Management of balanitis in adults
This algorithm summarizes our suggested approach to diagnosis and management of
balanitis. Most commonly, balanitis in uncircumcised males is due to inadequate hygiene with
superimposed Candida infection, though other etiologies are possible. While a specific
etiology is not always identified, recognition of associated findings can assist with more
efficient and specific treatment. Refer to UpToDate content on balanitis for additional details
on diagnosis and management.
HPV: human papillomavirus; HSV: herpes simplex virus.
* If improvement is noted, offer Candida testing or empiric treatment to female sexual
partners.
¶ STIs known to cause balanitis include trichomonas, HSV, syphilis, HPV, gonorrhea,
chlamydia, and Mycoplasma genitalium.
Δ Antimicrobial options: If anaerobes suspected (foul-smelling discharge) use topical
metronidazole 0.75% cream twice daily for 7 days; if gram positives suspected, use mupirocin
2% cream 3 times daily for 7 to 14 days. Tailor based on response to therapy and culture
results. For severe infection, refer to UpToDate topics on balanitis for approach to systemic
antimicrobial therapy.
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