What causes vaginal itching with frequent urinary symptoms?

Question

Hello doctor,

I am feeling itching at the end of my vagina (the vaginal opening outside and a little inside), and I have a UTI. Once a month, I feel like I need to go to the washroom continuously, but whenever I sit to urinate, only drops come out.

Sometimes, I also experience burning. The itching is very severe; I cannot even sit, and it occurs both inside the vaginal opening and at the outer end area. I have used a cream called Canesten vaginal cream when I started feeling the itching. I also took UTI medicine, including a syrup and tablets, from the chemist.

Kindly help.

Thank you.

Answer 1

Welcome to icliniq.com.

I read your query and understood your concern.

I have read your query and understand your concern about vaginal itching and discomfort when urinating.

Based on what you have described, marked vulvar and introital itching with intermittent burning or urgency during urination, the most likely cause is vulvovaginal candidiasis (VVC). There may also be a component of a simple urinary tract infection (UTI), so it is important to evaluate both possibilities before starting any antibiotics.

I suggest you undergo a proper assessment, including a vaginal exam and urine testing, and in some cases, screening for sexually transmitted infections (STIs).

Here are the likely causes:

Vulvovaginal candidiasis (VVC): This commonly causes intense itching, burning at the vaginal opening, soreness, and sometimes a thick “curdy” discharge. It can mimic UTI symptoms due to the external dysuria.
Acute uncomplicated cystitis: This typically causes burning during urination, urgency, frequency, and mild suprapubic discomfort. Dysuria is very specific in young women when vaginal irritation is not present, but overlap with vaginitis symptoms is common.
Trichomoniasis: Can also cause vaginal irritation, discharge, and external dysuria. Testing is recommended if there is a risk of STIs, and coinfections should be considered.
Other causes: Sometimes irritation can be due to inflammatory skin conditions, atrophic or irritant vaginitis, or pelvic floor issues, which may also cause burning or discomfort.

To help clarify the cause, I suggest the following investigations:

Urinalysis and urine culture before starting antibiotics, especially if symptoms recur. This helps distinguish UTI from vaginitis.
Pelvic examination with bedside vaginitis testing, vaginal pH, wet mount with saline and KOH (Potassium Hydroxide), and the whiff test to confirm yeast infection or other vaginitis causes. Typically, VVC shows a normal vaginal pH.

I suggest you follow the below mentioned treatment plan:

If acute cystitis is confirmed, take a short-course antibiotic such as Nitrofurantoin, Trimethoprim-Sulfamethoxazole, or Fosfomycin based on local resistance patterns. Duration is generally up to seven days.
For uncomplicated VVC, you can use Clotrimazole 1% cream intravaginally for 7 to 14 days, Clotrimazole 2% cream for three days, or oral Fluconazole 150 mg single dose if you are not pregnant. If your symptoms persist or recur within two months, a clinical evaluation is needed.
For severe or recurrent VVC, I suggest taking a longer course of topical azoles or oral Fluconazole on days 1, 4, and 7 may be used, with consideration of weekly Fluconazole for up to six months in recurrent cases. Avoid oral Fluconazole during pregnancy; use topical therapy instead.
If trichomoniasis is detected, I suggest you treat it with Metronidazole 500 mg orally twice daily for seven days, ensure your partner is treated simultaneously, abstain from sexual intercourse until treatment is complete and symptoms resolve, and retest in about three months.

I suggest you keep below mentioned instructions in mind:

Do not start antibiotics before sending a urine sample for culture if you have recurrent symptoms. Repeat cultures if symptoms persist.
Routine test-of-cure urine is usually not needed after successful cystitis treatment unless symptoms persist.
For recurrent or persistent candidiasis, return if your symptoms do not resolve within 7 to 14 days or recur, and consider culture testing to guide treatment. Specialist referral may be needed for resistant or non-albicans species.
Seek urgent medical attention if you develop fever, flank pain, vomiting, or other severe symptoms, or if you are pregnant with significant genitourinary symptoms.

Preventive measures I suggest are as follows:

Drink adequate water daily to reduce UTI risk.
Non-antibiotic prophylaxis, like cranberry products or Methenamine Hippurate, for recurrent UTIs.
Discuss antibiotic prophylaxis with your doctor only if other measures fail.
Practice safe sexual activity, use condoms consistently, and avoid douching to reduce the risk of STIs and reinfection.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.