From the Guidelines
The recommended treatment for a vaginal abscess typically involves incision and drainage as the primary intervention, followed by appropriate antibiotic therapy. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of prompt surgical intervention to prevent further complications and promote healing 1.
Key Considerations
- The procedure should be performed by a healthcare provider who will make a small incision in the abscess to allow the pus to drain, usually under local anesthesia in an outpatient setting.
- Following drainage, antibiotics are prescribed to eliminate the remaining infection. Common antibiotic regimens include amoxicillin-clavulanate, clindamycin, or a combination of metronidazole plus cephalexin for 7-10 days.
- Warm sitz baths for 15-20 minutes three times daily can help with pain relief and promote drainage.
- Pain management with acetaminophen or ibuprofen is also recommended.
- Patients should maintain good hygiene, wear loose cotton underwear, and avoid sexual activity until healing is complete.
Antibiotic Therapy
- The choice of antibiotic should be based on the severity of the infection and the presence of any underlying medical conditions.
- In cases where the abscess is large or the patient has signs of systemic illness, hospitalization and intravenous antibiotics may be necessary.
- The use of broad-spectrum antibiotics is recommended to cover for multiple organisms, including anaerobes, which are often involved in vaginal abscesses.
Follow-up Care
- Follow-up with a healthcare provider is important to ensure proper healing and to monitor for any signs of complications.
- Patients should be advised to return to the healthcare provider if they experience any increase in pain, redness, or swelling, or if they have any difficulty urinating or experiencing vaginal discharge.
Overall, the treatment of vaginal abscesses requires a comprehensive approach that includes prompt surgical intervention, appropriate antibiotic therapy, and careful follow-up care to prevent complications and promote healing.
From the FDA Drug Label
GYNECOLOGIC INFECTIONS, including endometritis, endomyometritis, tubo‑ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcusniger, and Peptostreptococcus species. The recommended treatment for a vaginal abscess is metronidazole as part of the treatment for gynecologic infections, which may include tubo-ovarian abscess and postsurgical vaginal cuff infection 2.
- The usual adult oral dosage is 7.5 mg/kg every six hours (approx. 500 mg for a 70 kg adult).
- The usual duration of therapy is 7 to 10 days.
- Indicated surgical procedures should be performed in conjunction with metronidazole tablet therapy.
From the Research
Vaginal Abscess Treatment
The recommended treatment for a vaginal abscess can vary depending on the size, location, and severity of the abscess.
- Treatment options may include:
Drainage Procedures
Drainage procedures can be performed using various techniques, including:
- Transvaginal ultrasonographically guided drainage: a minimally invasive procedure that uses ultrasound to guide the drainage catheter into the abscess 4, 5
- Transvaginal sonographically guided aspiration and drainage: a procedure that uses ultrasound to guide the aspiration and drainage of the abscess 6
- Incision and drainage: a surgical procedure that involves making an incision in the abscess to drain the pus and fluid 7
Antibiotic Therapy
Antibiotic therapy is often used in conjunction with drainage procedures to treat the underlying infection.
- The choice of antibiotic regimen may depend on the severity of the infection and the presence of any underlying medical conditions 3
- Common antibiotic regimens used to treat vaginal abscesses include cefotetan plus doxycycline, clindamycin plus gentamicin, and ampicillin plus clindamycin plus gentamicin 3