Streptococcal balanitis in a healthy adult male

Streptococcus pyogenes balanoposthitis

The main causative organism of balanoposthitis in sexually active adolescents is reportedly the group B hemolytic streptococcus. While cases of balanoposthitis caused by group A streptococcal infection in children have been reported, their occurrence in the adolescent age group is relatively rare.

We describe a case of balanoposthitis caused by Streptococcus pyogenes (group A streptococcus) in a 31-year-old man who presented to the hospital with complaints of pain and swelling in his penile foreskin for the past 6 days. The patient was treated successfully by performing a ventral incision on the foreskin and administering effective antimicrobial therapy involving amoxicillin 750 mg/day. Group A beta-hemolytic Streptococcus pyogenes should also be considered a causative organism in the differential diagnosis, while managing a patient with balanoposthitis.

Lancefield group G Streptococcus dysgalactiae subsp. equisimilis: an unusual aetiology of perianal streptococcal dermatitis acquired from heterosexual oral-anal intercourse

Perianal streptococcal dermatitis (PSD) is an uncommon superficial cutaneous infection of the perianal area, almost exclusively described in children and mainly caused by group A streptococci. We report here a case of PSD caused by Streptococcus dysgalactiae subsp. equisimilis, Lancefield group G, in an adult man due to heterosexual oral-anal sexual contact.

Penile cellulitis

A37-year-old married man presented to his GP with a 4-day history of itching and painless swelling of his penis. He was treated with a compound antifungal, anti-inflammatory disinfectant cream (Timodine cream, Reckitt & Colman, Hull) without response. Three days later, the patient attended the accident and emergency department at his local hospital with the same complaint. He was diagnosed as having an ‘infected penis’, and was advised instead to attend the genitourinary medicine (GUM) clinic.

At the GUM clinic, the patient denied any history of allergy or genital trauma before his complaint. He was in a monogamous sexual relationship with his wife, and only practised peno-insertive vaginal intercourse. He had sexual intercourse 2 weeks previously. There was no significant past medical history.

On examination, he was overweight and apyrexial. There was a painless diffusely swollen penis with a ring of crusts at the tip of the foreskin and purulent discharge around the glans penis. There was no urethral discharge and no inguinal lymphadenopathy (Figure 1). There was tenderness on attempting to retract the foreskin. Routine urinalysis for pyuria and proteinuria were negative. Screening for urethral gonococcal and chlamydial infections were negative. However, culture of the purulent discharge taken from the subpreputial sac grew beta-haemolytic group A Streptococcus pyogenes. The patient was initially treated with a 2-week course of amoxycillin and flucloxacillin, and his condition improved dramatically after 4 days.

Oral sex and transmission of non-viral STIs

OBJECTIVES

To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs).

METHOD

A Medline search was performed using the keywords oro-genital sex, and those specific to each infection. Further references were then taken from each article read.

CONCLUSIONS

Oral sex is a common sexual practice between both heterosexual and homosexual couples. Oro-genital sex is implicated as a route of transmission for gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by this route. Fellatio confers risk for acquisition of infection by the oral partner. Cunnilingus appears to predispose to recurrent vaginal candidiasis although the mechanism for this is unclear, while a link between oro-genital sex and bacterial vaginosis is currently being studied. Oro-anal sex is implicated in the transmission of various enteric infections. In view of the increased practice of oral sex this has become a more important potential route of transmission for oral, respiratory, and genital pathogens.