Management

If the patient is seen before an abscess has formed, antibiotics may avoid the need for surgery, for example:

• flucloxacillin 500mg four times/day or
• erythromycin 500mg four times/day.

Gonococcal infection should be excluded.

If an abscess has formed, refer the patient as an emergency for drainage and marsupialisation of the infected cyst.

Notes:

• NICE suggest that conservative management of symptomatic cysts or abscesses may include warm baths, compresses, analgesics, and antibiotics when appropriate
  • persistent and symptomatic cysts or abscesses are often treated surgically, by incision and drainage, or by marsupialisation (where the cyst is opened, and the skin edges are stitched to allow continual free drainage of the fluid from the cyst cavity)
  • balloon catheter insertion for Bartholin's cyst or abscess is supported as a management option by NICE (1)
    • aim of the procedure is to establish drainage of the abscess or cyst by creating a fistula or sinus track that will remain open in the long term. The underlying principle is that a foreign body reaction (to the balloon and catheter) induces formation of an epithelialised fistula
    • abscess or cyst is drained
    • a specially designed balloon catheter is inserted into the abscess or cyst cavity through the incision, and the balloon is inflated with saline to secure it in place. If pain persists after the balloon is inflated, it is partially deflated, leaving enough fluid to keep the catheter in position. A suture may be used to partially close the incision and hold the catheter in place
    • catheter stays in, usually for up to 4 weeks, to allow epithelialisation of the tract, after which it is deflated and removed
      • a period of a few weeks may be required for epithelialisation.

Reference:

• 1) NICE (December 2009). Balloon catheter insertion for Bartholin’s cyst or abscess