What is the treatment for a swollen and tender bump on the labia minora?

Treatment of a Swollen and Tender Bump on the Labia Minora

The most likely diagnosis is an infected Bartholin gland cyst or abscess, which requires incision and drainage if fluctuant, combined with empiric antibiotic coverage for gonorrhea and chlamydia, along with supportive care measures. 1

Immediate Diagnostic Considerations

The differential diagnosis for a swollen, tender bump on the labia minora includes:

• Bartholin gland infection/abscess - presents with swelling, erythema, and tenderness that can extend into the entire labia minora 1
• Herpes simplex virus - causes vulvar swelling with painful ulcerations 1
• Contact dermatitis or allergic reaction - causes inflammation with redness and swelling 1
• Lichen sclerosus - presents as porcelain-white papules and plaques, though typically causes pruritus rather than acute tender swelling 1

Initial Management Algorithm

Step 1: Assess for Abscess Formation

• If the bump is fluctuant and greater than 4 cm, incision and drainage is indicated 1
• Obtain cultures of any purulent drainage for bacterial identification 2

Step 2: Empiric Antibiotic Therapy

Treat empirically for sexually transmitted infections before culture results are available:

• Ceftriaxone 250 mg IM single dose PLUS Doxycycline 100 mg orally twice daily for 10 days 2
• This regimen covers both gonorrhea and chlamydia, which are common culprits in Bartholin gland infections 1

Alternative for patients allergic to cephalosporins or tetracyclines:

• Ofloxacin 300 mg orally twice daily for 10 days 2

Step 3: Supportive Care Measures

• Apply white soft paraffin ointment to affected areas every 2 hours 2
• Use warm saline compresses or sitz baths to promote drainage and comfort 2
• Prescribe analgesics for pain control 2
• Recommend rest and avoidance of tight clothing that may cause further irritation 2

Mandatory Testing

Obtain the following tests to guide definitive management:

• STI testing including gonorrhea and chlamydia nucleic acid amplification tests 3
• Viral culture for HSV if ulcerations are present 3
• Serologic testing for syphilis if papules or atypical lesions are noted 3
• Bacterial culture of any drainage 2

Critical Pitfalls to Avoid

• Do not delay drainage of a fluctuant abscess - this is the definitive treatment and antibiotics alone are insufficient 1
• Always assess for STI pathogens when Bartholin or Skene gland infections are present - these are common underlying causes 1
• Do not dismiss the possibility of herpes - perform viral culture when ulcers accompany the swelling 1
• Avoid assuming trauma or abuse without proper evaluation - consider dermatologic conditions like lichen sclerosus, especially in prepubertal or postmenopausal patients 1

Follow-Up Requirements

Failure to improve within 3 days requires reevaluation of both diagnosis and therapy 2

• Persistent swelling and tenderness after antimicrobial therapy completion warrants comprehensive evaluation for alternative diagnoses including tumor, chronic infection, or inflammatory conditions 2
• Instruct patients to avoid sexual intercourse until they and their partners complete therapy and are asymptomatic 2

Partner Management

Sex partners should be evaluated and treated if contact occurred within 60 days preceding symptom onset 2

• Partners require the same empiric antibiotic regimen for gonorrhea and chlamydia 2