Anal itching is usually not caused by an STI. Moisture, soap, over-enthusiastic cleaning, haemorrhoids, eczema and fungal infection top the list. An STI is on it, but lower down than people fear.
That is the reassuring part. The nuance is that you cannot tell the difference from the itch itself.
Below you will find the usual causes, why itching that flares at night has a story of its own, and at what point getting checked does make sense.
What causes anal itching?
The most common causes are moisture and irritation of the skin around the anus. Sweat in the cleft, soap residue, moist toilet paper and ointments can damage the skin just enough to start it itching. A review of anal pruritus stresses that the list of possible causes is long and that a thorough history plus physical examination remains the basis (Jakubauskas, 2023).
After that come the mechanical and skin causes.
| Cause | What comes with it | When this fits | What is needed |
|---|---|---|---|
| Moisture and irritation | Itching, sometimes red skin | Sweating, frequent washing, moist paper | Less soap, keep it dry |
| Haemorrhoids | Itching, sometimes blood on paper | Straining, constipation | Assessment by a GP |
| Eczema or psoriasis | Flaking, sharply bordered patch | Also elsewhere on the body | Assessment by a GP |
| Fungal infection (candida) | Itching, red edges | After antibiotics, with diabetes | Assessment by a GP |
| Pinworms | Itching mainly at night | Children in the house | Tape test at the GP |
| STI in the rectum | Itching plus mucus, pain or urge | Receptive anal contact weeks before | Anal swab (PCR) |
Look at the third column, not the second. The itch itself looks alike in all these cases; what surrounds it is what separates them.
When does anal itching point to an STI?
When the itching started in the weeks after receptive anal contact, and certainly when mucus, pain, an empty urge or blood comes with it. That combination is called proctitis, and itching sits explicitly in its symptom list in the European guideline (de Vries, 2021).
Itching on its own, without that history and without those extra symptoms, rarely points to an STI.
One thing makes this harder.
Rectal chlamydia and gonorrhoea usually cause no symptoms at all (de Vries, 2021). So itching without an STI is common, and an STI without itching is more common still. The full picture is in proctitis: symptoms, causes and testing.
Why is night-time itching often something else?
Because night-time anal itching is the classic sign of pinworms. A 2025 review names nocturnal pruritus ani as the most common symptom of an Enterobius vermicularis infestation (Leung, 2025). The female worm lays eggs around the anus at night, and that irritates.
Pinworms are most common in children aged 5 to 14, but adults in the same house pick them up easily.
The diagnosis is simple and happens at the GP with a tape test. One test finds around half of cases; three tests on different mornings raise that to roughly 90 percent (Leung, 2025).
If the itch is mainly nocturnal and you live with children, that is a conversation for your GP, not for us.
What can you do yourself about anal itching?
Less usually helps more than more. Drop the soap and the wet wipes, keep the skin dry after showering, wear cotton underwear, and do not scratch. Scratching damages the skin, which brings the itch back in a loop.
We do not give treatment advice, and the ointments that appear in the literature belong with a doctor.
What we can say: if itching persists for months with no clear cause, self-doctoring is rarely the way through. If the itch sits more towards the front, read itching and irritation down below.
When should you see a GP?
With itching that lasts more than a couple of weeks, with blood, with a visible abnormality, or when the itching disturbs your sleep. A doctor can look at the spot, and with anal complaints that is worth more than any list on the internet.
Also see a GP if fever appears or the pain increases.
Imagine two people with exactly the same itch, both for 3 weeks now.
For one it flares mainly at night, and two small children sleep in the house. For the other it started ten days after receptive anal contact. Same complaint, and yet I would send them to two very different places.
And if receptive anal contact was involved in the preceding weeks, you can rule the STI side out yourself with an anal swab. Our test for chlamydia, gonorrhoea and trichomonas uses a PCR for that; how the sample is taken is in STIs in the anus and how you test.
The RIVM tracks Dutch STI figures through the sexual health centres. Anal infections are included as standard there for certain groups, precisely because they so often stay silent. If it is blisters rather than itching, look at herpes around the anus.
References
- Jakubauskas M, Dulskas A. Evaluation, management and future perspectives of anal pruritus: a narrative review. European Journal of Medical Research, 2023. PMID 36732860.
- Leung AKC, et al. Pinworm (Enterobius Vermicularis) Infestation: An Updated Review. Current Pediatric Reviews, 2025. PMID 38288810.
- de Vries HJC, et al. 2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. Journal of the European Academy of Dermatology and Venereology, 2021. PMID 34057249.
- Chan PA, et al. Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infectious Diseases in Obstetrics and Gynecology, 2016. PMID 27366021.
- RIVM, STI surveillance Netherlands. Accessed August 2026.
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Discreettest
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