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Editor,—Balanoposthitis is a common condition affecting 11% of the male attendees at GUM clinics.1 It is an inflammation of the glans penis and the prepuce, and its causes include bacterial and yeast infections, parasitic infestations, trauma, and irritants.2 However, to our knowledge, no case has been reported to be caused by MRSA.
A 49 year old insulin dependent diabetic man who was an inpatient for repair of an upper jaw fracture developed a penile itch with swollen foreskin, which was difficult to retract, together with longitudinal fissures on the prepuce and subpreputial discharge. In his recent past he had had two incidents of unprotected sexual intercourse with two known females. He was clinically diagnosed as having candida balanitis and was commenced on clotrimazole cream, which did not produce a clinical response over the course of a week. The swabs taken before the commencement of clotrimazole cream failed to grow candida; however, MRSA resistant to erythromycin, penicillin, and flucloxacillin but sensitive to mupirocin was isolated.
Screening tests for chlamydia, gonorrhoea, and trichomonas were negative.
A 10 day course of mupirocin 2% ointment completely resolved his symptoms.
Subpreputial swab after treatment was negative.
MRSA has been a well recognised cause of hospital acquired infections worldwide since it was first detected in Europe in the 1960s.3 The organism can survive for long periods in both the hospital and the home environment and can colonise the skin, nose, or throat of patients and healthcare staff.4 Several reports have suggested that diabetic patients are more susceptible to Staphylococcus aureus bacteraemia5 MRSA has been isolated from different sites in diabetic patients but not the genitalia.6 MRSA rarely invades intact skin; however, it can give rise to severe infections—for example, wound infection, bacteraemia, endocarditis, and osteomyelitis.7
This case illustrates the fact that MRSA is an organism to consider in patients who develop balanoposthitis while in hospital or shortly after discharge especially those whose immune system is incompetent.
There may be implications of spread of MRSA in the community for sexual contacts of patients carrying MRSA in the genital area.
Contributors: Both authors managed the patient and wrote the manuscript.
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