Bartholin’s Gland: Abscess/Infection

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Chapter 67 Bartholin’s Gland: Abscess/Infection

INTRODUCTION

Description: An infection may occur in one or both Bartholin’s glands, resulting in swelling and/or abscess formation. Usually the process is unilateral and marked by pain and swelling. Systemic symptoms are minimal except in advanced cases.

Prevalence: Two percent of adult women develop infection or enlargement of one or both Bartholin’s glands.

Predominant Age: Of Bartholin’s gland infections, 85% occur during the reproductive years (peak: 20 to 29 years).

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Infection by Neisseria gonorrhoeae (80%), secondary infection by other organisms (e.g., Escherichia coli).

Risk Factors: Exposure to sexually transmitted disease, trauma.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Cystic, painful swelling of the labia in the area of the Bartholin’s gland (at 5 and 7 o’clock positions on the vulva) developing rapidly over 2 to 4 days; cysts can range in size to 8 cm or greater

• Fever and malaise (uncommon)

DIAGNOSTIC APPROACH

Workup and Evaluation

Laboratory: Because bartholinitis or Bartholin’s gland abscess may be gonococcal in origin, further evaluation for other sexually transmitted disease is prudent. Most often, culture-positive cysts are secondarily infected by coliform organisms or are polymicrobial, limiting the value of routine culture from the cyst.

Imaging: No imaging indicated.

Special Tests: None indicated.

Diagnostic Procedures: Inspection.

Pathologic Findings

Inflammation, dilation of the Bartholin gland duct, abscess formation.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation, perineal hygiene.

Specific Measures: Mild infections may respond to antibiotic or topical therapies. Warm to hot sitz baths provide relief and promote drainage. Spontaneous drainage typically occurs in 1 to 4 days. Simple drainage is associated with recurrence; therefore, placement of a Word catheter, packing with iodoform gauze, or surgical marsupialization of the gland is desirable.

Diet: No specific dietary changes indicated.

Activity: No restriction.

Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP088 (Disorders of the Vulva), AP009 (How to Prevent Sexually Transmitted Diseases).

Drug(s) of Choice

Ampicillin (500 mg PO four times a day) or other broad-spectrum antibiotic if cellulitis is present.

Ceftriaxone 125 mg IM or cefixime 400 mg PO single dose or ciprofloxacin 500 mg PO single dose for gonorrhea.

Contraindications: Known hypersensitivity or allergy to agent.

Alternative Therapies

Excision of the gland is often difficult and is associated with significant risk of morbidity, including intraoperative hemorrhage, hematoma formation, secondary infection, scar formation, and dyspareunia. For these reasons, excision is not generally recommended.

FOLLOW-UP

Patient Monitoring: Follow up to monitor for spontaneous drainage or the need for surgical intervention.

Prevention/Avoidance: Reduced exposure to sexually transmitted disease and vulvar trauma.

Possible Complications: Chronic cyst formation.

Expected Outcome: Recurrences occur in 5% to 10% of patients after marsupialization.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy.

ICD-9-CM Codes: 616.3.

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Cheetham DR. Bartholin’s cyst: marsupialization or aspiration? Am J Obstet Gynecol. 1985;152:569.

Eckert LO, Lentz GM. Infections of the lower genital tract. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:571.

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