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Bartholin gland cyst or abscess: Initial management

Bartholin gland cyst or abscess: Initial management
While most Bartholin masses are cysts or abscesses, Bartholin gland benign tumors and carcinomas can occur. Thus, biopsy should be performed of a mass of any size if any of the following are present: solid component, wall that is fixed to surrounding tissues, mass that is persistent (ie, unresponsive or worsening) despite treatment, patient is postmenopausal.

I&D: incision and drainage; MRSA: methicillin-resistant Staphylococcus aureus.

* If the abscess is very close to the surface, pus may break through the thin layer of skin at a point (pointing) and may drain spontaneously.

¶ A Word catheter will often not fit in an abscess this small.

Δ Antibiotic therapy should provide adequate coverage for staphylococcal (including MRSA) and streptococcal species and enteric gram-negative aerobes, specifically Escherichia coli. If positive for gonorrhea or chlamydia, include appropriate pathogen-directed antibiotics. Options for antimicrobial therapy are provided in related UpToDate content.

◊ Patients with abscess at high risk for complicated infection include:
  • Extensive surrounding cellulitis
  • Pregnancy
  • Immunocompromise
  • Risk factors for, or culture-positive, MRSA
  • Signs of systemic infection (eg, fever, chills)

§ A patient with an asymptomatic Bartholin cyst (of any size) may choose expectant management.

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