Every attempt should be made to make a precise diagnosis when patients present with symptoms and signs of balanoposthitis. Non-specific balanoposthitis is a diagnosis of exclusion and probably not common. STIs, immunosuppression, and diabetes must all be excluded.
As with all dermatological and genitourinary conditions, a full history should be taken and a thorough examination performed. Investigations may include appropriate swabs and skin biopsy. Two major goals of diagnosis and management should be to minimise problems with sexual and urinary function and identify any conditions placing the patient at risk of developing cancer of the penis.
A primary dermatosis is often present, such as psoriasis, seborrhoeic dermatitis, Zoon balanitis, lichen sclerosus, lichen planus, warts or carcinoma-in-situ. A suitably targeted biopsy can be helpful in the diagnosis, but histology may be non-specific. Preputial dysfunction is probably the cause in cases of non-specific balanoposthitis, and many patients are likely to have lichen sclerosus as the underlying morbid state.
Candidosis may be present as a secondary opportunistic phenomenon rather than as a primary cause of disease, in most if not all cases. Candidal balanoposthitis could be a STI with an affinity for the anatomically abnormal penis or in people predisposed by underlying disease or other factors. Screening should be done for other STIs.
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