Treatment of Bartholin Gland Infection
The most effective treatment for a Bartholin gland infection involves both surgical drainage and appropriate antibiotic therapy, with incision and drainage being the primary intervention for abscesses larger than 2 cm. 1
Diagnosis and Assessment
- Bartholin gland infections typically present as painful swelling in the posterior portion of the vulva
- Distinguish between:
- Bartholin cyst (non-infected, painless)
- Bartholin abscess (infected, painful, erythematous)
- Size assessment is important - abscesses larger than 2 cm generally require drainage 1
Treatment Algorithm
1. Surgical Management (Primary Intervention)
For Bartholin Abscesses:
- Incision and drainage is the first-line treatment 2, 1
- Word catheter placement is preferred for office/ED management 3
- A small balloon catheter is inserted into the abscess cavity after incision
- Should remain in place for 4-6 weeks to allow epithelialization
- Alternative: Marsupialization (creating a permanent opening)
- Simple incision and drainage alone leads to high recurrence rates 4
For Asymptomatic Cysts:
- Observation if small and asymptomatic
- Surgical intervention if symptomatic or larger than 2 cm 1
2. Antibiotic Therapy
Empiric Antibiotic Options:
Antibiotic Duration:
- 5-7 days is typically sufficient 6
- Continue antibiotics even if symptoms improve early
Microbiology Considerations
- Bartholin abscesses are commonly polymicrobial 5
- Common pathogens include:
- Coliform bacteria (most common)
- Anaerobic bacteria
- Occasionally respiratory pathogens like S. pneumoniae and H. influenzae 6
- Consider collecting cultures during drainage to guide antibiotic therapy
Follow-up and Recurrence Prevention
- Follow-up within 1-2 weeks to ensure resolution
- For recurrent infections:
- Consider marsupialization for permanent drainage
- In rare cases, gland excision may be necessary for multiple recurrences
Special Considerations
- Pregnancy: Use antibiotics safe in pregnancy if needed (avoid fluoroquinolones) 2
- HIV or Immunocompromised Patients: May require more aggressive treatment and longer antibiotic courses
Common Pitfalls
- Simple incision without catheter placement often leads to recurrence 4
- Failure to consider polymicrobial nature when selecting antibiotics 5
- Premature removal of Word catheter before epithelialization (should remain 4-6 weeks)
- Overlooking sexually transmitted infections that may coexist
By combining surgical drainage with appropriate antibiotic therapy, most Bartholin gland infections can be effectively treated with good outcomes and minimal risk of recurrence.