Definition

• A bacterial infection of the space between the foreskin and head of the penis
• The medical name is posthitis

Health Information

Symptoms

• Foreskin is pink or red.
• The foreskin is also often swollen.
• Passing urine thru the tender foreskin causes pain or burning.
• Pus or cloudy discharge may drain from the opening of the foreskin. This means a bacterial infection has occurred. Usually, the inside of the foreskin just looks reddened.
• Rare to have any fever.
• Peak age is 2 to 5 year old boys who are not circumcised.

Cause

• The infection is in the closed space under the foreskin.
• May start as reddened foreskin from getting soap or bubble bath trapped under it.
• May also start in a small cut. Cuts can be caused by pulling the foreskin back with too much force.
• Then germs get on the foreskin while touching it with dirty hands to pee.
• Usually, the foreskin is tight and can only be retracted a little. This makes it hard to keep the area clean.
• If there is pus, the most common bacterial cause is Strep. (as in Strep throat)
• Frequent bouts of foreskin infection often means the child needs a circumcision. This is when the foreskin is removed.

Prevention of Future Infections

• Wash the hands before touching the foreskin and penis.
• Retract and clean under the foreskin at least weekly.
• Don’t leave any soap under the foreskin.

Care Advice

1. Overview:
   • Infections under the foreskin are usually mild.
   • If treated early, an antibiotic ointment usually works.
   • Sometimes, an antibiotic given by mouth is needed.
   • Here is some care advice that should help.
2. Clean Under the Foreskin:
   • Cleaning the infected space is the most important step.
   • Retract the foreskin as far as it will go easily. Be gentle.
   • Then wash the exposed head of the penis gently with warm water. Reason: To help prevent foreskin infections.
   • Do not use soap or leave any soap under the foreskin. Reason: This can cause redness and swelling.
   • Wipe away any pus or dried discharge that you find there.
   • After cleansing, dry the head of the penis.
   • Then always pull the foreskin forward to its normal position.
   • Other option: soak in warm bath water without any soap in it. Shake the penis in the bath water
   • Do this 2 times per day to help clear up the infection.
3. Antibiotic Ointment:
   • Put an antibiotic ointment on the head of the penis and under the foreskin. No prescription is needed.
   • Do this 2 times per day.
   • Examples are Bacitracin or Polysporin. You can also use one you have at home.
   • Repeat the cleansing followed by ointment 2 times per day.
   • Keep using the ointment until the foreskin looks normal.
4. Antibiotic by Mouth:
   • Sometimes the infection needs a prescription antibiotic to clear it up.
   • The drug will kill the germs that are causing the foreskin infection.
   • Give the drug as directed.
   • Try not to forget any of the doses.
5. Foreskin Partial Retraction - How to Do It:
   • Start gentle partial retraction at 1 to 2 years of age.
   • It can be done once per week during bathing.
   • Gently pull the skin on the shaft of the penis backward towards the stomach.
   • This will make the foreskin open up. You will be able to see the part of the glans (head of the penis).
   • Be gentle. Pulling the foreskin back should never cause pain or crying.
   • Then clean the area with warm water.
   • Normal cleaning under the foreskin only needs to be done 1 or 2 times a week.
6. What to Expect:
   • On treatment, pain when passing urine should be gone in 2 days.
   • Foreskin should look better by 3 days.
   • Foreskin should look normal by 1 week.
7. Return to School:
   • The infection cannot spread to others. No need to miss any child care or school.

Call Your Doctor If

• After 3 days on antibiotic ointment, still has pain
• Foreskin not healed up in 1 week
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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