Bartholin’s Gland Disease

Treatment

• depends on the patient's symptoms.
• An asymptomatic cyst may require no treatment, but symptomatic Bartholin's duct cysts and gland abscesses require drainage. Unless spontaneous rupture occurs, an abscess rarely resolves on its own.
• Although incision and drainage is a relatively quick and easy procedure that provides almost immediate relief to the patient, this approach should be discouraged because there is a tendency for the cyst or abscess to recur.
• Definitive drainage involves Word catheter placement for Bartholin's duct cysts and gland abscesses, and marsupialization for duct cysts

Bartholin's gland abscesses 

• are polymicrobial
• Although Neisseria gonorrhoeae is the predominant aerobic isolate, anaerobes are the most common pathogens.
• Chlamydia trachomatis also may be a causative organism.
• However, Bartholin's duct cysts and gland abscesses are no longer considered to be exclusively the result of sexually transmitted infections.
• Vulvovaginal surgery is an uncommon cause of these cysts and abscesses.

Aerobic organisms

Neisseria gonorrhoeae

Staphylococcus aureus

Streptococcus faecalis

Escherichia coli

Pseudomonas aeruginosa

Chlamydia trachomatis

Anaerobic organisms

Bacteroides fragilis

Clostridium perfringens

Peptostreptococcus species

Fusobacterium species

Choice of Antibiotics

• Medications used in the treatment of Bartholin abscesses include topical and local anesthetics.
• Antibiotics for empiric treatment of STDs are advisable in the doses usually used to treat gonococcal and chlamydial infections.
• Ideally, antibiotics should be started immediately prior to incision and drainage
• Ceftriaxone
• effective monotherapy against N gonorrhoeae, ceftriaxone
• broad-spectrum efficiency against gram-negative organisms, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms
• Ciprofloxacin
• alternative monotherapy to ceftriaxone
• Doxycycline
• Indicated for C trachomatis
• Azithromycin
• Alternative monotherapy for C trachomatis

References:

1. http://www.aafp.org/afp/2003/0701/p135.html
2. http://emedicine.medscape.com/article/777112-medication#3