Additional Notes to Infections of the LGT

GENITAL HERPES: DIAGNOSIS

BARTHOLIN’S CYST AND ABSCESS Clinical inspection
BARTHOLIN’S GLAND ANATOMY Viral culture positive in primary episodes
 Pea-sized glands located at the entrance of the vagina Polymerase Chain most accurate and sensitive technique
at 5’ and 7 o’clock Reaction (PCR) Test for identifying HSV
 Normally not palpable Western blot assay for most specific method for diagnosing
 Open in a groove between the hymen and labia minora antibodies to HSV recurrent, unrecognized orsubclinical
in the posterior lateral wall of the vagina herpe
Type-specific Recurrent genital symptoms or atypical
BARTHOLIN’S ABSCESS HSV serologic Assay symptoms with negative HSV culture
Obstruction of the duct secondary to nonspecific inflammation or Clinical diagnosis of genital herpes
trauma without laboratory confirmation
↓ Partner with genital herpes
Continued secretion of glandular fluid ELISA and Immunoblot test
↓
Cystic dilatation of the bartholins duct Antiviral Treatment for HSV-Nonpregnant Patient
Indication Valacyclovir Acyclovir Famciclovir
First clinical 1000 mg bid 200 mg five 250 mg tid for
DIFFERENTIAL DIAGNOSIS
episode for 7–10 days times a day or 7–10 days
 Mesonephric cyst of the vagina  More anterior & cephalad in 400 mg tid
the vagina for 7–10 days
 Epithelial inclusion cyst More superficial Recurrent 1000 mg daily or 400 mg tid for 5 125 mg bid for
 Lipoma/ Fibroma episodes 500 mg bid days or 5 days 500 mg
 Hernia for 5 days (or 3 800 mg bid for 5 once
days) days or then 250 mg
 Vulvar varicosity
800 mg tid for 3 bid for 2 days;
 Hydrocele days 100 mg bid
for 1 day
BARTHOLIN’S CYST/ ABSCESS Daily 500 mg daily 400 mg bid or 250 mg bid
Cyst Abscess suppressive (≥10 1000mg/day
Location Found in the labia majora and duct orifices are at the therapy recurrences/year)
base of the labia minora just distal to the hymen or
500 mg/day o
Size 1 – 8 cm
(≤9
Laterality Often unilateral but may be bilateral recurrences/year)
Signs Tense Develops rapidly (2-4 days)
Erythema, tenderness, edema PREVENTION
Symptoms Nonpainful Acute vulva pain  Regular condom use (but not 100% protective)
Dyspareunia  Vaccine
Pain during walking
 HSV-seronegative women are three times as likely to acquire
 HSV infection from seropositive male partners compared with
BARTHOLIN’S GLAND ENLARGEMENT TREATMENT:
seronegative males acquiring HSV from infected female
Asymptomatic Cyst + No treatment partners.
Age < 40
Acute adenitis without Broad-spectrum antibiotics
SYPHILIS (TREATMENT)
abscess formation Hot sitz bath
Primary, Secondary and Early Latent Phase
Symptomatic Cyst or Marsupialization
 Benzathine Penicillin G, 2.4 million units IM
Abscess Word catheter
Penicillin Allergy / nonpregnant
Antibiotics not necessary
 Doxycycline 100 mg twice daily x 14 days or
unless there is cellulitis
 Tetracycline, 500mg orally qid for 2 wk
Women Age > 40 Excision biopsy

BARTHOLINS GLAND EXCISION NEISSERIA GONORRHOEAE

Indications TREATMENT: CDC 2010
 Persistent deep infection  Ceftriaxone 250 mg IM or
 Multiple recurrences of the abscess  Cefixime 400 mg PO
 Glandular enlargement in women > 40 y/o PLUS Chlamydia therapy if not ruled out

Complications Alternative Regimens

 Hemorrhage  Spectinomycin 2 grams IM in a single dose or
 Hamatoma formation  Ceftizoxime 500 mg IM; or Cefoxitin 2 g IM,
 Fenestration of the labia  administered with probenecid 1 g orally; or
 Postoperative scarring  Cefotaxime 500 mg IM
 Dyspareunia  Azithromycin 2 grams
PLUS Chlamydial therapy if infection not ruled out

caramelmacchiato (3B)