Herpetic Balanoposthitis

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HISTORY

  • 24 year old heterosexual male
  • In steady relationship for 12 months
  • Presented with sore throat and painful non-retractable prepuce.

 

EXAMINATION

OTHER FINDINGS

  • Diffuse pharyngitis
  • L inguinal lymphadenitis

 

INVESTIGATIONS

Smear from subprepuce

  • Micro: ++ polys, mucus, epi cells, +++ GPC, ?E/C GNDC
  • HSV PCR 
  • Bacterial culture
  • Gonococcal culture

First void urine:

  • Chlamydia SDA

 

DIAGNOSIS

Balanoposthitis of unknown aetiology

 

MANAGEMENT

Valaciclovir + Augmentin

 

RESULTS

  • HSV-1 DNA detected in penile and throat swabs
  • Group C streptococcus and Haemophilus influenzae isolated 
  • Gonococcal culture negative
  • Chlamydia SDA negative

 

THE LESSON

This case illustrates the difficulties in managing acute balanoposthitis when the prepuce can’t be retracted.

In such cases at MSHC, a multifactorial aetiology is  presumed, and initial treatment is an antiviral and a broad spectrum antibiotic, together with oral fluconazole if yeast infection is suspected or if  yeasts are seen on microscopy.

Dated November, 2007