Bartholin Gland Abscess

By Drs Jack-Ky Wang and Anna Mies Richie

At 37 weeks' gestation, a 27-year-old woman (gravida 1, para 0) presented with increasing vaginal pain and a yellowish white discharge of 1 week's duration. Despite use of a topical antifungal prescribed by another practitioner, the symptoms worsened and a vaginal mass suddenly appeared. The patient denied any history of sexually transmitted disease. Drs Jack-Ky Wang and Anna Mies Richie of Springfield, Ill, noted a tender mass with vulvar erythema and edema. They diagnosed an abscess of a Bartholin gland. Culture results ruled out gonorrhea; a Gram stain was positive for group β-hemolytic Streptococcus agalactiae. A variety of organisms can cause the usually unilateral acute inflammation of a Bartholin gland1; Neisseria gonorrhoeae has been identified in fewer than 10% of cases.2 Treatment options include incision and drainage, placement of a Word catheter, marsupialization, application of silver nitrate( to the abscess cavity, removal by carbon dioxide laser, and surgical excision in patients with severe pain. Avoid surgical treatment in pregnant patients because of the increased risk of bleeding. A cesarean section is required when the abscess obstructs the vagina. A broad-spectrum antibiotic, such as a penicillin, a cephalosporin, or a quinolone for women who are not pregnant, is given until the cellulitis resolves. Analgesics and ice packs or sitz baths may also be used. Initially, this patient was given ceftriaxone( and the abscess was incised and drained. A course of amoxicillin(/clavulunate was then prescribed along with acetaminophen/hydrocodone for pain. The abscess resolved. At 39 weeks' gestation, the patient gave birth to a healthy boy by a normal spontaneous vaginal delivery.