Summary: All humans are colonized with Candida species, mostly Candida albicans, yet some develop diseases due to Candida, among which genitourinary manifestations are extremely common. The forms of genitourinary candidiasis are distinct from each other and affect different populations. While vulvovaginal candidiasis affects mostly healthy women, candiduria occurs typically in elderly, hospitalized, or immunocompromised patients and in neonates. Despite its high incidence and clinical relevance, genitourinary candidiasis is understudied, and therefore, important questions about pathogenesis and treatment guidelines remain to be resolved. In this review, we summarize the current knowledge about genitourinary candidiasis.

Candida Infections of the Genitourinary Tract

A wide range of infectious, neoplastic, and inflammatory dermatoses can affect the glans penis or prepuce. Some are unique to the genitalia. Other more common dermatoses may have a unique appearance when they involve genital skin and mucosa. A thorough understanding of regional anatomy and a systematic diagnostic approach are helpful in the management of a refractory penile dermatosis. We review embryology and regional anatomy, drug-induced eruptions, allergic and irritant dermatitis, infection, neoplasia, and traumatic and inflammatory dermatoses as they relate to the glans and prepuce. Our discussion focuses on the clinical features, office laboratory studies, and histopathologic findings that assist in diagnosis and treatment.

Dermatoses of the glans penis and prepuce

/pdf/uk-standards-for-microbiology-investigations-4ef5e80gil.pdf

UK Standards for Microbiology Investigations

Patients with diabetes, especially those with poorly controlled glycemia, are prone to developing genital mycotic infections-vulvovaginal candidiasis in women and Candida balanitis in men-the latter almost exclusively in uncircumcised men. Candida albicans is the most common pathogen causing balanitis and is also the dominant cause of vulvovaginal candidiasis in women with diabetes, although Candida glabrata is a prominent pathogen in women with type 2 diabetes mellitus. Candida glabrata is less virulent but also less susceptible to conventional antifungal treatment. High blood glucose levels promote yeast attachment and growth, and also interfere with immune responses in the host. In uncircumcised men, the moist, warm space underneath the foreskin is thought to promote yeast growth, especially when hygiene is poor. Several other risk factors have been identified that predispose to genital mycotic infections, including antibiotic use, corticosteroid use, immunosuppression, atopy, and, in women only, genetics, pregnancy, estrogen/oral contraceptive use, and select sexual behaviors (eg, orogenital sex). In patients with hyperglycemia, risk is increased for not only incident infection but also for recurrence, underscoring the key role of establishing and maintaining euglycemia in the management of genital mycotic infections in patients with diabetes. In addition to blood glucose control, first-line treatment involves either an antifungal cream/ointment (or suppository for women only) that is applied intravaginally by women and directly to the affected area(s) by men, or oral treatment, which infrequently causes systemic side effects. Antifungal treatment should also be offered to sexual partners of patients with diabetes with a genital mycotic infection if the partner is similarly infected. Given high efficacy rates, follow-up test-of-cure after the completion of treatment is generally unnecessary.

Genital Mycotic Infections in Patients With Diabetes

OBJECTIVE--To evaluate clinical features and diagnostic investigations in patients with recurrent or unresponsive balanitis in order to institute rational management. DESIGN--Forty-three patients presenting to a genitourinary medicine clinic with recurrent or persistent balanitis were studied. All patients were asked whether they had a history of atopic illness and about their practice of genital washing. All patients were investigated by taking a swab specimen from the preputial area for bacterial and viral culture and 30 underwent biopsy of the affected skin. Follow-up was between three and six months. SETTING--Outpatient genitourinary medicine clinic, St Mary's Hospital, London, UK. RESULTS--In 31 (72%) of the patients a diagnosis of irritant dermatitis was made. In comparison with the remaining patients, they had a greater lifetime incidence of atopic illness and more frequent daily genital washing with soap. For 28 (90%) of these patients, use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily. For the remaining 12 patients, a variety of diagnoses were made. Biopsy proved a well tolerated and diagnostic investigation, but the isolation of microbial pathogens from preputial swabs was irrelevant to management. CONCLUSION--A history of atopic illness and of the practice of penile washing are important aspects in the evaluation of patients with recurrent balanitis. Biopsy is an important investigation in the condition when it does not seem to be caused by irritant dermatitis.

https://sti.bmj.com/content/sextrans/69/5/400.full.pdf

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

Eighty-six patients with balanitis/balanoposthitis who presented at the department of genitourinary medicine in Coventry between October 1989 and August 1990 were investigated. While 34 (41%) cases had no specific aetiological factor Candida spp. accounted for 26 cases (30%), and group B beta haemolytic streptococci for 11 cases (13%) (one patient, a diabetic, was culture positive for both Candida spp. and group B beta haemolytic streptococci). The remaining 14 patients had other miscellaneous causes of balanitis/balanoposthitis.

Balanitis (balanoposthitis) in patients attending a department of genitourinary medicine.

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Balanitis (balanoposthitis) in patients attending a department of genitourinary medicine.