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BARTHOLIN'S GLAND ABSCESSES — Bartholin's gland ducts and cysts can become infected and form abscesses (show picture 2).

Etiology — Abscesses of Bartholin's gland are the result of polymicrobial infections, but they are also occasionally associated with sexually transmitted diseases. These relationships are illustrated in the following reports:

Aspirates of 28 Bartholin's gland abscesses were studied for aerobic and anaerobic bacteria [5]. Sixty-seven bacterial isolates (43 anaerobic and 24 aerobic and facultative) were recovered, accounting for 2.6 isolates per specimen (1.7 anaerobic and 0.9 aerobic and facultative). Single bacterial isolates were recovered in six infections. The predominant aerobic and facultative bacteria were Escherichia coli and N. gonorrhoeae; the most common anaerobic bacteria were Bacteroides species.
A study of 62 women with Bartholin's gland abscesses undergoing marsupialization found four N. gonorrhea and one C. trachomatis isolates [6]. In addition, bacteriological examination of the uterine cervix yielded another case of N. gonorrhea and four more of C. trachomatis.
An emergency department-based case-control study to examine demographic risk factors for Bartholin's gland abscess noted that the risk factor profile for this condition is similar to that of most sexually transmitted diseases [7].
In view of these findings, women with a Bartholin's gland abscess should have both routine cultures (for anaerobic and aerobic bacteria) and specialized tests for gonorrhea and chlamydia taken of the abscess in conjunction with surgical therapy. Examination and treatment of their sexual partners or referral of the partners should also be recommended when a sexually transmitted disease is uncovered. (See "Treatment" belowSee "Treatment" belowSee "Treatment" below). (See "Neisseria gonorrhoeae infections in women" and see "Genital Chlamydia trachomatis infections in women")

Clinical manifestations and diagnosis — The diagnosis is based upon characteristic clinical findings. Women usually present with such severe pain and swelling that they are unable to walk, sit, or have sexual intercourse. On examination, the lesion appears as a large, tender, soft or fluctuant mass in the medial labia majora or lower vestibular area, occasionally with erythema, edema, and pointing of the abscess.

Treatment — Immediate pain relief occurs with drainage of pus. Women with abscesses that point and rupture spontaneously may not require broad spectrum antibiotics and may only need sitz baths and pain medication. An unruptured abscess, on the other hand, can be managed by placement of a Word catheter, marsupialization (show figure 2), or silver nitrate insertion plus broad spectrum antibiotics (see "Treatment" abovesee "Treatment" abovesee "Treatment" above, section on Bartholin's cysts).

Antibiotic regimens which we use are one dose of ceftriaxone (125 mg intramuscularly) or cefixime (400 mg orally) to cover E. coli and N. gonorrhoeae plus clindamycin (300 mg orally four times per day for seven days) to cover anaerobic organisms. The regimen may have to be modified based upon culture results (eg, if C. trachomatis is present, administer azithromycin [1 g orally as a single dose]).

A chronic Bartholin's abscess with loss of mucus secretion rarely results in vaginal dryness or dyspareunia. However, a scar or mass that exists after the acute infection has subsided may cause discomfort. It may be necessary to excise the entire gland in these cases.
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