Skene Gland Abscess

A Skene gland abscess is a collection of pus in the paraurethral (Skene) gland. It arises from infection of a blocked gland by gonorrhoea, chlamydia or skin and gut flora.

• It is also called paraurethral abscess or skenitis.
• It causes pain, dysuria and urinary retention.
• It needs drainage and antibiotic treatment.

Acute pain and swelling beside the urethral meatus.

• Dysuria, frequency, urethral discharge, dyspareunia, difficulty passing urine or complete retention, fever.
• Tender fluctuant, red swelling lateral to the meatus; pus may be expressed from the gland on pressure.
• Differential diagnosis: urethral diverticulum with infection, Bartholin abscess, vulval abscess, urethral caruncle, urethritis, herpes genitalis, urethral carcinoma.
• Complications: urinary retention, urethral fistula, recurrence, urethral stricture, spread to cellulitis.

Diagnosis is clinical, with culture of pus and swabs for sexually transmitted infection.

• Clinical diagnosis.
• Expressed pus for Gram stain and culture; urethral and endocervical swabs for NAAT or Gram stain for gonorrhoea and chlamydia.
• Urine dipstick and midstream urine culture.
• Pelvic ultrasound or MRI where available when a urethral diverticulum or deep collection is suspected.
• HIV, syphilis tests, random blood glucose.

Drain the abscess, give antibiotics that cover gonorrhoea, chlamydia and anaerobes, and protect the urethra.

• Supportive: warm sitz baths 10 to 15 minutes, 3 to 4 times daily; oral fluids at least 2 litres daily; rest; avoid sexual intercourse until treated; partner notification and treatment.
• Pharmacological: ceftriaxone 500 mg IM single dose plus doxycycline 100 mg oral 12-hourly for 7 days plus metronidazole 400 mg oral 12-hourly for 7 days. Alternative for non-gonococcal organisms: amoxicillin-clavulanate 625 mg oral 8-hourly for 7 days. Severe infection: ceftriaxone 1 g IV daily plus metronidazole 500 mg IV 8-hourly until afebrile for 24 hours, then oral to complete 7 days. Analgesia with paracetamol 1 g oral 6-hourly (maximum 4 g in 24 hours) and ibuprofen 400 mg oral 8-hourly with food for 5 days (maximum 1.2 g in 24 hours).
• Procedures: incision and drainage with a small incision over the swelling under 1 percent lignocaine (maximum 3 mg/kg, absolute maximum 200 mg plain), taking care not to damage the urethra. Insert an indwelling urethral catheter (size 14 Fr) for 24 to 72 hours if there is retention or after drainage. Marsupialisation or excision after the infection has resolved if the abscess recurs.
• Special groups: in pregnancy give azithromycin 1 g oral single dose instead of doxycycline and avoid ibuprofen from 28 weeks; metronidazole is acceptable. In girls and adolescents use weight-based doses: ceftriaxone 50 mg/kg IM or IV single dose (maximum 1 g), metronidazole 7.5 mg/kg oral 8-hourly, and consider sexual abuse.
• Red flags: urinary retention, fever above 38.5 degrees Celsius, spreading cellulitis, pain out of proportion, pelvic infection symptoms.
• Follow-up: review at 48 to 72 hours; test of cure for gonorrhoea at 2 weeks and re-test at 3 months; investigate for urethral diverticulum if recurrent.