NORTH DAKOTA FAMILY PLANNING PROGRAM PROTOCOLS REPRODUCTIVE DISEASES

BARTHOLIN'S CYST AND ABSCESS

DEFINITION A post-inflammatory pseudocyst that forms proximally to the obstructed duct of a Bartholin's gland. The cyst may become infected and an abscess may develop in the gland. The flora is usually a mixture of aerobic and anerobic from the vagina, with chlamydia trachomatis and n. gonorrhoeae cultured in approximately 10% of the cases. Predominant pathogens leading to abscess are gonococcus and chlamydial organisms. May include: 1. Painful swollen lump in the vaginal area. 2. Difficulty sitting or walking due to severe pain and swelling. 3. History of infected Bartholin's gland, with or without antibiotic treatment. 4. History of sexually transmitted disease. 5. Fever 6. Dyspareunia May include: 1. No symptoms. 2. Cyst is characteristically located in the lower half of the labia with its inner wall immediately adjacent to the lower vaginal wall. 3. Lesions may vary in size from 1-10 cm. 4. The involved area may be painfully tender and erythemic. May include: 1. Vaginitis/cervicitis screening, as appropriate. Bartholin's Cyst Treatment options may include: 1. Asymptomatic cyst may require no treatment 2. Abscesses require antibiotic treatment. A. Doxycycline 100 mg PO bid x 7d, OR B. Cephalexin 500 mg PO bid x 7d, OR C. Cephalexin 250 mg PO qid x 7d, OR D. Ampicillin 500 mg PO qid x 7d. E. Advise sitz baths qid for 30 minutes for relief of pain. F. Advise OTC analgesic (ASA or NSAID) q4h prn for pain. 3. If cyst has increased in size or there is no change in size after 3 days of antibiotic therapy, a physician referral may be needed. 4. Symptomatic cysts and gland abscesses may require drainage. Bartholins Cyst RD-

SUBJECTIVE

OBJECTIVE

LABORATORY

ASSESSMENT PLAN

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CLIENT EDUCATION CONSULT / REFER TO PHYSICIAN Revised 07/10

1. Provide client education handout(s). Review symptoms, treatment options, and medication side effects. 2. Advise to avoid intercourse until completion of medication. 1. If above treatment under plan is ineffective refer to a physician.

References: 1. Hawkins, Joellen W.; Roberto-Nichols, Diane M.; Stanley-Haney, J. L. (2000). Protocols for Nurse Practitioners in Gynecologic Settings (7th ed.). New York: Tiresias Press, Inc. pp.149-150. 2. Omole, F., Simmons, B.J. & Hacker, Y. (2003) Management of Bartholins Duct Cyst and Gland Abscess. American Family Physician. 68 (1). pp. 135-40. 3. Bartholin Cyst (2010). Retrieved April 1, 2010 from http://www.mayoclinic.com/health/bartholin-cyst/DS00667 4. Bartholin Cyst and Abscess. 2009 Marx: Rosens Emergency Medicine (7th ed.). Retrieved from www.mdconsult.com . 5. Bartholins Abscess. (2010). Retrieved April1, 2010 from http://www.nlm.nih.gov/medlineplus/ency/article/001489.htm.

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Bartholins Cyst

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