What is the recommended treatment for Skene gland infection?

Treatment of Skene Gland Infection

For Skene gland infection (skenitis), treat empirically with antibiotics covering common urogenital pathogens—specifically ceftriaxone 1 g IM/IV plus doxycycline 100 mg orally twice daily for 7 days to cover both gonococcal and chlamydial infections, as these glands are paraurethral structures susceptible to sexually transmitted pathogens. 1

Initial Antibiotic Therapy

The Skene glands are paraurethral structures located on the anterior vaginal wall that drain into the distal urethra, making them vulnerable to the same pathogens that cause urethritis 2. Treatment should mirror urethritis protocols:

First-Line Regimen

• Ceftriaxone 1 g IM or IV as a single dose PLUS Azithromycin 1 g orally as a single dose 1
  • This dual therapy covers Neisseria gonorrhoeae and Chlamydia trachomatis, the most common sexually transmitted pathogens affecting paraurethral structures 1
  • The 2024 European Association of Urology guidelines support this as the standard approach for gonococcal urethritis 1

Alternative Regimen

• Doxycycline 100 mg orally twice daily for 7 days for non-gonococcal infection when the pathogen is unidentified 1
• If cephalosporin allergy: Gentamicin 240 mg IM single dose plus azithromycin 2 g orally single dose 1

When Conservative Treatment Fails

If the infection progresses to abscess formation or symptoms persist despite appropriate antibiotics:

Surgical Management

• Surgical excision of the Skene gland is indicated when conservative antibiotic therapy fails 3
• Success rate after initial excision is 88.2%, with overall success after all treatments reaching 85.3% 3
• Recurrence occurs in approximately 30% of cases, but 88.8% of recurrences resolve with further therapy 3

Imaging Considerations

• Pelvic MRI or ultrasound should be obtained if physical examination is non-diagnostic, as half of women with paraurethral gland symptoms present with non-palpable lesions 2
• Skene glands appear at the symphysis level, paramedian to the urethra on the anterior vaginal wall 2

Clinical Pitfalls to Avoid

Do not treat as simple cystitis or UTI alone—Skene gland infections require coverage for sexually transmitted pathogens, not just typical urinary pathogens like E. coli 2, 4. The location and drainage pattern of these glands make them susceptible to gonococcal and chlamydial infections.

Do not delay imaging in unclear cases—patients may present with chronic urethral pain, recurrent UTIs, dyspareunia, or dysuria without obvious physical findings 2, 4. If symptoms persist despite standard UTI treatment, imaging is warranted.

Ensure partner treatment—as with other urogenital infections, sexual partners should be evaluated and treated to prevent reinfection 1. Patients should avoid sexual intercourse until therapy is completed and symptoms resolve.

Special Populations

Pregnancy

• Avoid quinolones and tetracyclines 1
• Use ceftriaxone 125-250 mg IM plus azithromycin 1 g orally or amoxicillin for presumptive chlamydial coverage 1

Cephalosporin Allergy

• Spectinomycin 2 g IM single dose is an alternative, though less readily available 1
• Gentamicin 240 mg IM plus azithromycin 2 g orally is the preferred alternative per current guidelines 1