Anal itching: few tests, chosen according to the context
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Anal itching without lesion or clue: no tests
- No routine laboratory tests: history, examination of the anal margin, digital rectal examination and anoscopy.
Also consider
- Erosions or ulcers? Consider herpes or syphilis: see the page "Genital or anal ulceration".
- Generalised itching? Generalised itching comes under the page "Itch without skin lesion (pruritus sine materia)".
Do not order
Clue present: threadworms, candidiasis or STI
Tests depending on the context
- Anal sticky-tape test (Scotch test), in the morning before passing stool and washing (nocturnal itching, child in the household, several people affected)if needednon-French guidelineLooking for pinworm eggs on the anal margin is the method of choice; sample in the morning, before the stool and washing [3]. Excluding enterobiasis is reasonable when several family members are scratching [2]. See the page "Intestinal parasitic infection".
- Mycological sample from the anal margin (intertrigo, pustules, diabetes)if needednon-French guidelineIn a diabetic patient with a violaceous pink colour of the margin, exclude a fungal infection; in perianal dermatitis, Candida cultures on mycological medium [2].
- Chlamydia trachomatis and gonococcus NAAT (PCR) on an anal swab (receptive anal intercourse in the last 6 months)if neededAnorectal pruritus is one of the symptoms of proctitis; with anorectal symptoms and receptive anal intercourse in the past 6 months, look for gonorrhoea and Chlamydia on a rectal sample, with complete STI screening [4].
- HIV serologyif neededComplete HIV and STI screening, including hepatitis B and C, in patients suspected of anorectal STI [4]. See the page "STIs".
- Syphilis serologyif neededComplete HIV and STI screening, including hepatitis B and C, in patients suspected of anorectal STI [4]. See the page "STIs".
- Hepatitis B serologyif neededComplete HIV and STI screening, including hepatitis B and C, in patients suspected of anorectal STI [4]. See the page "STIs".
- Hepatitis C serologyif neededComplete HIV and STI screening, including hepatitis B and C, in patients suspected of anorectal STI [4]. See the page "STIs".
Also consider
- Erosions or ulcers? Consider herpes or syphilis: see the page "Genital or anal ulceration".
Do not order
- Stool parasitology to look for enterobiasis: eggs are found less often there than on the anal margin [3]; do a sellotape test.
Sources (9)
- Abramowitz L, Benabderrahmane M, Pospait D, Philip J, Laouénan C. The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract. 2014;20(4):301-6.
- Ortega AE, Delgadillo X. Idiopathic pruritus ani and acute perianal dermatitis. Clin Colon Rectal Surg. 2019;32(5):327-32.
- Centers for Disease Control and Prevention, DPDx (Laboratory Identification of Parasites of Public Health Concern). Enterobiasis, page consultée le 12 octobre 2026.
- de Vries HJC, Nori AV, Kiellberg Larsen H, Kreuter A, Padovese V, Pallawela S, Vall-Mayans M, Ross J. 2021 European guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. J Eur Acad Dermatol Venereol. 2021;35(7):1434-43.
- Cohee MW, Hurff A, Gazewood JD. Benign Anorectal Conditions: Evaluation and Management. Am Fam Physician. 2020;101(1):24-33.
- British Association of Dermatologists. Pruritus ani. Patient information leaflet, août 2004, mise à jour en novembre 2022 (Royaume-Uni).
- Marino F, Martellucci J, Giuffrida MC, et al. Practice Parameters for Evaluation and Management of Pruritus Ani on Behalf of the Italian Society of Colorectal Surgery (SICCR). J Cutan Med Surg. 2026;30(5):464-469.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0263 (recherche d'œufs d'helminthes sur la marge de l'anus), 0286 (examen parasitologique des selles) et 5214 (examen microbiologique de la peau et des phanères).
- Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187 (Centers for Disease Control and Prevention).