Abscessed Skene's gland cyst

Specialty: Gynecology and breast.

• Paraurethral abscess
• suppurative skenitis
• purulent infection of Skene's gland

Why it occurs

• Acute bacterial superinfection of a previously existing Skene's cyst by uropathogenic germs (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis) or by sexually transmitted pathogens (Neisseria gonorrhoeae or Chlamydia trachomatis) that causes obstruction and accumulation of pus under tension in the paraurethral gland

Initial workup

Gynecological and urethral examination (a very painful, fluctuating, erythematous and warm mass is observed on the anterior vaginal wall, adjacent to the urinary meatus). Sampling of the purulent exudate of the gland by expression or puncture-aspiration with a fine needle for common microbiological culture, anaerobes, PCR for chlamydia and gonococcus. Urethral or transvaginal ultrasound to assess the extent of the abscess and rule out secondary urethro-vaginal fistulas.

Standard management

• Ceftriaxone 500 mg intramuscularly in a single dose associated with Doxycycline 100 mg every 12 hours orally for 7 days — broad initial empirical coverage for gonococcus and chlamydia
• Amoxicillin/clavulanic acid 875/125 mg every 8 hours orally for 10 days
• Ibuprofen 600 mg every 8 hours orally to control pain and inflammation
• The treatment of choice consists of surgical incision and drainage of the abscess under local anesthesia or sedation, assessing marsupialization of the gland once the acute process has resolved to avoid recurrences (note: avoid excessive manipulation to prevent systemic bacterial dissemination).