেন
- Active ulcer/discharge/STI suspicion থাকলে sex avoid; condom use; partner testing/treatment
- Diabetes থাকলে glycaemic control
- Recurrent balanitis + phimosis হলে circumcision consider; MSD Manual hygiene, saline irrigation, specific cause treatment এবং persistent phimosis after inflammation resolves হলে circumcision consider করতে বলে।
Pharmacological treatment — cause-based
1. Candida balanitis
Generic name: Clotrimazole 1% cream
Therapeutic category: Antifungal
Pharmacological class: Imidazole antifungal
Dose/duration: Thin layer BD × 7–14 days; symptoms settle হওয়ার পর 2–3 days continue করা যায়
কেন used হয়: Candida cell membrane ergosterol synthesis inhibit করে fungal growth কমায়
Side effects: Local burning, stinging, irritation, rash
Interaction: Topical use-এ minimal; latex condom damage risk uncommon but cream base issue হতে পারে
Bangladesh brand examples: Afun 1%, Cabazol 1%, Canten 1%, Clotrim 1%, Clotrizen 1%, Dermasim 1%, Fungin 1%, Neosten 1% cream.
Generic name: Miconazole nitrate 2% cream
Therapeutic category: Antifungal
Pharmacological class: Imidazole antifungal
Dose/duration: Thin layer BD × 7–14 days
কেন used হয়: Candida/dermatophyte coverage
Side effects: Burning, erythema, contact dermatitis
Interaction: Topical use minimal; systemic absorption low
Bangladesh brand examples: G-Miconazole 2%, Miaz 2%, MIC 2%, Micoderm 2%, Micoheal 2%, Miconex 2%, Mitigal 2% cream.
Severe Candida / marked symptoms:
Generic name: Fluconazole 150 mg capsule/tablet
Therapeutic category: Systemic antifungal
Pharmacological class: Triazole antifungal
Dose/duration: 150 mg orally single dose
কেন used হয়: Severe candidal balanitis বা topical therapy difficult হলে
Side effects: Nausea, abdominal pain, headache, rash; rare hepatotoxicity/QT prolongation
Interaction: Warfarin, sulfonylurea, phenytoin, carbamazepine, some statins, QT-prolonging drugs; liver disease-এ caution
Bangladesh brand examples: Flugal 150 mg, Flucovax 150 mg, Fluderm 150 mg, Fludex 150 mg, Fluzole 150 mg, Funga 150 mg, Fluconazole 150 mg.
IUSTI 2022 summary table candidal balanoposthitis-এ clotrimazole 1% বা miconazole 2%, severe symptoms-এ fluconazole 150 mg stat alternative হিসেবে দিয়েছে।
2. Marked inflammation with Candida / irritant dermatitis
Generic name: Hydrocortisone acetate 1% cream
Therapeutic category: Anti-inflammatory dermatological drug
Pharmacological class: Low-potency topical corticosteroid
Dose/duration: OD–BD thin layer, maximum 7–14 days; genital skin thin, তাই prolonged use নয়
কেন used হয়: Redness, burning, itching, inflammation কমাতে
Side effects: Skin thinning, burning, steroid acne, secondary fungal/bacterial worsening if misused
Interaction: Local; occlusion করলে absorption বাড়ে
Bangladesh brand examples: Topicort 1%, Cortider 1%, Cortimet 1%, Hydrocort 1%, Intasone 1% cream.
Combination option when Candida + marked inflammation:
Generic name: Clotrimazole 1% + Hydrocortisone 1% cream
Therapeutic category: Antifungal + anti-inflammatory
Pharmacological class: Imidazole antifungal + low-potency corticosteroid
Dose/duration: BD × 5–7 days, then antifungal alone complete 7–14 days
Bangladesh brand examples: Clori HC 1%+1%, Clotison 1%+1%, H-Trimazole 1%+1%.
Generic name: Miconazole 2% + Hydrocortisone 1% cream
Dose/duration: BD × 5–7 days
Bangladesh brand examples: Micosone 2%+1%, Fungidal-HC 2%+1%, Gemison 2%+1%, Fungi MH 2%+1%, Fungitop HC 2%+1%.
Warning: Betamethasone/clobetasol mixed “quad” cream routine balanitis-এ avoid; fungal/HSV/wart worsen করতে পারে এবং genital skin atrophy করতে পারে।
3. Aerobic bacterial balanitis
Generic name: Mupirocin 2% ointment
Therapeutic category: Topical antibacterial
Pharmacological class: Protein synthesis inhibitor; isoleucyl-tRNA synthetase inhibitor
Dose/duration: Apply 2–3 times/day × 7–10 days
কেন used হয়: Staph/Strep superficial bacterial infection
Side effects: Burning, itching, local irritation
Interaction: Minimal topical; other topical products একই জায়গায় একসাথে না দেওয়া ভালো
Bangladesh brand examples: Mupiron 2%, Mupibac 2%, Mupicin 2%, Mupiderm 2%, Piroban 2%, Skinobac 2%, Systop 2%, Bactrocin 2%.
Severe bacterial infection/cellulitis while culture pending:
Generic name: Flucloxacillin 500 mg capsule
Therapeutic category: Antibiotic
Pharmacological class: Penicillinase-resistant penicillin
Dose/duration: 500 mg QID × 7 days
Side effects: GI upset, rash, allergy, cholestatic hepatitis rare
Interaction: Warfarin effect alter হতে পারে; penicillin allergy contraindication
Bangladesh brand examples: Fluclox 500 mg, G-Flucloxacillin 500 mg, Flu-K 500 mg, Flutam 500 mg, Flucloxi 500 mg, Flucloxin 500 mg.
Penicillin allergy alternative:
Generic name: Clarithromycin 250 mg tablet
Class: Macrolide antibiotic
Dose/duration: 250 mg BD × 7 days
Side effects: Nausea, metallic taste, QT prolongation, liver enzyme rise
Interaction: Statins, warfarin, carbamazepine, digoxin, QT-prolonging drugs
Bangladesh brand examples: Claricin 250 mg, Klarix 250 mg, Klabid 250 mg, Maclar 250 mg.
IUSTI 2022 aerobic infection-এ mupirocin 2–3 times/day × 7–10 days এবং severe cases-এ systemic antibiotic while awaiting culture result উল্লেখ করেছে।
4. Anaerobic balanoposthitis
Generic name: Metronidazole 400 mg tablet
Therapeutic category: Antibacterial/antiprotozoal
Pharmacological class: Nitroimidazole
Dose/duration: 400 mg BD × 7 days
কেন used হয়: Anaerobic bacteria, foul-smelling discharge/erosive balanoposthitis
Side effects: Metallic taste, nausea, abdominal discomfort, dark urine, peripheral neuropathy if prolonged
Interaction: Alcohol avoid during treatment and 48–72 h after; warfarin effect বাড়াতে পারে; lithium caution
Bangladesh brand examples: Amodis 400 mg, Metro 400 mg, G-Metronidazole 400 mg, Jetrazole 400 mg, Kemet 400 mg, Kilpro 400 mg.
Alternative:
Generic name: Amoxicillin 250 mg + Clavulanic acid 125 mg = 375 mg tablet
Class: Aminopenicillin + beta-lactamase inhibitor
Dose/duration: 375 mg TDS × 7 days
Side effects: Diarrhoea, rash, allergy, cholestatic hepatitis rare
Interaction: Warfarin, methotrexate; penicillin allergy contraindication
Bangladesh brand examples: Bioclavid 250+125 mg, Tyclav 250+125 mg, Demoxiclave 250+125 mg.
IUSTI 2022 anaerobic infection-এ metronidazole 400 mg twice daily × 1 week এবং co-amoxiclav 375 mg TID × 1 week alternative দিয়েছে।
5. STI-related balanitis/ulcer/urethral discharge — treat after testing or strong clinical suspicion
HSV genital herpes
Generic name: Acyclovir 400 mg tablet
Class: Antiviral; guanosine nucleoside analogue
Dose/duration: First episode: 400 mg TID × 7–10 days
Side effects: Nausea, headache; renal impairment-এ dose adjust
Interaction: Nephrotoxic drugs caution; probenecid may increase level
Bangladesh brand examples: Clovir 400 mg, Novirax 400 mg, Simplovir 400 mg.
CDC first-episode genital herpes-এ acyclovir 400 mg orally TID × 7–10 days recommend করে; topical antiviral minimal benefit বলে discourage করে।
Gonorrhoea urethritis suspicion
Generic name: Ceftriaxone 500 mg IM
Class: 3rd-generation cephalosporin antibiotic
Dose/duration: 500 mg IM single dose if body weight <150 kg
Bangladesh brand examples: Ceftron 500 mg/vial, Enocef 500 mg/vial, Eracef 500 mg/vial, Bakticef 500 mg/vial.
CDC uncomplicated gonorrhoea-এ ceftriaxone 500 mg IM single dose; chlamydia exclude না হলে doxycycline add করতে বলে।
Chlamydia not excluded / NGU
Generic name: Doxycycline 100 mg capsule
Class: Tetracycline antibiotic
Dose/duration: 100 mg BD × 7 days
Side effects: Gastritis, photosensitivity, esophagitis; pregnancy/children contraindication
Interaction: Antacid/iron/calcium/dairy absorption কমায়; warfarin effect বাড়তে পারে
Bangladesh brand examples: Doxacil 100 mg, Doxibac 100 mg, Doxy-A 100 mg, Doxicap 100 mg, Doxicline 100 mg, Doxin 100 mg.
CDC chlamydial infection-এ doxycycline 100 mg BD × 7 days recommended regimen হিসেবে দেয়।
Syphilitic balanitis/chancre suspicion
Generic name: Benzathine benzylpenicillin G
Class: Long-acting natural penicillin antibiotic
Dose/duration: 2.4 million units IM single dose for primary/secondary syphilis
Bangladesh brand examples: Benzapen 12 lac units/vial, G-Benzathine Penicil 12 lac units/vial; 2.4 million units দিতে সাধারণত 12 lac + 12 lac IM separate sites লাগে।
CDC primary/secondary syphilis-এ benzathine penicillin G 2.4 million units IM single dose recommend করে।
6. Lichen sclerosus / chronic dermatoses — specialist treatment
Generic name: Clobetasol propionate 0.05% ointment/cream
Therapeutic category: Topical anti-inflammatory
Pharmacological class: Ultra-potent topical corticosteroid
Dose/duration: Usually OD for 1–3 months then reassess; only dermatologist/urologist supervision
কেন used হয়: Lichen sclerosus/BXO inflammation ও scarring কমাতে
Side effects: Skin atrophy, telangiectasia, secondary infection, HSV/wart flare
Bangladesh brand examples: Dermasol 0.05%, Dermacort 0.05%, Dermovate 0.05%, Exovate 0.05%, Nyclobate 0.05%, Topiclo 0.05%, Temovate 0.05%.
IUSTI lichen sclerosus-এ ultra-potent topical steroid এবং circumcision referral option উল্লেখ করে।
7) Prevention — কীভাবে প্রতিরোধ করবেন
- Daily gentle wash with water; harsh soap/antiseptic/perfumed gel avoid
- Wash করার পর শুকনো রাখা
- Foreskin gently retract করে clean করা; জোর করে টানবেন না
- Diabetes control; recurrent Candida হলে HbA1c check
- Unprotected sex avoid; condom use; STI suspicion হলে partner testing/treatment
- Same towel/undergarment share না করা
- Tight/sweaty underwear avoid; cotton underwear
- Recurrent phimosis/balanoposthitis হলে urology referral; circumcision consider
- OTC steroid-mixed cream বারবার ব্যবহার না করা
- Persistent ulcer/plaque/bleeding/induration হলে biopsy/referral delay করা যাবে না
Red flags — জরুরি referral
- Urinary retention বা প্রস্রাব বন্ধ
- Paraphimosis
- Fever + rapidly spreading swelling/cellulitis
- Black/necrotic lesion
- Painful multiple ulcers or suspected HSV first episode
- Painless ulcer/syphilis suspicion
- Persistent lesion >4 weeks despite treatment
- Hard/bleeding/irregular penile lesion
- Recurrent balanitis with diabetes/immunosuppression
- Child sexual abuse suspicion
Overview / Summary
Balanitis হলো glans inflammation; balanoposthitis হলো glans + foreskin inflammation। Common causes: Candida, bacterial infection, anaerobic infection, STI, irritant/contact dermatitis, psoriasis, lichen sclerosus, Zoon’s balanitis এবং premalignant penile lesions। Mild Candida-like case topical clotrimazole/miconazole দিয়ে treat করা যায়; severe/recurrent/ulcer/discharge/diabetes/phimosis/persistent lesion হলে investigations এবং specialist review দরকার।
Actionable Plan / Steps
- History + genital exam করুন: discharge, ulcer, dysuria, sexual exposure, soap/condom/diabetes/phimosis।
- Mild Candida-like: clotrimazole 1% BD 7–14 days + hygiene।
- Marked inflammation: short course hydrocortisone 1% with antifungal; potent steroid avoid unless specialist diagnosis।
- Pus/foul smell: swab C/S; bacterial হলে mupirocin; anaerobic হলে metronidazole।
- Urethral discharge/ulcer/STI risk: NAAT for GC/CT, HSV PCR, syphilis serology, HIV test; treat per CDC/IUSTI.
- Recurrent disease: HbA1c/FBS, HIV risk assessment, phimosis assessment।
- Persistent/atypical lesion: biopsy/referral to dermatology/urology.
Reference List
Textbooks
- Harrison’s Principles of Internal Medicine, 22nd ed. McGraw Hill, 2025 — Infectious diseases, STI, dermatologic/systemic disease principles.
- Davidson’s Principles and Practice of Medicine, 24th ed. Elsevier, 2022 — clinical features, investigation and management framework for adult medicine.
- Robbins, Cotran & Kumar Pathologic Basis of Disease, 11th ed. Elsevier, 2025 — pathology of inflammation, premalignancy/malignancy principles.
Guidelines
- Edwards SK, Bunker CB, van der Snoek EM, van der Meijden WI. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol. 2023;37:1104–1117. DOI: 10.1111/jdv.18954.
- CDC. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1–187. DOI: 10.15585/mmwr.rr7004a1.
- NICE CKS. Balanitis — adults: management; hydrocortisone 1% up to 14 days for suspected non-specific dermatitis.
Peer-reviewed journals
- Lisboa C, Santos A, Dias C, Azevedo F, Pina-Vaz C, Rodrigues A. Candida balanitis: risk factors. J Eur Acad Dermatol Venereol. 2010;24:820–826. DOI: 10.1111/j.1468-3083.2009.03533.x.
- Stary A, Soeltz-Szoets J, Ziegler C, Kinghorn GR, Roy RB. Comparison of oral fluconazole and topical clotrimazole in Candida balanitis. Genitourin Med. 1996;72:98–102. PMID: 8698375
Md.Rafiqul Islam Lipu,Date:-01-06-2026 Monday, Time:-12-29-37 Pm