TOPLINE

For women past menopause, rubbing estrogen cream around the urinary opening may prevent repeat UTIs long-term just as well as inserting it into the vagina with an applicator.

METHODOLOGY

• Researchers conducted a randomized noninferiority trial to compare applying an estradiol cream around the urethra using a finger with applying it inside the vagina for preventing recurrent UTIs.
• Overall, 114 postmenopausal participants with recurrent UTIs (mean age, 71.1 years) at two US hospitals between 2023 and 2024 were included.
• Half of the participants were randomly assigned to apply 1 g of 0.01% estradiol cream inside the vagina using an applicator. The other half were assigned to apply 0.5 g of the cream around the urethra using a finger. Both groups applied the cream every night for 14 days.
• The primary outcome was being free of UTIs at 6 months. The finger-application method was deemed noninferior if the UTI‑free rate was no more than 25 percentage points lower than the vaginal application method.
• Secondary outcomes included pH of the vagina.

TAKEAWAY

• About half of the participants in each group were free of UTIs at 6 months — 52.6% of those using the applicator method and 50.9% of those using the finger method.
• Both groups had a median of zero UTIs at 6 months and a similar time to the first UTI. Both groups experienced similar reductions in vaginal pH.
• Vaginal itching at 3 months was more common in participants who put the cream inside the vagina than those using the finger method (24.0% vs 2.4%; P < .01).
• Most participants reported feeling “much better” or “very much better” at 6 months and planned to continue their method.

IN PRACTICE

“Healthcare professionals may consider recommending this alternative application method to patients who find the use of an intravaginal applicator to be unacceptable or technically challenging (eg, due to arthritis, obesity, or vaginal stenosis),” the researchers wrote.

SOURCE

The study was led by Stephanie W. Zuo, MD, MS, of the University of Virginia, Charlottesville. It was published online on July 27 in Obstetrics & Gynecology.

LIMITATIONS

The trial was not powered to detect smaller differences. Patient experience was measured using a nonvalidated survey. Adherence was self-reported.

DISCLOSURES

The study received support from the Magee-Womens Research Institute. One author disclosed serving on an advisory committee for Amara Therapeutics, without compensation. Another author reported receiving institutional research grants and consulting fees from Cepheid.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.