What is the treatment for an infected Bartholin (Bartholin's) cyst?

Treatment of Infected Bartholin Cysts

For infected Bartholin cysts (Bartholin gland abscesses), incision and drainage with placement of a Word catheter or similar drainage device is the recommended first-line treatment, followed by oral antibiotics to treat the infection.

Diagnosis and Assessment

• Bartholin gland cysts account for approximately 2% of all gynecologic visits per year 1
• An infected Bartholin cyst (abscess) typically presents with significant pain, swelling, and tenderness at the posterior portion of the labia majora 2
• Infected cysts larger than 2 cm should be drained as they do not tend to resolve spontaneously and have high risk of recurrence 3

Treatment Options

First-line Treatment: Drainage Procedures

• Incision and drainage with Word catheter placement is the most frequently employed technique for office and emergency department management 4
• The Word catheter is inserted into the cyst or abscess cavity after making a small incision, then inflated with 2-3 mL of water or saline to keep it in place 2
• The catheter should remain in place for 4-6 weeks to allow epithelialization of the drainage tract 4
• Alternative drainage techniques include:
  • Placement of a loop of plastic tubing if a Word catheter is unavailable 4
  • Marsupialization (creating a permanent opening by suturing the cyst wall to the surrounding tissue) 2

Antibiotic Therapy

• After drainage, oral antibiotics should be prescribed to treat the infection 4
• Common pathogens include skin flora and polymicrobial infections 5
• Appropriate antibiotic options include:
  • Amoxicillin-clavulanate (500/875 mg twice per day) as first-line therapy 5
  • Alternatives for penicillin-allergic patients include:
    • Doxycycline (100 mg twice per day) 5
    • Clindamycin (300 mg three times per day) 5
• Duration of antibiotic therapy is typically 5-9 days 5

Special Considerations

• Be aware that some Bartholin gland abscesses may be caused by resistant organisms:
  • Cases of penicillin-resistant Streptococcus pneumoniae (PRSP) and beta-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR) have been reported 6
  • For suspected resistant organisms, consider cephalosporins like cefteram pivoxil 6
• For recurrent infections, more definitive surgical options may be considered:
  • Complete surgical excision of the Bartholin gland 1
  • Carbon dioxide laser treatment 1
  • Silver nitrate application 1

Follow-up Care

• Patients should be seen for follow-up in 2-3 weeks to ensure proper healing 4
• The drainage device (Word catheter or tubing) can be removed after epithelialization of the drainage tract, typically after 4-6 weeks 4
• Patients should be instructed to return sooner if symptoms worsen or if the catheter falls out prematurely 2

Common Pitfalls to Avoid

• Simple lancing without catheter placement often leads to recurrence and should be avoided 2
• Failure to provide adequate analgesia before the procedure can make it difficult to perform properly 2
• In women over 40, consider the possibility of malignancy in cases of persistent or recurrent Bartholin gland enlargement 1
• Inadequate antibiotic coverage may lead to treatment failure, especially with resistant organisms 6