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Balanitis - Management
How should I manage an adult with balanitis?

  • Advise daily cleaning under the foreskin with luke warm water, followed by gentle drying.
    • Soap or other irritants should not be used on the genitalia.
    • Consider prescribing an emollient (such as emulsifying ointment) as a soap substitute.
  • For suspected non-specific dermatitis, with or without candidal colonization:
    • Prescribe topical hydrocortisone 1% combined with an imidazole cream (clotrimazole 1%, miconazole 2%, or econazole 1%) once or twice a day until symptoms settle, or for up to 14 days.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected irritant or allergic contact dermatitis:
    • Discontinue any suspected triggers (such as latex condoms, creams, or soaps).
    • Prescribe a mild topical hydrocortisone 1% cream or ointment once a day until symptoms settle, or for up to 14 days.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected candidal balanitis:
    • Prescribe an imidazole cream (clotrimazole 1%, econazole 1%, ketoconazole 2%, or miconazole 2%) twice a day until symptoms settle, or oral fluconazole 150 mg as a single dose (licensed for people 16 years of age and older).
    • If inflammation is causing discomfort, consider prescribing hydrocortisone 1% cream or ointment for up to 14 days in addition to antifungal treatment.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected or confirmed Gardnerella-associated balanitis:
    • Prescribe oral metronidazole (400 mg twice a day) for 7 days.
    • If inflammation is causing discomfort, consider prescribing hydrocortisone 1% cream or ointment for up to 14 days in addition to metronidazole.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected or confirmed streptococcal balanitis:
    • Prescribe oral amoxicillin (500 mg four times a day) for 7 days.
    • Oral erythromycin (500 mg four times a day) or clarithromycin (250 mg twice a day) for 7 days are alternatives for men who are allergic to penicillin.
    • If inflammation is causing discomfort, consider prescribing hydrocortisone 0.5–1% cream or ointment for up to 14 days in addition to antibiotic treatment. If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • If symptoms are worsening or have not settled with treatment, review the diagnosis, take a sub-preputial swab (if this has not been done already) and adjust treatment (if indicated), or seek specialist advice.

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