This study was approved by the Medical Ethics Committee of the First People’s Hospital of Changshu City (approval number 2010-csyy-1), and all patients provided written informed consent to participate.
Patients
The observation group comprised patients with cryptitis beside the preputial frenulum who were treated at the First People’s Hospital of Changshu from January 2010 to December 2022, the control group comprised healthy individuals in the same period.
The inclusion criteria were skin lesions within the crypt beside the preputial frenulum, with local redness, swelling, heat, and pain in the crypt. The exclusion criteria were trauma and infection by gonococcus, Chlamydia trachomatis, herpes virus, and Treponema pallidumas causes of cryptitis beside the preputial frenulum.
Methods
Clinical data
The following demographic data were recorded for both the observation group and control group: age, education, occupation, marital status, sexual exposure history, sexual orientation, sexual pattern, condom use, foreskin condition, and frequency of cleaning the glans.
The shortest distance between the opening edges of the left and right crypts beside the preputial frenulum was measured in both groups as follows. The participant was placed in the supine position to expose the external genitalia, and the penis was placed in dorsal extension. The prepuce was retracted to expose the glans, preputial frenulum, and crypt beside the preputial frenulum, and the shortest distance between the opening edges of the left and right crypts beside the preputial frenulum was measured as the width of the frenulum (Figure 1).
The presence of a blind cavity-like structure at the crypt as well as the shape, diameter, and depth of the blind cavity-like structure were recorded and measured in both groups. Moreover, the occurrence site, manifestations of cryptitis beside the preputial frenulum, urinary pain, micturition frequency, urination urgency, and pyorrhea of the urethral orifice were recorded in the observation group.
Laboratory examination
All specimens were subjected to Gram staining; microscopic examination was then performed to detect Gram-negative intracellular diplococci within phagocytes. All specimens were also cultured to detect general bacteria (excluding gonococcal species) and fungi. Genetic materials from gonococcal species, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, M.genitalium, and herpes simplex virus type 1 or 2 were detected using polymerase chain reaction. Dark-field microscopic examination was performed to detect T. pallidum in penile cutaneous lesion secretions from all patients. Venous blood samples were collected from all patients and subjected to analysis using a rapid plasma reagin test, T. pallidum hemagglutination assay, and human immunodeficiency virus antibody assay.
Treatment
All patients’ lesions were washed with povidone-iodine. For fungal infections, the patients were prescribed oral itraconazole (0.2 g once a day for 7 days) along with external application of clotrimazole cream twice a day. For non-fungal infections, the patients were prescribed oral levofloxacin (0.5 g once a day for 7 days) along with external application of erythromycin eye ointment twice a day.
Evaluation criteria for therapeutic effect
The patient was considered to have recovered when the skin lesions of the crypt had healed and the local redness, swelling, heat, and pain had disappeared. Treatment was considered to have failed if the skin lesions of the crypt had not healed or the local redness, swelling, heat, and pain in the area persisted.
Statistical analysis
Data analysis was performed using R4.2.1 statistical software (R Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; https://www.R-project.org/).Rates were compared using chi square test. The normality of the shortest distance between the opening edges of the left and right crypts beside the preputial frenulum in both groups was tested using the Shapiro–Wilk method, and the rank sum test (Wilcoxon method) was used to compare the data that did not conform to anormal distribution. A P value of <0.05 was considered statistically significant.