Management of Recurrent Infected Bartholin Gland Cyst
For a recurrent infected Bartholin gland cyst, obtain cultures for gonorrhea and chlamydia, drain the abscess with Word catheter placement or marsupialization (not simple incision and drainage), prescribe antibiotics covering STI pathogens plus Staphylococcus aureus if systemic signs are present, and implement a decolonization protocol if recurrent S. aureus is identified. 1, 2
Immediate Diagnostic Steps
- Obtain microbiological cultures before initiating treatment, specifically testing for Neisseria gonorrhoeae and Chlamydia trachomatis, as Bartholin gland infections are frequently caused by sexually transmitted pathogens 1
- Assess for signs of systemic infection including fever, tachycardia, or meeting SIRS criteria, which necessitate broader antimicrobial coverage 1
- Examine for erythema, swelling, tenderness extending into the labia minora, and purulent drainage 1, 2
Antibiotic Management Algorithm
For localized infection without systemic signs:
- Prescribe antibiotics covering N. gonorrhoeae and C. trachomatis as adjunctive therapy to drainage 1
- Appropriate options include Metronidazole, Ciprofloxacin, Levofloxacin, or Ceftriaxone for 5-10 days 1, 2
For systemic infection (fever, tachycardia, SIRS criteria):
- Broaden coverage to include Staphylococcus aureus, including MRSA when risk factors exist 1
- Continue coverage for STI pathogens concurrently 1
Drainage Procedure Selection
Critical pitfall to avoid: Simple incision and drainage has significantly higher recurrence rates and should not be performed 3
Recommended drainage techniques with similar healing and recurrence rates:
- Word catheter placement (most common office/ED technique) 4, 3
- Marsupialization 5, 3
- Silver nitrate or alcohol sclerotherapy 3
- Novel loop tubing technique using readily available materials if Word catheter unavailable 4
Avoid: Needle aspiration and simple incision and drainage due to increased recurrence 3
Management of Recurrent Staphylococcus aureus
If cultures reveal recurrent S. aureus infection, implement decolonization protocol: 1
- Intranasal mupirocin twice daily for 5 days 1
- Daily chlorhexidine body washes 1
- Routine cleaning of personal items 1
Considerations for Alternative Diagnoses
When a cyst recurs at the same anatomic site despite appropriate treatment, consider: 1
Size-Based Treatment Threshold
- Infected Bartholin duct cysts or glandular abscesses larger than 2 cm should be drained, as they do not resolve spontaneously and tend to recur 6
- Asymptomatic, non-infected cysts may resolve spontaneously without intervention 6
The evidence strongly supports that antibiotics serve as adjunctive therapy only—adequate drainage remains the cornerstone of treatment. 1 The key distinction for recurrent disease is obtaining cultures to guide targeted antibiotic therapy and implementing decolonization if S. aureus is identified, which addresses the underlying cause of recurrence rather than simply treating each episode in isolation.