A case-control study of risk factors associated with Zoon balanitis in men.

BACKGROUND: Zoon balanitis (ZB) is a chronic inflammatory benign mucositis. Its etiopathogenesis still remains hypothetical and speculative. OBJECTIVES: To determine risk factors associated with genital ZB in men. METHODS: This is a case-control study including 30 patients diagnosed with ZB and 54 patients with dermatological diseases other than ZB enrolled in the Dermatological Clinic of the University of Padova, Italy, from September 2015 to June 2018. Univariate and multivariate logistic regression analyses were used for analysis of data collected. RESULTS: According to multivariate logistic regression analysis, risk factors for ZB were as follows: the mean daily cigarettes consumption (OR 1.065; 95% CI 1.8-11.4; P = 0.006) and the number of weekly foreskin retractions (OR 0.847; 95% CI 5.5-24.1; P = 0.003). There were no statistically significant differences between cases and controls according to age, presence of circumcision as well in number of sexual partners. CONCLUSIONS: To our knowledge, this is the first case-control study showing that smoking and poor genital hygiene are associated with being affected by ZB.

[Correlation between the genotypes and clinical symptoms of human papilloma virus in male outpatients at STD clinics].

OBJECTIVE: To investigate the distribution of the human papilloma virus (HPV) and its genotypes in the male outpatients at the clinics of sexually transmitted diseases (STD) in Changshu and analyze its association with the primary clinical symptoms so as to provide some evidence for the prevention and treatment of HPV infection in men. METHODS: We collected exfoliated cell samples from the external genitals of 602 male outpatients at the STD clinics in Changshu from February 2016 to February 2018, extracted and amplified nucleic acids from the samples, and detected the HPV genotypes using the gene chip technique. We performed statistical analyses on the types of symptoms in clinical diagnosis and their correlation with the genotypes of HPV using the chi-square test. RESULTS: The HPV positive rate in the male STD clinics was 48.2%, of which 47.2 % fell into the low-risk type, 30.0% with multiple infections. The main genotypes included HPV types 6, 11, 39, and 52, and the main HPV-related clinical symptoms were verruca (43.1%) and erythra (41.0%). Low-risk types 6 and 11 accounted for a significantly higher percentage than the high-risk types in the verruca patients (60.0% vs 15.0%, , P < 0.05), but showed no statistically significant difference from the latter in the erythra patients (38.7% vs 38.7%, P > 0.05). The incidence of low-risk infection was remarkably higher than that of high-risk infection in the acrobystitis and balanitis patients (P < 0.05), while the high-risk types constituted a markedly higher percentage than the low-risk and high- and low-risk mixed types in the asymptomatic men at physical examination (84.6% vs 0.0% and 15.4%, P < 0.05). CONCLUSIONS: The HPV positive rate was as high as 48.2% in the males at the STD clinics in Changshu, and the main infection type was low-risk genotype single infection. The clinical symptoms of low-risk infection were mainly verruca and prepuce balanitis, and the high-risk type was mostly asymptomatic at physical examination.

Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children.

BACKGROUND: Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences. METHODS: We report here the prevalence of S. pyogenes isolates in genital tract specimens from girls (n = 1692) with symptoms of vulvovaginitis and from boys (n = 52) with balanitis in the municipality of Nis, Southeast-Serbia (the Western Balkans) in a 10 year period, and the seasonal distribution, patient age and sensitivity to bacitracin and antimicrobial drugs used in the treatment of streptococcal infection. RESULTS: Streptococcal vulvovaginitis was diagnosed in 2.30% of examinees. Of those cases, 64.10% were detected from April to September, and it was most common (71.79%) in girls aged 3-7 years. Streptococcal balanitis was diagnosed in two instances: in a 4-year-old boy and in a 7-year-old boy. S. pyogenes strains resistant to bacitracin were identified in five girls. Two isolates with M phenotype and five isolates with cMLSB phenotype were identified. CONCLUSIONS: Streptococcal vulvovaginitis was diagnosed less often in the present study, but it was still far more common than streptococcal balanitis in childhood. Bacitracin resistance of S. pyogenes strains should be taken into account in routine microbiological identification, and the detection of S. pyogenes isolates resistant to erythromycin requires surveillance in the present geographical territory.

Vulvovaginitis and balanitis in patients with diabetes treated with dapagliflozin.

BACKGROUND: Vulvovaginitis, balanitis, and related genital infections are common in patients with type 2 diabetes. Glucosuria, which is an outcome of treatment with sodium glucose cotransporter 2 (SGLT2) inhibitors, is among the possible causes. Dapagliflozin, an SGLT2 inhibitor with demonstrated glycemic benefits in patients with diabetes, has been studied across a broad spectrum of patients. Analysis of multi-trial safety data may better define the relationship between glucosuria and genital infection. METHODS: Safety data were pooled from 12 randomized, placebo-controlled Phase 2b/3 trials to analyze the association of glucosuria with genital infection in patients with suboptimally controlled diabetes (HbA1c >6.5%-12%). Patients were randomized to receive dapagliflozin (2.5mg, 5mg, or 10mg) or placebo once daily, either as monotherapy or add-on to metformin, insulin, sulfonylurea, or thiazolidinedione for 12-24weeks. The incidence of clinical diagnoses and of events suggestive of genital infection was evaluated. RESULTS: The pooled safety data included 4545 patients: 3152 who received once-daily dapagliflozin (2.5mg [n=814], 5mg [n=1145], or 10mg [n=1193]) as monotherapy or add-on treatment, and 1393 placebo-treated patients. For dapagliflozin 2.5mg, 5mg, 10mg, and placebo, diagnosed infections were reported in 4.1%, 5.7%, 4.8%, and 0.9%, respectively. Most infections were mild or moderate and responded to standard antimicrobial treatment. Discontinuation due to these events was rare. No clear dose-response relationship between dapagliflozin and genital infection was demonstrated. CONCLUSIONS: Treatment with dapagliflozin 2.5mg, 5mg, or 10mg once daily is accompanied by an increased risk of vulvovaginitis or balanitis, related to the induction of glucosuria. Events were generally mild to moderate, clinically manageable, and rarely led to discontinuation of treatment.

Reduced bacterial colonisation of the glans penis after male circumcision in children--a prospective study.

OBJECTIVE: The aim of this prospective study was to evaluate the effect of male circumcision on the bacterial colonisation of the glans penis in children. PATIENTS AND METHODS: 244 males were included in this study. The study group consisted of 143 boys admitted for circumcision between August 2009 and July 2010. Periurethral swabs were taken preoperatively and one week postoperatively. The control group included 101 boys without phimosis, in which only one swab was taken. Patients were subgrouped according to age below and above five years. Bacterial cultures were analysed, results were categorized by non-uropathogenic and uropathogenic bacteria, and compared within and between groups. RESULTS: Patients in both control group and study group before circumcision showed significant bacterial colonisation (>98%), involving known uropathogenic bacteria in over 86%. After circumcision, bacterial colonisation dropped from 100% to 86.3% (p < 0.005) in boys younger than five years and from 98.57% to 77.14% (p < 0.001) in those aged five or above, respectively. Moreover, the fraction of uropathogenic bacteria decreased significantly. CONCLUSION: Male circumcision significantly reduces the bacterial colonisation of the glans penis with regard to both non-uropathogenic and uropathogenic bacteria.

Incidence of genital infection among patients with type 2 diabetes in the UK General Practice Research Database.

The objective of this population-based study was to evaluate the incidence of vaginitis (females) and balanitis (males) among a cohort of type 2 diabetes patients and compare this risk to patients without diabetes. The study population included 125,237 female patients and 146,603 males identified from GPRD. All patients were followed for 1-year from their study index date for the first record of an infection or a censored event. Among patients with diabetes the incidence of vaginitis was 21.0/1000PY (95% CI 19.8-22.1) with the risk being 1.81 (95% CI 1.64-2.00) greater that patients without diabetes. The incidence of balanitis among diabetes patients was 8.4/1000PY (95% CI 7.8-9.1) with a relative risk of 2.85 (2.39-3.39) compared to patients without diabetes. Additional analyses were performed by HbA1c level. Results from this large population-based study indicate that patients with diabetes are at an increased risk of being diagnosed with infections of the genital tract and patients with poorly controlled diabetes have higher risks.

Factors associated with failure in breeding soundness examination of Western USA rams.

Breeding-soundness examination (BSE) and eradication of Brucella ovis infection in rams are critical components of flock-health programs. The aims of this retrospective, cross-sectional study were to describe the results of BSE in a large sample of rams in the Western USA and to determine the association between BSE outcome and the semen collection method (penis manually extended vs. retained in the preputial cavity), ram body-condition score (BCS), the presence of ulcerative posthitis, and the size of the flock of origin. We evaluated the first BSE in a given year for rams from Colorado, Wyoming, and Utah, USA, from 2000 through 2007. Breeding-soundness examination consisted of physical examination, scrotal circumference and BCS measurement, semen collection by electroejaculation, and microscopic examination of semen motility, morphology, and leukocyte concentration. We assigned a reason for failure to each failed BSE and used multivariable logistic and Poisson regressions to measure associations between ram and flock variables and the risk or reason for failure on BSE. A non-random, owner-selected subset of rams was tested for antibodies to B. ovis by serum indirect ELISA (iELISA). The Rogan-Gladen corrected B. ovis seroprevalence was measured. Of the 14,667 BSEs performed on 11,804 rams, 29.0% were classified as "failed;" the most common reason for failure was substandard semen parameters (43.8%). Breeding-soundness examinations were more likely to have been categorized as failure for inflammatory causes when performed on rams from medium-sized flocks (OR 1.6; 95% CI 1.1, 2.3) and large flocks (OR 1.4; 95% CI 1.0, 1.9) (P=0.02), suggesting that larger flocks are at higher risk of contagious diseases. The adjusted seroprevalence of B. ovis antibodies among tested rams in this study was 10.0%. Of 233 rams seropositive to B. ovis, 125 (53.6%) were subclinical, a finding that supports the importance of this test in ram BSE. We found that emaciation in rams was associated with an increased risk of BSE failure from substandard semen parameters (P<0.001), but ulcerative posthitis and the semen collection method were not (P=0.09 and 0.34, respectively). However, collection of semen with the penis retained in the preputial cavity resulted in greater odds of leukospermia relative to semen collection with the penis extended (OR 4.1; 95% CI 2.9, 5.9; P<0.001), presumably from contamination of the semen sample with preputial leukocytes. For ram BSE, therefore, semen collection with the penis manually extended from the sheath is recommended to limit leukocyte contamination of the sample.

Balanoposthitis, dyspareunia, and treponema in the critically endangered Gilbert's potoroo (Potorous gilbertii).

The Gilbert's potoroo (Potorous gilbertii) is one of Australia's most critically endangered mammals with a current estimated population of 70 individuals. Both the wild and captive populations have a long history of balanoposthitis with associated crusting, ulceration, and preputial discharge. We sought to identify the microbial species found in the discharge, determine their significance in causing balanoposthitis, and correlate these findings with reproductive success and survivorship. Bacteriologic examination revealed the discharge to be a polymicrobial infection involving Treponema spp., Actinobacillus spp., and Pasteurella spp. Preputial histopathology reported a moderate, chronic, erosive inflammatory response with diffuse, moderate to marked secondary epithelial hyperplasia in conjunction with moderate numbers of spirochetes, suggesting a causative relationship. Clinical examination, preputial biopsies, and serologic screening found no evidence of associated systemic disease. The clinical investigation of Treponema is significant with respect to the overall recovery of Gilbert's potoroo, given the clinical and histopathologic similarities to Treponema paraluis-cuniculi found in rabbits, causing dyspareunia, and the severity of the associated balanoposthitis.

Candida balanitis: risk factors.

BACKGROUND: The amount of available information on the prevalence and incidence of candida balanitis is still surprisingly scarce. OBJECTIVES: To determine the prevalence of candida colonization and candida balanitis in men attending a Sexually Transmitted Diseases (STD) clinic. To identify risk factors associated with candida balanitis. METHODS: During a 36-month period, a cross-sectional study was carried out on consecutive men attendees of the STD clinic in Hospital S. João, Porto. Clinical and epidemiological data were recorded. Specimen collection from the glans penis and the coronal sulcus followed two procedures: a cotton tipped swab and the direct impression on the surface of CHROMagar Candida medium. Risk factors were considered singly and in combination through logistic regression models. RESULTS: Among 478 men enrolled, the prevalence of candida colonization was 26.2% and the prevalence of candida balanitis was 18%. Candida colonization was strongly associated with an age above 60 years (OR = 3.375; 95% CI: 1.547-7.362) and with the presence of other cause of balanitis apart from Candida organisms (OR: 2.466; 95% CI: 1.491-4.078). An age above 40 years (OR: 2.27; 95% CI: 1.005-4.500), diabetes mellitus (OR: 19.390; 95% CI: 7.789-48.273) and more than ten candida colonies recovered by culture (OR: 9.586; 95% CI: 2.682-34.263) were risk factors for candida balanitis. CONCLUSIONS: This study highlights the impact of factors other than sexual behaviours upon the epidemiology of this infection. For both candida colonization and infection, age was an important risk factor. Diabetes mellitus was an independent risk factor for candida balanitis. More than ten colonies recovered from culture are associated with clinical signs and symptoms.

Foreskin inflammation is associated with HIV and herpes simplex virus type-2 infections in Rakai, Uganda.

DESIGN: We assessed foreskin inflammation associated with HIV and herpes simplex virus type 2 (HSV-2) in circumcised men. METHODS: Foreskin tissues were assessed in 97 HIV-infected and 135 HIV-uninfected men enrolled in randomized trials of circumcision in Rakai, Uganda. Inflammation was quantified using an ordinal score evaluating extent, intensity, and cellular composition of infiltrates in the epithelium and stroma. Prevalence rate ratios of inflammation were estimated by multivariate Poisson regression. RESULTS: Foreskin inflammation was primarily focal. Epithelial inflammation was present in 4.2% of men with neither HIV nor HSV-2 infection; 7.8% of men with only HSV-2; 19.0% with HIV alone (P = 0.04); and 31.6% in HIV/HSV-2 coinfected men [prevalence rate ratio (PRR) 7.5, 95% confidence interval (CI) 2.3-23.8, P < 0.001]. Stromal inflammation was present in 14.1% of HIV/HSV-2 uninfected men, compared with 29.7% in men with HSV-2 alone (P = 0.03), 33.3% in men with HIV alone (P = 0.04), and 61.0% in men with HIV/HSV-2 coinfection (PRR 4.3, 95% CI 2.3-7.9, P < 0.001). In HIV-infected men, epithelial inflammation was associated with higher HIV viral load. Epithelial inflammation was more frequent among men reporting recent genital ulceration. Both epithelial and stromal inflammation were more common among men with smegma on physical examination. CONCLUSION: Foreskin inflammation is increased with HIV and HSV-2 infections, higher HIV viral load and presence of smegma. Foreskin inflammation may have implications for HIV transmission and acquisition in uncircumcised men.

Infectious balanoposthitis: management, clinical and laboratory features.

BACKGROUND: Balanitis is defined as inflammation of the glans penis, often involving the prepuce (balanoposthitis). It is a common condition due to a wide variety of causes with infection being the most frequent and several microorganisms reported. The clinical aspect is often non specific. The management of balanoposthitis remains a clinical challenge. OBJECTIVE: To evaluate the prevalence of infectious balanitis, its management, clinical features, laboratory procedures and treatment options. SUBJECTS AND METHODS: One hundred eighteen patients with infectious balanitis were evaluated between 1995 and 2004 and laboratory data were collected. RESULTS: Balanitis was diagnosed in 219 (10.7%) of the men that have attended the sexually transmitted disease (STD) Clinic. One hundred eighteen (53.9%) had clinically been assumed to suffer from infectious balanitis. In 75 (63.6%) patients the diagnosis was confirmed by culture studies. Candida albicans was isolated from 24 patients. Staphylococcus spp. and groups B and D Streptococci were the most frequently isolated bacteria. All men were uncircumcised. Ninety-one (77.1%) of infectious balanitis patients were treated with antifungal agents. Twelve patients with infectious noncandida balanitis were treated with general antibiotic therapy. Fifty-five (46.6%) patients had a follow-up of 3 to 12 months during which recurrences were registered in 7 (12.7%) patients. CONCLUSIONS: Infectious balanitis was a common condition, affecting 53.9 % of male STD clinic patients in this study. Candida spp. were the most frequently isolated microorganisms. The clinical aspect is of little value in predicting the infectious agent associated with balanoposthitis.

Ulcerative vulvitis and balanitis in sheep flocks.

Outbreaks of ulcerative vulvitis and balanitis occurred in three commercial sheep flocks in England and Wales. Between 29 and 44 per cent of the ewes were affected; most of the lesions resolved in three weeks. Pathogens such as mycoplasmas, which have previously been associated with these conditions, were not detected despite using improved laboratory techniques. In one of the flocks, ovine herpesvirus type 2 was detected by pcr in the blood of two acutely affected ewes, from the vulval ulcers of one of them, and from the penis of an affected ram.

Lichen sclerosus: review of the literature and current recommendations for management.

PURPOSE: We reviewed the literature regarding the clinical presentation, etiology, natural history, and medical and surgical management of lichen sclerosus in men. MATERIALS AND METHODS: We performed a comprehensive search of the literature in PubMed, MEDLINE and other electronic databases between 1950 and 2006 using the key words lichen sclerosis, balanitis xerotica obliterans and urethral stricture. Our search resulted in 1,268 sources containing the words lichen sclerosus or balanitis xerotica obliterans. We reviewed 68 articles in the peer reviewed journals and 2 chapters on this subject. RESULTS: Lichen sclerosus is a chronic, lymphocyte mediated skin disease that was first described in 1887. It shows a predilection for the anogenital area in men and women. Much has been discovered regarding the epidemiology, natural history and histological features of this disease process during the last century, including the discovery of a strong association between lichen sclerosus and squamous cell carcinoma. The techniques of medical and surgical management of this disorder are still being elucidated. Biopsy of the initial lesion for definitive diagnosis and long-term followup of affected patients are well established, critical elements in the management of lichen sclerosus. CONCLUSIONS: Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant voiding complications. Biopsy is recommended in all patients suspected of having lichen sclerosus to rule out squamous cell carcinoma. Further research is needed to improve the prevention, understanding and treatment of this challenging condition.

Neonatal circumcision and penile inflammation in young boys.

This study prospectively documents the incidence of penile inflammation in a consecutive sample of boys according to circumcision status whose visit with the physician included a genital examination in a private primary care pediatric practice in rural northern Wisconsin. Penile inflammation was more common in circumcised than noncircumcised boys, especially in the first 3 years of life (exact odds ratio, 8.01, 95% confidence interval, 31-329.15). When adjusted for the number of genital examinations and age younger than 3 years, exact logistic regression found an adjusted exact odds ratio of 7.91 (95% confidence interval, 1.76-77.66). The study found that rather than protecting against penile inflammation, neonatal circumcision increases the risk of penile inflammation, particularly in boys younger than 3 years old.

Candidiasis cutaneomucosas. Manifestaciones clínicas / Mucocutaneous candidiasis. Clinical manifestations

Resumen La candidiasis cutaneomucosa se presenta con una gran variedad de manifestaciones clínicas y con características especiales en las diversas etapas de la vida. En la infancia es característica la aparición del muguet o de la candidiasis del área del pañal; en la edad adulta muchas manifestaciones orales están asociadas al uso de prótesis dentales, y entre adultos jóvenes es muy frecuente la balanitis y la vulvovaginitis candidiásica. No hay que olvidar que entre los pacientes con sida genera una enfermedad frecuente y resistente. Durante muchos años, en España no fue raro encontrar, entre heroinómanos, una foliculitis producida por Candida; sin embargo, la manifestación cutánea más relevante es el intertrigo, relacionado con factores de humedad y a veces en relación con la diabetes. La perionixis y la onixis por Candida no son muy frecuentes y precisan un diagnóstico certero para su tratamiento. Controvertida es la alergia a Candida, no aceptada por todos, y que sin embargo es importante tener en cuenta en algunos procesos cutáneos (AU)

Mucocutaneous candidiasis presents a wide variety of clinical manifestations with special characteristics in the distinct stages of life. In childhood, candidal napkin dermatitis around the nappy area is common; in adults, many oral manifestations are associated with the use of dental prostheses, and among young adults candidal balanitis and vulvovaginitis are frequent. This infection is both frequent and often resistant among patients with AIDS. For many years, it was not uncommon to find candidiasis folliculitis among heroin addicts in Spain; however, the most important cutaneous manifestation is intertrigo, which is related to humidity and sometimes to diabetes. Candidal perionyxis and onyxis are not common and require an accurate diagnosis for treatment. Candida allergy is controversial and not universally accepted. However, it should be borne in mind in some cutaneous processes (AU)

Balanitis xerotica obliterans in boys.

PURPOSE: Balanitis xerotica obliterans (BXO) is a chronic dermatitis of unknown etiology most often involving the glans and prepuce but sometimes extending into the urethra. We report our 10-year experience with BXO in pediatric patients. MATERIALS AND METHODS: Our pathology database was queried for all tissue diagnoses of BXO from 1992 to 2002. Available charts were reviewed and patient presentation, clinical and referral history, operative procedure(s) and postoperative course were recorded. RESULTS: A total of 41 patients had a tissue confirmed diagnosis of BXO. Median patient age was 10.6 years. Of the patients 85% were 8 to 13 years old and all had referrals available for review. The most common referral diagnoses were phimosis (52%), balanitis (13%) and buried penis (10%). No patient had the diagnosis of BXO at referral. Of the patients 19 (46%) underwent curative circumcision or redo circumcision and had no recurrence at a mean followup of 12.5 months (range 1 to 57). A total of 11 patients (27%) had BXO involvement of the meatus and underwent circumcision combined with meatotomy or meatoplasty. Nine patients (22%) required extensive plastic operation(s) of the penis, including buccal mucosa grafts in 2. CONCLUSIONS: The incidence of BXO in pediatric patients may be higher than previously reported, with the diagnosis rarely made by pediatricians. Our study demonstrates that older patients, those with BXO involvement of the meatus and those with a history of surgery for BXO tend to have a more severe and morbid clinical course.

High incidence of balanitis xerotica obliterans in boys with phimosis: prospective 10-year study.

This prospective study was designed to address the incidence and clinical and histologic characteristics of balanitis xerotica obliterans in a large random pediatric population with phimosis. We investigated 1178 boys who presented consecutively with phimosis between 1991 and 2001. All patients who underwent complete circumcision and surgical specimens were typed histologically as early, intermediate, or late forms of this disorder or as nonspecific chronic inflammation. Patients with balanitis xerotica obliterans were controlled at 1, 6, and 12 months postoperatively, then yearly. Balanitis xerotica obliterans was found in 471 of the 1178 patients (40%), with the highest incidence in boys aged 9 to 11 years (76%). Secondary phimosis occurred in 93% of boys with balanitis xerotica obliterans and in 32% of those without the disorder. In six instances of balanitis xerotica obliterans, meatotomy and in one meatoplasty was performed, as well as circumcision. On histologic evaluation, we found 19% had early, 60% intermediate, and 21% late form of balanitis xerotica obliterans. Glanular lesions disappeared completely within 6 months in 229 out of 231 patients. Our data strongly suggest that the true incidence of childhood balanitis xerotica obliterans is higher than previously assumed. Its incidence peaks in the 9 to 11 years age group, in whom secondary phimosis was almost exclusively caused by balanitis xerotica obliterans.

High prevalence of ulcerative posthitis in Rasa Aragonesa rams associated with a legume-rich diet.

This study describes an outbreak of ulcerative posthitis that eventually affected 76 of 80 of rams in a flock of Rasa Aragonesa sheep on a legume-rich diet. Lesions were confined to the prepuce and varied from mild hyperaemia to ulcerations. Corynebacterium renale was isolated from the lesions. Treatment of an initial group of 17 was based on a change of diet and topical treatment with Veterin Banedif with prednisolone once a day for 15 days and was successful. Lesions in this group were completely resolved after 15 days. The relationship between a legume-rich diet, ruminal alkalosis, elevated urine pH and posthitis is discussed.