Balanitis or balanoposthitis (acute, recurrent or chronic)

Local sample

• Swab of the glans and balanopreputial sulcus: mycological and bacteriological examination (atypical appearance, severe form, recurrence or treatment failure)if needednon-French guidelineThe tests are proposed when the diagnosis is uncertain; the subpreputial swab is used to rule out an infectious cause or superinfection of a dermatosis ^[1].
• Herpes PCR on the erosion (if erosion or ulceration)if neededHSV PCR (nucleic acid amplification) if an ulceration is present ^[1]; NABM reimbursement for atypical mucocutaneous involvement ^[2].
• Trichomonas vaginalis PCR on a subpreputial swab (foul-smelling balanoposthitis, oedema, erosions: anaerobic infection)if needednon-French guidelineRecommended by the European guideline in anaerobic balanoposthitis ^[1]; outside the fee schedule.

Urine tests

• Urine dipstick: glycosuria (if candidiasis suspected)if needednon-French guidelineTesting urine for glucose to be considered, especially if candidiasis is suspected; age and diabetes are risk factors for candidal balanoposthitis ^[1].

Laboratory tests

• Fasting plasma glucose (if glycosuria, or recurrent or persistent candidal balanitis)if needednon-French guidelineDiabetes promotes balanoposthitis, candidal in particular ^[1]. Diagnostic criteria: see the page “Diabetes: discovery”.
• HIV serology (severe or persistent candidal balanitis; or depending on sexual exposure)if needednon-French guidelineLook for HIV or another cause of immunosuppression if candidal balanitis is severe or persistent; STI screening, including HIV, according to sexual history ^[1].
• Syphilis serology (if erosion or ulceration; repeat at 3 months if negative)if needednon-French guidelineFor an ulceration: Treponema PCR where available, or serology to be repeated after 3 months ^[1].
• Chlamydia trachomatis and gonococcus NAAT (PCR) on first-void urine (sexual risk-taking, circinate balanitis)if neededSTI screening guided by sexual history; Chlamydia to be sought in circinate balanitis ^[1]. Urethral discharge or burning: see the page “Urethritis or cervicitis” (multiplex PCR with Mycoplasma genitalium, procedure 5304) ^[2].

Laboratory tests

• Chlamydia trachomatis and gonococcus NAAT (PCR) on first-void urine
• Syphilis serology
• HIV serology
• HLA-B27 (if diagnostic doubt or joint, eye or digestive signs)if needednon-French guidelineTo be considered: if positive, it helps confirm the diagnosis and informs the risk of associated involvement (urethritis, digestive involvement, arthritis) ^[1].