Treatment of a Bartholin abscess

1. Analgesia and supportive care
   • NSAID or paracetamol for pain.
   • Warm sitz baths can provide temporary symptom relief, especially if the abscess has begun to drain spontaneously.
2. Drainage with Word catheter: first-line for most cases
   • Make a small incision on the mucosal/medial surface of the vestibule, drain pus, and insert a Word catheter.
   • The balloon catheter is left in place for about 4 to 6 weeks to maintain drainage and create a permanent epithelialized tract, reducing recurrence.
   • Send pus for culture when infection is severe, recurrent, atypical, or antibiotic selection may be needed. Bartholin abscesses are often polymicrobial. Sabiston Textbook of Surgery, p. 2790.
3. Antibiotics are not routine after adequate drainage Give antibiotics if there is:
   • Surrounding cellulitis
   • Fever, sepsis, or systemic illness
   • Recurrent abscess
   • Immunocompromise or poorly controlled diabetes
   • High risk of MRSA
   • Suspected or confirmed STI
   Choose treatment based on local antimicrobial guidance and culture results. Where MRSA cover is needed, regimens may include trimethoprim-sulfamethoxazole, with additional anaerobic/enteric coverage when clinically indicated, as summarized in the Merck Manual guidance.
4. STI assessment
   • Test for gonorrhea and chlamydia when risk factors are present.
   • Treat patient and sexual partner(s) according to local STI protocols if an STI is diagnosed.
5. Recurrent disease
   • Marsupialization is appropriate for recurrent abscesses or when Word catheter placement fails or is unsuitable.
   • It creates a permanent drainage opening by suturing the cyst wall to the vestibular mucosa.
   • Definitive gland excision is reserved for persistent/recurrent cases or suspected malignancy. Roberts and Hedges’ Clinical Procedures in Emergency, p. 1378.
6. Exclude malignancy when appropriate
   • Refer to gynecology and consider biopsy for a solid, fixed, irregular, persistent, or non-responding mass, particularly in an older or postmenopausal patient. Berek & Novak’s Gynecology, p. 2473.

Urgent gynecology review/admission