Clinical features and management of recurrent balanitis; association with atopy and genital washing

Prophylactic interventions on children: balancing human rights with public health

Bioethics committees have issued guidelines that medical interventions should be permissible only in cases of clinically verifiable disease, deformity, or injury. Furthermore, once the existence of one or more of these requirements has been proven, the proposed therapeutic procedure must reasonably be expected to result in a net benefit to the patient. As an exception to this rule, some prophylactic interventions might be performed on individuals "in their best interests" or with the aim of averting an urgent and potentially calamitous public health danger. In order to invoke these exceptions, a stringent set of criteria must first be satisfied. Additionally, where the proposed prophylactic intervention is intended for children, who are unlikely to be able to provide a meaningfully informed consent, a heightened scrutiny of any such measures is required. We argue that children should not be subjected to prophylactic interventions "in their best interests" or for public health reasons when there exist effective and conservative alternative interventions, such as behavioural modification, that individuals could employ as competent adolescents or adults to avoid adverse health outcomes. Applying these criteria, we consider the specific examples of prophylactic mastectomy, immunisations, cosmetic ear surgery, and circumcision.

Balanoposthitis associated with the presence of subpreputial "smegma stones"

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Balanitis and balanoposthitis: a review

OBJECTIVES

To give an overview of the literature on balanitis, with a special emphasis on infective causes.

METHOD

A data search was performed using the OVID CD plus Medline 1967-1995, using balanitis and balanoposthitis as textword search strategy. Specific subjects such as anaerobic infection, Zoon's balanitis were sought separately and subgroups combined. Original articles and abstracts were referenced to illustrate each condition. These were mainly English language articles, but included appropriate non-English language papers.

CONCLUSIONS

Balanitis is a common condition among genitourinary medicine clinic attendees, the cause often remaining undiagnosed. Many cases are caused by infection, with candida being the most frequently diagnosed. However, gardnerella and anaerobic infections are common, and there are a wide variety of other rarer infective causes. In addition irritant balanitis is probably a contributing factor in many cases. Balanitis which persists and in which the cause remains unclear warrants biopsy.

Candidal balano-posthitis: a study of diagnostic methods

OBJECTIVES

To compare microscopy with culture for diagnosing candidal balanoposthitis and to document which diagnostic methods are used in genitourinary medicine clinics in Great Britain.

DESIGN

(a) Penile material for microscopy and fungal culture were obtained from men with balano-posthitis. A "plain-slide" method of collecting material for microscopy was compared with a novel "adhesive-tape" method of sampling. (b) Questionnaires were sent to all genitourinary medicine clinics in Great Britain.

SETTING

The Department of Genitourinary Medicine, Addenbrooke's Hospital, Cambridge, England.

MAIN OUTCOME MEASURES

The sensitivity and specificity of microscopy using culture as the "gold standard" for diagnosis.

RESULTS

Candida was isolated from 35% of 450 men with balano-posthitis attending the clinic over a three year period. The sensitivity of microscopy compared with culture was 12% ("plain-slide" method of material collection) and 65% ("adhesive-tape" method) (p < 0.0001). The respective specificities were 95% and 81%. The positive predictive values for the two methods of material collection were 50% ("plain-slide" method) and 75% ("adhesive-tape" method). The respective negative predictive values were 71% and 72%. 60% of 250 genitourinary medicine clinics returned questionnaires. 13% routinely diagnosed candidal balanoposthitis by appearance only and 34% sometimes relied only on clinical appearance. Culture was used by 78% and microscopy by 69% of clinics. Material for microscopy was most commonly collected by using a cotton-wool tipped swab and the Gram stain was the favoured method for microscopy.

CONCLUSION

Candida is a common cause of balano-posthitis. Diagnosis by microscopy has a low sensitivity and varies with the method used for collecting material. Although up to one third of genitourinary medicine clinics may rely solely on clinical appearance for diagnosis most continue to use microscopy and culture.