Male Genitalia Infection

Overview

Male genitalia infections encompass a variety of infectious conditions affecting the penis, scrotum, testicles, and associated structures. These infections can be caused by bacteria, viruses, fungi, or parasites, and may result from sexually transmitted infections (STIs), poor hygiene, underlying medical conditions, or ascending infections from the urinary tract. The male reproductive system's external location makes it susceptible to various infections, which can range from superficial skin conditions to deep tissue infections requiring urgent medical attention.

Common types of male genital infections include balanitis (inflammation of the glans penis), posthitis (inflammation of the foreskin), epididymitis (inflammation of the epididymis), orchitis (inflammation of the testicles), and various sexually transmitted infections. These conditions affect males of all ages, from infants to elderly men, though certain infections are more prevalent in specific age groups or populations. For instance, epididymitis is the most common cause of scrotal pain in adult males, affecting approximately 600,000 men annually in the United States.

The importance of recognizing and treating male genital infections cannot be overstated. Untreated infections can lead to serious complications including abscess formation, chronic pain, infertility, sepsis, and in rare cases, loss of testicular tissue. Additionally, many genital infections can be transmitted to sexual partners, making prompt diagnosis and treatment essential for both individual and public health. Understanding the various types of infections, their symptoms, and risk factors is crucial for early detection and appropriate management.

Symptoms

Symptoms of male genitalia infections vary depending on the specific type and location of infection. Recognition of these symptoms is crucial for timely diagnosis and treatment.

Common General Symptoms

• Swelling of scrotum - Common in epididymitis and orchitis
• Pain in testicles - May be sudden or gradual onset
• Abnormal appearing skin - Redness, scaling, or discoloration
• Bumps on penis - May indicate various infections or STIs
• Mass in scrotum - Can be due to abscess or swelling
• Discharge from the penis
• Painful urination (dysuria)
• Fever and chills
• Itching or burning sensation

Symptoms by Specific Conditions

Balanitis (Glans Penis Infection)

• Redness and swelling of the glans
• Soreness and irritation
• Discharge under the foreskin
• Foul odor
• Difficulty retracting foreskin
• White patches or plaques

Epididymitis

• Gradual onset of scrotal pain
• Swelling of epididymis
• Warmth and redness of scrotum
• Pain radiating to groin
• Urethral discharge
• Blood in semen (hematospermia)

Orchitis

• Sudden testicular pain and swelling
• Heavy sensation in scrotum
• Nausea and vomiting
• High fever
• Pain with ejaculation

Sexually Transmitted Infections

• Herpes: Painful blisters or ulcers
• Gonorrhea: Purulent urethral discharge
• Syphilis: Painless ulcer (chancre)
• HPV: Genital warts
• Chlamydia: Often asymptomatic or mild discharge

Systemic Symptoms

• Fever and chills - Indicates systemic infection
• Malaise and fatigue
• Nausea and vomiting - Common with severe infections
• Lower abdominal pain
• Swollen lymph nodes in groin
• Irritable infant - In pediatric cases

Age-Specific Presentations

Infants and Children

• Irritability and crying
• Refusal to void
• Scrotal swelling and redness
• Diaper rash extending to genitals

Elderly Men

• May have atypical presentations
• Less prominent fever
• Confusion or altered mental status
• Urinary retention

Causes

Male genitalia infections can result from various pathogens and mechanisms. Understanding these causes helps in appropriate treatment selection and prevention strategies.

Bacterial Infections

Common Bacterial Pathogens

• Escherichia coli (E. coli): Most common cause of epididymitis in older men
• Chlamydia trachomatis: Leading cause in sexually active young men
• Neisseria gonorrhoeae: Causes gonorrhea and complications
• Staphylococcus aureus: Skin and soft tissue infections
• Streptococcus species: Cellulitis and balanitis
• Pseudomonas aeruginosa: In immunocompromised patients

Mechanisms of Bacterial Infection

• Ascending infection: From urethra to epididymis/testicles
• Hematogenous spread: Through bloodstream
• Direct inoculation: Through breaks in skin
• Lymphatic spread: From adjacent structures

Fungal Infections

Candidiasis (Yeast Infection)

• Candida albicans most common species
• Thrives in warm, moist environments
• More common in uncircumcised men
• Associated with diabetes and immunosuppression

Other Fungal Causes

• Dermatophytes (tinea cruris/jock itch)
• Malassezia species
• Rare systemic fungi in immunocompromised

Viral Infections

• Herpes simplex virus (HSV): Types 1 and 2
• Human papillomavirus (HPV): Causes genital warts
• Molluscum contagiosum: Poxvirus infection
• Mumps virus: Can cause viral orchitis
• Cytomegalovirus (CMV): In immunocompromised

Parasitic Infections

• Scabies: Sarcoptes scabiei mites
• Pubic lice: Phthirus pubis
• Trichomonas vaginalis: Protozoan parasite

Non-Infectious Causes

Some conditions mimic infections but have non-infectious origins:

• Contact dermatitis: From soaps, detergents, latex
• Fixed drug eruption: Medication reactions
• Psoriasis: Can affect genital area
• Lichen planus: Inflammatory condition
• Trauma: Zipper injuries, friction

Predisposing Conditions

• Phimosis: Inability to retract foreskin
• Poor hygiene: Accumulation of smegma
• Urinary obstruction: Promotes ascending infection
• Indwelling catheters: Infection risk
• Recent urological procedures: Iatrogenic infection

Risk Factors

Multiple factors increase the risk of developing male genitalia infections. Understanding these helps identify high-risk individuals and implement preventive measures.

Sexual Behavior Risk Factors

• Unprotected sexual intercourse: Highest risk for STIs
• Multiple sexual partners: Increased exposure risk
• Men who have sex with men (MSM): Higher STI prevalence
• New sexual partner: Unknown infection status
• History of STIs: Indicates risk behaviors
• Sexual partner with STI: Direct transmission risk

Medical Conditions

• Diabetes mellitus: Impaired immunity, glucose in urine
  • Increased risk of balanitis
  • Poor wound healing
  • Recurrent infections
• Immunosuppression:
  • HIV/AIDS
  • Chemotherapy
  • Organ transplantation
  • Chronic steroid use
• Urinary tract abnormalities:
  • Benign prostatic hyperplasia
  • Urethral strictures
  • Neurogenic bladder

Anatomical Factors

• Uncircumcised status: Higher risk of balanitis and STIs
• Phimosis: Inability to clean under foreskin
• Congenital abnormalities: Hypospadias, epispadias
• Previous genital surgery: Scar tissue, altered anatomy

Age-Related Factors

• Young adults (15-35 years): Highest STI risk
• Elderly men: UTI-related epididymitis
• Infants: Diaper dermatitis, congenital abnormalities
• Adolescents: Risk-taking behaviors

Lifestyle Factors

• Poor hygiene: Bacterial and fungal growth
• Tight clothing: Moisture retention
• Hot, humid environments: Fungal infections
• Shared facilities: Gyms, dormitories
• Substance abuse: Impaired judgment, risky behaviors

Medical Interventions

• Urinary catheterization: Infection pathway
• Recent urological procedures: Cystoscopy, prostate biopsy
• Antibiotic use: Fungal overgrowth risk
• Immunosuppressive medications: Increased susceptibility

Occupational and Environmental

• Healthcare workers: Exposure to pathogens
• Military personnel: Close quarters, limited hygiene
• Athletes: Shared equipment, moisture
• Tropical climates: Fungal infection risk

Diagnosis

Accurate diagnosis of male genitalia infections requires a combination of clinical history, physical examination, and appropriate laboratory testing. The diagnostic approach varies based on the presenting symptoms and suspected etiology.

Clinical History

Essential History Components

• Onset and duration of symptoms
• Sexual history (partners, practices, protection)
• Previous STIs or genital infections
• Urinary symptoms
• Systemic symptoms (fever, malaise)
• Recent trauma or procedures
• Medications and allergies
• Underlying medical conditions

Physical Examination

Inspection

• Skin changes: redness, scaling, ulcers, vesicles
• Discharge: character, color, odor
• Swelling: location, extent, symmetry
• Lesions: type, distribution, morphology
• Lymphadenopathy: inguinal nodes

Palpation

• Tenderness: location and severity
• Masses: size, consistency, mobility
• Testicular examination: size, consistency
• Epididymal assessment: swelling, induration
• Cremasteric reflex: absent in torsion

Laboratory Testing

Urinalysis and Urine Culture

• First-void urine for STI testing
• Midstream for UTI evaluation
• Pyuria suggests infection
• Culture identifies pathogens

Urethral Swab

• Gram stain: immediate results
• Culture: bacterial identification
• NAAT for gonorrhea and chlamydia
• Trichomonas testing

Blood Tests

• Complete blood count: infection markers
• C-reactive protein: inflammation
• Blood cultures: if systemic infection
• Serologic tests: syphilis, HIV, hepatitis

Microbiological Studies

• Bacterial culture: Identifies pathogen and sensitivities
• Fungal culture: For suspected candidiasis
• Viral studies: HSV PCR, HPV testing
• Wet mount: Trichomonas, yeast

Imaging Studies

Ultrasound

• First-line imaging for scrotal pathology
• Doppler flow: differentiates torsion from infection
• Identifies abscesses or complications
• Evaluates testicular architecture

Other Imaging

• MRI: Complex cases or tumor evaluation
• CT: If intra-abdominal pathology suspected
• Nuclear scan: Testicular torsion vs epididymitis

Special Tests

STI Comprehensive Panel

• Gonorrhea and chlamydia NAAT
• Syphilis serology (RPR/VDRL, treponemal)
• HIV testing
• Hepatitis B and C
• HSV antibodies or PCR

Skin Scraping/Biopsy

• KOH preparation: fungal elements
• Tzanck smear: herpes diagnosis
• Skin biopsy: uncertain diagnosis
• Dark field microscopy: syphilis

Differential Diagnosis Considerations

• Testicular torsion: Emergency requiring immediate surgery
• Trauma: History and imaging findings
• Testicular cancer: Painless mass, tumor markers
• Hernia: Reducible mass, bowel sounds
• Hydrocele: Transillumination positive
• Varicocele: "Bag of worms" feel

Treatment Options

Treatment of male genitalia infections depends on the causative organism, severity of infection, and presence of complications. Early, appropriate treatment prevents complications and transmission.

Antibiotic Therapy

Empiric Treatment

Initial therapy before culture results:

• Young sexually active men:
  • Ceftriaxone 500mg IM single dose AND
  • Doxycycline 100mg PO BID x 10 days
  • Covers gonorrhea and chlamydia
• Older men/non-STI:
  • Ciprofloxacin 500mg PO BID x 10-14 days OR
  • Levofloxacin 500mg PO daily x 10 days
  • Covers enteric bacteria

Specific Bacterial Infections

• Gonorrhea: Ceftriaxone 500mg IM single dose
• Chlamydia: Doxycycline 100mg BID x 7 days
• Syphilis: Benzathine penicillin G based on stage
• Cellulitis: Cephalexin or dicloxacillin
• MRSA: Trimethoprim-sulfamethoxazole or doxycycline

Antifungal Therapy

Topical Antifungals

• Mild candidal balanitis:
  • Clotrimazole 1% cream BID x 7-10 days
  • Miconazole 2% cream BID x 7-10 days
  • Nystatin cream QID x 7-10 days
• Application instructions:
  • Clean and dry area thoroughly
  • Apply thin layer to affected area
  • Retract foreskin if present

Oral Antifungals

• Severe or recurrent cases:
  • Fluconazole 150mg PO single dose
  • May repeat in 3 days if needed
  • For recurrent: weekly prophylaxis

Antiviral Therapy

Herpes Simplex

• First episode:
  • Acyclovir 400mg TID x 7-10 days OR
  • Valacyclovir 1g BID x 7-10 days
• Recurrent episodes:
  • Acyclovir 800mg TID x 2 days OR
  • Valacyclovir 500mg BID x 3 days
• Suppressive therapy: For frequent recurrences

Other Viral Infections

• Molluscum contagiosum: Cryotherapy, curettage
• Genital warts (HPV): Imiquimod, podophyllin, cryotherapy

Supportive Care

General Measures

• Scrotal support: Reduces discomfort in epididymitis
• Ice packs: 20 minutes QID for swelling
• Sitz baths: Warm water for comfort
• Hygiene: Gentle cleaning, thorough drying
• Loose clothing: Cotton underwear

Pain Management

• NSAIDs: Ibuprofen 400-600mg TID
• Acetaminophen: 500-1000mg QID
• Severe pain: Short course of opioids
• Nerve blocks: For refractory pain

Surgical Interventions

Indications

• Abscess formation: Incision and drainage
• Fournier's gangrene: Emergency debridement
• Testicular torsion: Emergency detorsion
• Chronic epididymitis: Epididymectomy
• Phimosis: Circumcision

Partner Treatment

• Essential for all STIs
• Concurrent treatment prevents reinfection
• Expedited partner therapy where legal
• Abstain from sex until treatment complete

Treatment Monitoring

Follow-up

• Clinical improvement: Expected within 48-72 hours
• Test of cure: For gonorrhea/chlamydia at 3 months
• Persistent symptoms: Re-evaluate diagnosis
• Complications: May need imaging

Treatment Failure Considerations

• Incorrect diagnosis
• Antibiotic resistance
• Poor compliance
• Reinfection from partner
• Underlying condition (tumor, abscess)

Special Populations

Pediatric Treatment

• Weight-based antibiotic dosing
• Consider non-infectious causes
• Evaluate for abuse if STI diagnosed

Immunocompromised Patients

• Longer treatment courses
• Broader empiric coverage
• Consider opportunistic infections
• Lower threshold for hospitalization

Prevention

Prevention of male genitalia infections involves multiple strategies addressing hygiene, sexual health, and risk factor modification.

Personal Hygiene

Daily Care

• Regular washing: Daily with mild soap and water
• Foreskin hygiene: Retract and clean if uncircumcised
• Thorough drying: Prevents fungal growth
• Clean underwear: Change daily
• Avoid irritants: Harsh soaps, perfumes

Post-Activity Care

• Shower after exercise or swimming
• Change out of wet clothing promptly
• Clean genital area after sexual activity
• Urinate after intercourse

Safe Sexual Practices

Barrier Methods

• Condom use: Consistent and correct use
• Latex or polyurethane: For latex allergies
• Dental dams: For oral contact
• Fresh condom: For each act

Partner Communication

• Discuss STI testing status
• Mutual monogamy agreements
• Disclosure of symptoms or infections
• Regular testing schedules

Medical Prevention

Vaccinations

• HPV vaccine: Prevents genital warts and cancers
• Hepatitis B vaccine: Prevents HBV transmission
• Hepatitis A vaccine: For at-risk individuals

Prophylactic Measures

• Post-exposure prophylaxis: For HIV exposure
• Pre-exposure prophylaxis (PrEP): High-risk individuals
• Antibiotic prophylaxis: Recurrent UTIs

Regular Health Screening

• Annual STI testing: Sexually active individuals
• More frequent testing: Multiple partners
• Partner notification: If infection diagnosed
• Routine physical exams: Early detection

Lifestyle Modifications

Clothing and Environment

• Wear breathable cotton underwear
• Avoid tight-fitting clothing
• Change wet swimsuits promptly
• Use personal towels
• Avoid sharing personal items

Risk Reduction

• Limit number of sexual partners
• Avoid sexual contact during outbreaks
• Manage underlying conditions (diabetes)
• Maintain healthy immune system
• Avoid douching or harsh cleansers

Special Considerations

Uncircumcised Men

• Extra attention to foreskin hygiene
• Daily retraction and cleaning
• Consider circumcision if recurrent infections

Diabetic Patients

• Optimal glucose control
• Regular genital examination
• Prompt treatment of infections
• Antifungal prophylaxis if recurrent

When to See a Doctor

Timely medical attention for genital infections prevents complications and ensures appropriate treatment. Some symptoms require emergency care.

Seek Emergency Care For:

• Severe testicular pain with sudden onset
• High fever (>101°F) with genital symptoms
• Rapidly spreading redness or swelling
• Signs of sepsis (confusion, low blood pressure)
• Inability to urinate
• Black or purple discoloration of skin
• Severe pain not relieved by pain medication

Schedule Urgent Appointment For:

• Any genital ulcer or sore
• Discharge from penis
• Painful urination with discharge
• Swollen, painful testicle
• Persistent rash or skin changes
• Blood in urine or semen
• Painful bumps or blisters

Make Routine Appointment For:

• Recurrent infections
• Mild itching or irritation
• STI screening (no symptoms)
• Questions about prevention
• Follow-up after treatment

Red Flag Symptoms

• Fournier's gangrene signs: Rapidly spreading infection
• Testicular torsion: Sudden severe pain, high-riding testicle
• Abscess formation: Fluctuant mass, fever
• Systemic infection: Chills, confusion, weakness

What to Tell Your Doctor:

• Complete symptom timeline
• Sexual history (be honest)
• All medications and supplements
• Previous infections or treatments
• Partner's symptoms if applicable
• Travel history

Related Conditions

Several conditions are related to or may be confused with male genitalia infections:

• Epididymitis - Specific infection of the epididymis
• Balanitis - Inflammation of the glans penis
• Orchitis - Testicular inflammation
• Prostatitis - Prostate gland infection
• Urethritis - Urethral inflammation
• Fournier's Gangrene - Life-threatening genital infection
• STIs - Various sexually transmitted diseases
• Testicular Torsion - Emergency condition
• Hydrocele - Fluid accumulation in scrotum
• Varicocele - Enlarged scrotal veins

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.
2. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009;79(7):583-587.
3. Edwards SK, Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014;25(9):615-626.
4. Leslie SW, Sajjad H, Kumar S. Fournier Gangrene. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
5. Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 12th ed. Philadelphia, PA: Elsevier; 2020.
6. Morris BJ, Krieger JN. Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision. Int J Prev Med. 2017;8:32.
7. Agarwal A, Allamaneni SS. Sexually transmitted infections and male infertility: old enigma, new insights. Reprod Biomed Online. 2011;23(4):456-460.