Here’s everything you need to know about the harsh realities of penile thrush.

Candidiasis, more commonly known as a yeast infection or thrush, is caused by the fungus Candida. Thrush can affect the vagina, anus and rectum, oral cavity, and elsewhere in the human body. Candidiasis can even affect the penis, resulting in a condition known as balanitis. Penile thrush, while easily treatable with modern medication, is not uncommon and immunocompromised individuals like people living with HIV are particularly at risk.

Balanitis is the inflammation of the glans or head of the penis. It affects approximately 3 to 11 percent of all men at some point during their lifetime. Balanoposthitis is the inflammation of the glans and foreskin, and affects approximately 6 percent of all uncircumcised males. Posthitis is the inflammation of just the foreskin.

There are three general types of balanitis. Zoon’s balanitis usually impacts middle-aged and older uncircumcised males, and is characterized by inflammation and swelling of the glans and foreskin. Circinate balanitis is characterized by small, painless, shallow ulcers on the glans, and is associated with reactive arthritis, a condition where infections cause pain and inflammation elsewhere in the body like the ankles, knees, and urethra. Pseudoepitheliomatous keratotic and micaceous balanitis result in scaly, wart-like lesions on the glans.

Those suffering from balanitis can expect several general symptoms and conditions. The glans of the penis becomes inflamed, swollen, and painful. This swelling can lead to or exacerbate existing cases of phimosis, the inability to fully retract the foreskin. Balanitis also often creates a discharge of smegma, the white, curd-like, and foul-smelling discharge from under the foreskin. The urethra and its external opening, known as the meatus, can also be affected.

Balanitis is caused by several different issues including thrush. Most cases, though, are related to poor personal hygiene in uncircumcised males. Smegma accumulates in the warm, moist, and unwashed environment under the foreskin, forming the ideal incubator to grow the organisms that cause balanitis. For comparison, circumcised males are 68 percent less likely to contract balanitis.

The second leading cause of balanitis is a fungal infection, and of these, those involving Candida albicans, which cause thrush, are the most common. Uncircumcised males living with HIV should take particular care to wash under their foreskin regularly and frequently. Those who use condom catheters, suffer from diabetes or STIs, live in a nursing home environment, are morbidly obese, or have certain chemical or allergic reactions are also at heightened risk of balanitis and penile thrush and should practice good hygiene habits.

Topical antifungals administered over one to three weeks have proven effective in treating most cases of balanitis. Twice-daily bathing of the infected areas, especially under the foreskin, using a saline solution is also recommended. In more severe cases, doctors might recommend topical steroids and oral medication like fluconazole.

Thrush is not generally common in healthy individuals, but immunocompromised folks like people living with HIV are at a heightened risk. Uncircumcised men living with HIV should take particular care to practice good hygiene habits to help prevent balanitis caused by penile thrush.