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Question: GU

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You are seeing a 2 year old boy with complaint of penile pain for 2 days. He is previously healthy, fully immunized, afebrile, and has not had this before. He has been able to urinate although he complains of pain with urination. There is no history of trauma to the area. He is uncircumcised. Exam shows the tip of the foreskin to be swollen and erythematous and tender to the touch. There is no discharge, evidence of trauma, discoloration of the penile shaft or perineum, nor inguinal lymphadenopathy. The testes are descended and nontender.

What is the best course of management?

pemsou5_wp • June 30, 2020

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  1. Kelly July 1, 2020 - 8:28 pm Reply

    A) Sitz baths, instructions on foreskin hygiene for the parents, and wash with only water (no soap)
    The patient has simple acute balanoposthitis. Without evidence of penile cellulitis or purulent urethral discharge, oral antibiotics are not indicated. Pressure to reduce edema and reduction maneuvers would be appropriate for paraphimosis. Lack of urethral discharge in this prepubertal non-sexually active child makes sexually transmitted infection unlikely, and azithromycin to treat chlamydia and ceftriaxone to treat gonorrhea is not indicated. The patient is able to urinate and has not had a trial of conservative management yet, so referral to a specialist is not warranted.

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