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General: Comply with follow-up care. Discuss STD prevention and condom use.
Activity: Rest
Diet: As tolerated
Medications: As above. If patient develops GI intolerance, pre-medicate with any oral antiemetic before
antibiotic dose.
Prevention: Patient must not have intercourse with untreated partner even if he is asymptomatic. Avoid
high-risk sexual behaviors. Use barrier methods to prevent STD transmission.
No Improvement/Deterioration: Return for transfer/hospitalization/evaluation for alternative diagnosis.
Follow-up Actions
Return evaluation: 48-72 hours
Evacuation/Consultation Criteria: Patients whose diagnosis is unclear or whose pain is worsening despite
treatment will require immediate evacuation for extensive workup, including laparoscopy, pelvic ultrasound, CT
scan, cervical cultures for gonorrhea and chlamydia, CBC, and testing for HIV, Hepatitis B and for syphilis.
Symptom: GYN Problems: Bartholin’s Gland Cyst/Abscess
MAJ Ann Friedmann, MC, USAIntroduction: The mucus-secreting Bartholin’s glands drain by way of a 2 cm duct into the vaginal vestibule
immediately outside the hymenal ring at about the 4:00 and 8:00 position. Blockage of the duct causes
secretion accumulation and cyst formation in the gland itself. Blockage may be a slow, chronic process
leading to an asymptomatic vulvar mass as the gland gradually accumulates fluid, or it may be an acute
inflammatory process leading to a painful, infected mass. An acute abscess may occur as the result of
infection (chlamydia, gonorrhea, perineal aerobes and anaerobes), vaginal surgery, episiotomy or trauma as
in childbirth.
Subjective: Symptoms
Pain with walking, tight clothing or intercourse; mass presents right or left outside of the vagina.
Objective: Signs
Using Basic Tools: Tender, cystic mass in the area of the Bartholin’s duct and gland; warm, red overlying
skin; purulent drainage from duct. A chronic duct obstruction will often be asymptomatic and an incidental
finding on pelvic exam (no treatment required).
Using Advanced Tools: Lab: Gram stain may disclose gonococci or clue cells. Culture gonorrhea from
exudate.
Assessment:
Differential Diagnosis: Adenopathy, gumma, bubo, trauma, tumor, scar.
Plan:
Treatment
Primary
- Antibiotics (per pelvic inflammatory disease protocol): ceftriaxone 250 mg IM and doxycycline 100 mg
po bid x 10-14 days. - Incision & drainage (see procedure description below).
- Pain control with ibuprofen 800 mg tid (or other NSAID). Occasionally patient will need a mild narcotic for
the first 24-48 hours (Tylenol #3 or Percocet).
Alternative: Any of the other antibiotic regimens as listed in the PID section.
Primitive: Antibiotics, warm compresses or sitz baths, pain medications and transfer for further care. A
Bartholin’s cyst may resolve with only this treatment but it is best to drain an abscess.