Introduction

Understanding posthitis

Posthitis is a condition of the penis, which is characterised by inflammation of the foreskin(thin layer of skin on the penis head/glans) caused due to bacterial or fungal infection.¹ Itching and pain when urinating or having sex. The cause of infection can be due to improper hygiene, having unprotected sex etc.² Although it is extremely discomforting, it is not considered a serious problem. It is a fairly common condition among uncircumcised men, as per studies, 12-20% of uncircumcised males struggle with this problem at some point in their lives. In most cases, it can be treated with non-surgical options such as antifungal ointments and antibiotics, but severe and recurrent cases may require circumcision surgery for treatment.¹

Symptoms of posthitis

Symptoms of posthitis involve:

• Pain
• Edema (swelling)
• Itching
• Foul-smelling discharge (smegma)
• Discoloration (red, purple or slightly darker than your usual skin colour)
• Difficulty peeing in severe cases

Causes of posthitis

Below are some common causes of posthitis in adults:

Bacterial or fungal infections are frequent culprits, often stemming from poor penile hygiene, which creates an ideal environment for microbial growth, especially if faecal matter accumulates under the foreskin.³

Skin conditions like psoriasis, eczema, or dermatitis can trigger foreskin inflammation. Sexually transmitted infections (STIs) such as gonorrhoea can infect the penis, leading to posthitis. Allergic reactions to hygiene products, latex condoms, or climax-delaying sprays can cause foreskin swelling.²

Types of Posthitis

Posthitis can result from various factors, leading to its classification into three types based on the underlying cause:

• Fungal infection: It is one of the most common posthitis in adult men, also known as candidal posthitis. It results from the overgrowth of candida fungi either on or under the foreskin⁴
• Bacterial infection: Improper hygiene leads to excess accumulation of bacteria under the foreskin, which results in posthitis
• Sexually transmitted infections: Sexually Transmitted Infections such as Gonorrhea or trichomoniasis, can also be responsible for posthitis.¹

Posthitis diagnosis and tests 

When diagnosing posthitis, healthcare providers primarily rely on a physical examination to assess symptoms and examine the penis for any signs of inflammation or infection. To further determine the cause of posthitis, additional tests may be ordered:

• Skin test: This involves using a cotton swab to collect a sample from the foreskin. The collected sample is then sent to a laboratory for examination, where healthcare professionals look for bacteria or viruses on the skin. By identifying specific pathogens, healthcare providers can tailor treatment more effectively
• Urethral discharge swab: During this test, a cotton swab is inserted approximately 2 cm into the urethral opening and gently rotated to collect a sample. The collected sample is sent to a laboratory for testing to identify any bacteria or viruses in the urethra. This test is particularly useful for detecting infections that may contribute to posthitis symptoms, especially if there is discharge or discomfort during urination
• Urinalysis: Urinalysis involves analysing various aspects of urine, including its colour, clarity, pH levels, and the presence of substances such as bacteria or sugar. Patients provide a urine sample in a specialised cup, which is then sent to a laboratory for analysis. Healthcare providers use the urinalysis results to identify potential infections or other underlying conditions that may be causing or contributing to posthitis symptoms. Additionally, urinalysis can help detect conditions such as diabetes, which may predispose individuals to certain types of infections

Posthitis treatment options

The most common treatment options for posthitis include:

• Medications: When bacterial or fungal infections contribute to posthitis, seeking guidance from a healthcare professional is crucial for accurate diagnosis and treatment. They may prescribe antibiotics or antifungal medications to address the infection, along with steroid creams to alleviate inflammation and itching. For fungal infections specifically, antifungal creams may be prescribed. If allergens are the culprit, doctors may suggest antihistamine⁵
• Circumcision: For individuals experiencing persistent or severe posthitis that doesn't improve with other therapies, a healthcare provider might suggest circumcision surgery. This procedure, known for its safety and effectiveness, entails the removal of the foreskin, which can harbour bacteria and fungi, potentially causing infection and inflammation. There are primarily three types of circumcision surgery available:⁶
  • Laser circumcision: Laser circumcision uses a highly focused beam of laser, which makes an incision along the incision line. This is an advanced procedure and very precise, so surgery does not carry any risk of deep cuts or excessive bleeding. It is generally performed outpatient, and recovery can take 7-10 days⁷
  • Stapler circumcision: This procedure is comparatively more invasive than laser circumcision but equally beneficial. It involves the use of a stapler device to cut and remove the foreskin. The device is placed over the head of the penis and snugly cuts the foreskin, followed by closing the incision wound with a silicon ring. Incision wound generally takes 7-14 days to heal.
  • Open circumcision: It is a conventional method that involves the use of a scalpel or surgical scissors. Compared to laser and stapler circumcision, wounds take more time to heal in open circumcision, so it carries an increased risk of excessive bleeding and infection⁷

Prevention strategies

• Every day, wash your penis to keep your penis clean
• Avoid the use of harsh soaps or chemicals that could irritate the skin of your penis⁸
• Avoid having sex with a person with an infection or disease.
• Use mild and unscented soap if necessary.
• Wash your hands before going to the toilet if you work with chemicals, which could irritate the skin.
• If you experience irritation on the penis, consult an expert⁹
• Wear loose-fitting clothes
• Every month, schedule an appointment with a urologist or dermatologist to maintain good hygiene¹⁰
• As moisture provides a medium for bacteria and fungi growth, keep the area dry. After cleaning, pat the area dry with a clean towel
• If you have known allergies, avoid using potential allergens that may trigger an allergic reaction, like certain fabrics, latex or personal care products
• After sexual activity, clean the genital area thoroughly to avoid any potential pathogens
• Wear a condom while having sex, it will help prevent STIs that can cause posthitis

Home remedies

Some natural remedies that might help ease posthitis symptoms, as recommended by healthcare providers, include:

• Tea tree oil: Recommended by healthcare providers for its antibacterial and antifungal properties. It is particularly useful for relieving symptoms of candidal posthitis
• Yoghurt: Contains natural probiotics that promote the growth of beneficial bacteria. Helps combat infections such as candida and thrush, contributing to symptom relief
• Garlic: Possesses antibacterial and antifungal properties. Effective in managing various posthitis symptoms
• Apple cider vinegar: Diluted application can alleviate symptoms due to its antifungal properties. Recommended by healthcare providers for its potential to ease posthitis discomfort
• Coconut oil: Antifungal action aids in easing posthitis symptoms. It is suggested as a natural remedy by healthcare providers for symptom relief

Summary

Posthitis, marked by inflammation of the foreskin, typically triggered by bacterial or fungal infections, presents discomfort but is generally manageable. It affects a notable percentage of uncircumcised men, manifesting symptoms like pain, itching, swelling, and discharge. Adequate hygiene practices, encompassing regular cleansing and avoiding potential irritants, stand as pivotal preventive measures, alongside practising safe sex and promptly consulting medical professionals upon symptom onset. Treatment options encompass antibiotics, antifungal creams, and, in severe or recurring instances, circumcision surgery. While home remedies such as tea tree oil, yoghurt, garlic, apple cider vinegar, and coconut oil are advocated for symptom alleviation, their efficacy requires further substantiation through research. Overall, prioritising stringent penile hygiene, promptly addressing symptoms, and embracing preventive protocols is paramount in managing and forestalling posthitis, curtailing its impact on individuals' well-being and quality of life. Recording of meetings