From the Research
Antibiotics are not routinely recommended for uncomplicated Bartholin's cysts that are asymptomatic, but may be indicated for infected Bartholin's cysts or abscesses alongside drainage procedures. For Bartholin's abscesses, empiric antibiotic coverage should target polymicrobial infections including anaerobes, as suggested by 1. A common first-line regimen is amoxicillin-clavulanate 875/125 mg orally twice daily for 7-10 days. Alternative options include cephalexin 500 mg orally four times daily plus metronidazole 500 mg orally twice daily, or doxycycline 100 mg orally twice daily for 7-10 days. For patients with penicillin allergies, clindamycin 300 mg orally four times daily for 7-10 days can be used, as noted in the general treatment guidelines 2. If sexually transmitted infections are suspected, coverage should be expanded to include ceftriaxone 250 mg intramuscularly once plus doxycycline 100 mg orally twice daily for 7 days.
Key Considerations
- Antibiotics alone are generally insufficient treatment for abscesses, and incision and drainage or marsupialization procedures are typically necessary for definitive management, as highlighted by 3 and 4.
- The rationale for antibiotic therapy is to address the polymicrobial nature of these infections, which often include normal vaginal flora, anaerobes, and occasionally sexually transmitted pathogens.
- Current evidence does not support the use of any single surgical intervention for the treatment of a symptomatic cyst or abscess of the Bartholin's gland, as noted in 1.
Treatment Options
- Marsupialization
- Incision and drainage
- Word catheter insertion
- Antibiotic therapy with amoxicillin-clavulanate, cephalexin, metronidazole, or doxycycline
- Consideration of sexually transmitted infection coverage with ceftriaxone and doxycycline if suspected.