Journal Reading

Association of Bartholin cysts and abscesses

and sexually transmitted infection
Nadhirah Ananda Idris | 70700120034
Ahmad Fari Arief Lopa | 70700120038

Supervisor Pembimbing :
Dr. dr. Sitti Musafirah, Sp.KK, FINS-DV

SEBAGAI TUGAS KEPANITERAAN KLINIK

DEPARTEMEN KULIT DAN KELAMIN
FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS ISLAM NEGERI ALAUDDIN MAKASSAR
2021
 Journal Data

Author Journal
Justin M. Elkins, MD, Osman S. Hamid, MD, Leslie V. Simon, DO,
Johnathan M. Sheele, MD, MPH Elsevier : American Journal of Emergency Medicine

Departement Publication
Department of Emergency, Medicine Mayo Clinic, Jacksonville, 9 April 2020
FL, United States of America
 Source jurnal
Justin M Elkins, Osman S Hamid, Leslie V simon, Jonathan
M Sheele. Association of Bartholin cysts and abscesses and
sexually transmitted infections. Elsevier. American Journal of
Emergency Medicine. 2020.
 ABSTRACT
Introduction
Bartholin gland cysts or abscesses account for many
gynecologic visits in the emergency department (ED).
Previous studies have suggested a link between
Bartholin cysts/abscesses and sexually transmitted
infections (STIs).
Method
Retrospectively identified patients aged 18 years or older
seen in 1 ED between January 2012 and March 2017 who
had urinalysis and urine culture and/or were tested for
gonorrhea, chlamydia, or trichomonas by nucleic acid
amplification testing.
Results
Data were collected for 75,000 ED patients; 64
patients had a diagnosis of Bartholin cyst or abscess,
40 of whom were also tested for Neisseria
gonorrhoeae or Chlamydia trachomatis.
10%  were infected Bartholin cyst or abscess
Conclusions
Clinicians in the ED should consider testing
patients with a Bartholin cyst/abscess for
gonorrhea.
 INTRODUCTION
-SOMEONE FAMOUS

• Bartholin gland cysts and abscesses occur in reproductive-

aged women and account for approximately 2% of annual
gynecologic visits
• Although There are no established risk criteria for Bartholin
cysts, abscesses may be more common in women at risk for
STIs
• The incidence of Bartholin cysts and abscesses appears to
increase with age until menopause and then decrease
• Bartholin gland infections may be caused by aerobic and
anaerobic organisms arising from the normal vaginal and
cervical flora, but most are polymicrobial
 INTRODUCTIO
N
consists primarily of surgical

Treatment drainage, often with placement of a

Word catheter with an inflatable
balloon to facilitate drainage.

First-line choices of antibiotics for Bartholin cysts/abscesses include those that

are effective against both aerobic and anaerobic bacteria of the genital tract, such
Antibiotics as ampicillin, cephalosporins, clindamycin, or metronidazole

The objective of the current study was to determine whether Bartholin cysts or abscesses addressed in
the ED are associated with concurrent STIs or specific findings on urinalysis or vaginal wet preparation
(wet prep)
 METHOD

01 02 03

structured
query language (SQL) Identified patient Considered infected
demographics, information with Trichomonas vaginalis if the organism
The dataset contained adult patients (≥18
obtained during ED triage, STI was identified on urinalysis or wet prep or if
years). Encounter dates in the dataset were
testing and results, and the results of they had a positive nucleic acid
from April 18, 2014, to March 7, 2017.
the vaginal wet prep and urinalysis. amplification test (NAAT) result.
 METHOD
Canceled tests  lab report as an error or with
Descriptive statics  univariate and
conclusive results and missing data were not
multivariate
included

χ2 test  categorical values

T-tests  continous variable
Binominal regression  dependent
variable
Statistical significance was set at
P ≤ .05. Jamovi version 0.9.6.8 and JMP Pro 14
(SAS Institute Inc) software
were used for statistical analyses.
 RESULTS
• 75,000 patient encounters during the study period
• 55,692 patients were women
RESULTS Among 17,411 women who underwent testing for gonorrhea,
chlamydia, or both
RESULTS
 RESULTS
There were no significant differences in the prevalence of urinary tract infections or bacterial
vaginosis between those with and without a Bartholin cyst/abscess among women tested for N
gonorrhoeae and/or C trachomatis
RESULTS
 RESULTS

Considering only women who had N

gonorrhoeae and C trachomatis
testing, urine urobilinogen was still
the only laboratory result significantly
higher for those with a Bartholin
cyst/abscess
RESULTS
 RESULTS
• Among the 64 women with a Bartholin cyst/abscess,
those who were not tested for gonorrhea and/or
chlamydia were significantly older than those who
were
• 8% of patients not tested  treated with ceftriaxone
or cefixime plus azithromycin or doxycycline.
• 4 of 33 women (12%) tested  didn’t have either
STI but were nevertheless empirically treated with
ceftriaxone or cefixime plus azithromycin or
doxycycline in the ED.
• 3 of 7 women (43%) with a Bartholin cyst/abscess
who tested positive  empirically treated with
ceftriaxone or cefixime plus azithromycin or
doxycycline in the ED
• Analysis of women with Bartholin cyst/abscess who
had testing for N gonorrhoeae (n = 40) indicated no
significant differences in age, mean number of wet
prep WBCs, urine leukocyte esterase value, number of
urine WBCs, and urine urobilinogen value between
those with and without gonorrhoeae
• All 4 women with N gonorrhoeae and a Bartholin
cyst/abscess were black and unmarried.
• linier regression  age and having gonorrhea were
significant factors
 DISCUSSION
Bartholin cysts/abscesses were diagnosed in only 0.09% (64/75,000) of ED patient encounters
in our dataset, and only 63% of those with a Bartholin cyst/abscess (40/64) underwent testing
for N gonorrhoeae, C trachomatis, or both. The prevalence of N gonorrhoeae in association with
Bartholin cysts/abscesses could vary depending on the prevalence of N gonorrhoeae in the
reference population and whether the cervix or abscess fluid was sampled. n logistic regression,
there were no significant differences in patient demographics or triage data for those with and
without a Bartholin cyst/abscess. Additionally, logistic regression showed no significant
differences in wet prep or urinalysis results for those with and without a Bartholin cyst/abscess
except for urine urobilinogen level. Increased urine urobilinogen levels can be seen in conditions
generating more bilirubin, such as in a hemolytic anemia, or in liver disease, such as hepatitis.
In our dataset, high urine urobilinogen values were associated with both older age and infection
with N gonorrhoeae; however, we are unable to propose a clear pathological reason for urine
urobilinogen being associated with a Bartholin cyst/abscess except that some women with a
Bartholin cyst/abscess could have systemic manifestations of N gonorrhoeae (eg, Fitz-Hugh–
Curtis syndrome).
 DISCUSSION
No emergency medicine guidelines have been published about testing for STIs in women with a
Bartholin cyst/abscess. Although neither C trachomatis nor Trichomonas vaginalis infection was
significantly associated with a Bartholin cyst/abscess in our study, N gonorrhoeae was strongly
associated, so ED clinicians should consider STI testing in all women with a Bartholin cyst/abscess
 CONCLUSION
Clinicians should consider testing for N gonorrhoeae in women with a Bartholin cyst/abscess seen in
the ED. Neither C trachomatis nor T vaginalis infection was associated with Bartholin cysts/abscesses
 REFERENCES
[1] Marzano DA, Haefner HK. The bartholin gland cyst: past, present, and future. J Low Genit Tract Dis 2004 Jul;8(3):195–204.
[2] Omole F, Simmons BJ, Hacker Y. Management of Bartholin’s duct cyst and gland abscess. Am Fam Physician 2003 Jul 1;68(1):135–40.
[3] Aghajanian A, Bernstein L, Grimes DA. Bartholin’s duct abscess and cyst: a casecontrol study. South Med J 1994 Jan;87(1):26–9.
[4] Yuk JS, Kim YJ, Hur JY, Shin JH. Incidence of Bartholin duct cysts and abscesses in the Republic of Korea. Int J Gynaecol Obstet 2013 Jul;122(1):62–4.
[5] Begum S, Roy S, Yusuf MA. Anaerobic bacteria: infection and management. IOSR J Dent Med Sci 2015;14(12):69–72 12/31.
[6] Parker RT, Jones CP. Anaerobic pelvic infections and developments in hyperbaric oxygen therapy. Am J Obstet Gynecol 1966 Nov 1;96(5):645–59.
[7] Bleker OP, Smalbraak DJ, Schutte MF. Bartholin’s abscess: the role of chlamydia trachomatis. Genitourin Med 1990 Feb;66(1):24–5.
[8] Lee YH, Rankin JS, Alpert S, Daly AK, McCormack WM. Microbiological investigation of Bartholin’s gland abscesses and cysts. Am J Obstet Gynecol
1977 Sep 15;129(2): 150–3.
[9] Tanaka K, Mikamo H, Ninomiya M, Tamaya T, Izumi K, Ito K, et al. Microbiology of Bartholin’s gland abscess in Japan. J Clin Microbiol 2005
Aug;43(8):4258–61.
[10] Kessous R, Aricha-Tamir B, Sheizaf B, Steiner N, Moran-Gilad J, Weintraub AY. Clinical and microbiological characteristics of Bartholin gland abscesses.
Obstet Gynecol 2013 Oct;122(4):794–9.
[11] Davies JA, Rees E, Hobson D, Karayiannis P. Isolation of chlamydia trachomatis from Bartholin’s ducts. Br J Vener Dis 1978 Dec;54(6):409–13.
[12] Hoosen AA, Nteta C, Moodley J, Sturm AW. Sexually transmitted diseases including HIV infection in women with Bartholin’s gland abscesses. Genitourin
Med 1995 Jun;71(3):155–7.
[13] Brook I. Aerobic and anaerobic microbiology of Bartholin’s abscess. Surg Gynecol Obstet 1989 Jul;169(1):32–4.
[14] Hill DA, Lense JJ. Office management of Bartholin gland cysts and abscesses. Am Fam Physician 1998 Apr 1;57(7):1611–1616, 9–20.
[15] Ross J. Pelvic inflammatory disease. BMJ 2001 Mar 17;322(7287):658–9
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