Posthitis is due to
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Posthitis - Causes
Posthitis is inflammation of the prepuce (foreskin) of the penis. When the glans (head) is also involved, it is called balanoposthitis.
Primary Cause: Poor Hygiene (most common)
According to multiple authoritative surgical and emergency medicine textbooks, posthitis and balanoposthitis are usually due to poor hygiene, with accumulated sebaceous material (smegma) under the foreskin leading to microbial overgrowth. It is most common in young uncircumcised males.
- Rosen's Emergency Medicine, p. 3269: "Inflammation of both the glans (balanitis) and foreskin (posthitis) is usually due to poor hygiene."
- Tintinalli's Emergency Medicine: Describes it as cellulitis of the foreskin, noting "poor hygiene and phimosis predispose children."
Specific Etiologies
| Category | Causes |
|---|---|
| Infectious - Bacterial | Bacterial overgrowth from retained secretions; STIs (Neisseria gonorrhoeae, Chlamydia) |
| Infectious - Fungal | Candida species (especially in diabetics; recurrent candidal infection is a red flag for diabetes) |
| Infectious - Viral | HPV |
| Predisposing structural factor | Phimosis (tight foreskin trapping secretions and moisture) |
| Non-infectious | Contact dermatitis, chemical irritants, trauma |
| Dermatologic | Psoriasis, lichen sclerosus (BXO - balanitis xerotica obliterans) |
| Metabolic | Diabetes mellitus (predisposes to recurrent fungal/bacterial infections) |
Key Points
- Phimosis is a major predisposing factor as it traps secretions under the foreskin
- Diabetes mellitus is strongly associated - recurrent balanoposthitis should prompt blood glucose testing
- In adults, scarring from recurrent posthitis or lichen sclerosus can lead to secondary (acquired) phimosis
- Recurrent balanoposthitis is an indication for circumcision
Sources: Rosen's Emergency Medicine; Bailey & Love's Short Practice of Surgery 28th Ed.; Tintinalli's Emergency Medicine; Campbell-Walsh-Wein Urology
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