From the Guidelines
Periurethral itching in a 24-year-old woman is most likely caused by urethral infections, which can be treated with empiric antibiotics, and proper hygiene is essential to prevent recurrence, as suggested by the European Association of Urology guidelines 1.
Causes of Periurethral Pruritus
The causes of periurethral pruritus can be divided into infectious and noninfectious causes. Infectious causes include urethral infections, which can be transmitted through sexual contact, and can be caused by various microorganisms such as Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis 1. Noninfectious causes can include contact dermatitis, vaginal infections, and urinary tract infections.
Treatment Options
For immediate relief, it is recommended to:
- Apply over-the-counter antifungal creams like clotrimazole 1% or miconazole 2% to the external area twice daily for 7 days if a yeast infection is suspected
- See a healthcare provider for possible metronidazole 500mg twice daily for 7 days or clindamycin cream 2% intravaginally at bedtime for 7 days if symptoms suggest bacterial vaginosis
- Remove irritants (scented soaps, douches) and apply a thin layer of 1% hydrocortisone cream twice daily for up to 7 days for contact dermatitis Proper hygiene is essential, including:
- Wiping front to back after using the toilet
- Wearing cotton underwear
- Avoiding tight clothing
- Using mild, unscented soaps If symptoms persist beyond 7-10 days, worsen, or are accompanied by abnormal discharge, pain during urination, or fever, medical evaluation is necessary.
Importance of Proper Hygiene
Proper hygiene is crucial in preventing the recurrence of periurethral pruritus, as the periurethral area is sensitive to changes in vaginal flora, chemical irritants, and infections that disrupt the normal acidic environment and protective bacterial balance. The European Association of Urology guidelines suggest that empiric treatment should commence on diagnosis, and that all at-risk sexual partners should be evaluated and treated while upholding patient confidentiality 1.
Additional Considerations
It is also important to note that urethral infections can be asymptomatic, and that symptoms such as mucopurulent or purulent discharge, dysuria, and urethral pruritus can occur 1. The role of Ureaplasma spp. in causing urethritis is debated, with recent data suggesting that U. urealyticum, but not U. parvum, is an aetiological agent in non-gonococcal urethritis 1.
In cases of severe urethritis, empiric treatment should commence on diagnosis, and if the patient’s symptoms are mild, it is advisable to delay treatment until guided by the results of the nucleic acid amplification tests 1.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor
The causes of periurethral pruritus are not specified in the drug label. For treatment options, the label suggests applying hydrocortisone to the affected area not more than 3 to 4 times daily for external anal and genital itching in adults. It is recommended to clean the affected area with mild soap and warm water and gently dry before applying the medication 2.
From the Research
Causes of Periurethral Pruritus
- The exact causes of periurethral pruritus in a 24-year-old female are not directly stated in the provided studies, but possible related conditions include:
- Urethral stricture disease, which can result from traumatic injury, iatrogenic injury, or inflammatory disease leading to periurethral fibrosis 3
- Periurethral masses, such as urethral caruncles, urethral diverticula, and Skene's gland cysts 4, 5, 6
- Recurrent urinary tract infections (RUTI), which can be a symptom of various underlying conditions 7
Treatment Options
- Treatment options for conditions related to periurethral pruritus include:
- Conservative management with dilatation, endoscopic treatment, or open repair with various tissue flaps or grafts for urethral stricture disease 3
- Topical estrogen therapy, close follow-up, or excision for urethral meatal lesions such as urethral caruncles and prolapse 4
- Surgical management of benign periurethral gland masses, such as Skene's gland cysts, Gartner's duct cysts, and Mullerian duct cysts 4, 5
- Surgical excision of urethral diverticulum with tension-free, water-tight, three-layer closure, and possible concomitant treatment of preexisting stress incontinence 6
- Prevention of RUTI through antibiotic treatment, non-antibiotic measures, or a combination of both 7