Circinate balanitis as the presenting symptom of sexually-acquired reactive arthritis: a case report.

266 British Journal of General Practice, May 2015 IntroduCtIon The clinical triad of urethritis, arthritis, and conjunctivitis, commonly referred to as Reiter’s syndrome, though more recently and appropriately called sexually-acquired reactive arthritis (SARA), rarely presents in clinic as such a neat, definitive diagnosis.1 Indeed it would appear that the majority of cases of SARA are incomplete; less than one-third of patients will present with the classically-described triad.2 SARA is not fully understood. However, two features correlate with the development of reactive arthritis: genetic factors and infections, most notably Chlamydia,3 but also Salmonella, Yersinia, and Shigella.4 Patients who are HLA-B27 positive are predisposed to developing the condition and in some cases recurrence in the absence of reinfection.5 As a pentad the condition includes circinate balanitis and keratoderma blenorrhagicum as characteristic lesions.6 Circinate balanitis macroscopically presents as shallow erosions, geographical in distribution with a flaky edge7 or, particularly in circumcised men, as maculopapular hyperkeratotic plaques that may mimic psoriasis.8 Lone circinate balanitis and chlamydial infection has been reported in the past.9 This current case report describes a patient who presented with circinate balanitis and dysuria who later developed other symptoms of SARA.