- 24 year old heterosexual male
- In steady relationship for 12 months
- Presented with sore throat and painful non-retractable prepuce.
- Diffuse pharyngitis
- L inguinal lymphadenitis
Smear from subprepuce
- Micro: ++ polys, mucus, epi cells, +++ GPC, ?E/C GNDC
- HSV PCR
- Bacterial culture
- Gonococcal culture
First void urine:
Balanoposthitis of unknown aetiology
Valaciclovir + Augmentin
- HSV-1 DNA detected in penile and throat swabs
- Group C streptococcus and Haemophilus influenzae isolated
- Gonococcal culture negative
- Chlamydia SDA negative
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