Case Study : Bartholin's Abscess

Clinical Notes : Dermatology

176. Bartholin's Abscess

A Bartholin's duct cyst is a non-infectious occlusion of the distal Bartholin's duct, with resultant retention of secretions.

A Bartholin's duct cyst may be asymptomatic if the cyst is small.

Duct cysts and gland cysts are indistinguishable, and the terms are used interchangeably.

A Bartholin's duct abscess may be primary (from bartholinitis) or secondary (from infection of Bartholin's cyst)

Abscesses of Bartholin’s glands may arise either spontaneously, in which case the infection is almost always polymicrobial, or as a results of gonococcal or chlamydial infection.

Streptococcal infection is uncommon.

Bartholin’s glands are the female homologues of Cowper’s glands in men.

How indifferent embryonic organs differentiate into the respective sex organs in males and females

Surgical Treatment :

The aim of surgical management are to preserve glandular function and prevent recurrence of disease.

Small, asymptomatic cysts may not require any treatment.

When the abscess points and ruptures spontaneously, conservative management with regular sitz baths and analgesia is usually all that is required.

Small unruptured abscesses can also be treated with local application of warm, wet dressings or regular sitz baths to promote spontaneous drainage or development to a stage suitable for incision and drainage.

Incision and drainage may be required if spontaneous drainage does not occur.

Packing the cavity may reduce the risk of recurrence.

Abscess after incision and drainage recurs in up to 15% of cases.

Marsupialization involves excising the cyst wall and suturing the edges to the vulvar mucosa, to form a shallow cavity which remains open and can drain freely.

Another technique is the placement of a Word catheter.
This is a small latex catheter inserted through an incision into the abscess cavity.

The balloon is inflated with water or gel and the free end is tucked into the vagina.
This is left in place for 4 weeks, by which time a new drainage tract will have re-epithelialized.

Broad-spectrum antibiotics :

In the absence of cellulitis, antibiotic therapy is unnecessary.

More than 80% of cultures from Bartholin's cysts and about 33% of cultures from Bartholin's abscesses are sterile.

In the presence of cellulitis, and if an abscess points and ruptures spontaneously or surgically, broad-spectrum antibiotics should be given.

A 1-week course usually suffices.

While there is no evidence to support a particular antibiotic regimen, coverage for staphylococcal (including MRSA) and streptococcal species, as well as for enteric gram-negative aerobes, specifically Escherichia coli , are suggested.

Primary option :