Infections of Bartholin Gland - Causes, Symptoms and Management

Introduction

The Bartholin glands are two pea-sized glands located in the posterior region of the vaginal opening of the female reproductive system. This gland is associated with vaginal lubrication and mucus secretion. These glands are susceptible to infections and abscess formations that result in vestibular pain and dyspareunia. The abscess culture shows polymicrobial infection. The bacteria involved in infection are Streptococcus pneumonia, Escherichia coli, Neisseria gonorrhoeae, and Chlamydia.

What Is Bartholin Gland Infection?

Bartholin gland infection or bartholinitis is a common infection in the gynecological department that results from mucus accumulation in the gland ducts, especially in women in their reproductive period. The most common bacteria involved in bartholinitis is Streptococcus pneumonia. In addition, the infection may result from a cyst or abscess formation in the gland.

What Are the Causes of Infection?

The Bartholin gland infection is primarily caused by bacterial invasion due to abscess and cyst formation. Other causes include:

• Trauma or Injury: A concussion or damage to the gland can occur during childbirth, sexual intercourse, or other activities that cause pressure on the glands.

• Infection or Inflammation: A sexually transmitted infection like chlamydial infection or Neisseria gonorrhea leads to inflammation of glands, which increases the risk of abscess formation.

• Hormonal Changes: Changes during pregnancy or hormonal imbalances makes the glands more susceptible to infection.

• Genetics: In a few cases, a genetic predisposition can cause ductal blockage in the glands.

• Poor Hygiene: Poor hygiene practices also increase the risk of infection or abscess formation.

• Obstructions: The presence of cysts or tumors can obstruct the gland's duct, which accumulates fluid, increasing the risk of infection.

• Immunocompromised Conditions: People with immunodeficiency conditions such as HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and cancers are more susceptible to developing an infection and abscess formation in the Bartholin gland.

• Age: Bartholin gland abscess is more common in young women and can occur at any age.

What Are the Symptoms of Bartholin Gland Infection?

Some cases of Bartholin gland abscess or infection may be asymptomatic. But symptoms may include:

• Swelling and redness in the affected area.

• A lump or mass on either side of the vaginal opening.

• Fever in people with weakened immunity.

• Pain while walking or sitting.

• Vaginal pressure.

• Pain during sexual intercourse.

• Vaginal discharge.

• Cellulitis and lymphangitis - abscess formation.

• Painless mass.

• Vestibular pain.

• Erythema and edema.

• Spontaneous rupture and drainage in case of a large abscess.

• Urinary retention.

How Does Infection of the Bartholin Gland Occur?

The infection of the Bartholin glands occurs due to cyst formation in the gland. The cyst affects the ductal region of the gland due to blockage of the outlet, leading to obstruction in the orifice and mucus buildup. Infection results in abscesses. An abscess is three times more common than a cyst and does not occur due to cyst formation. The bacteriology of Bartholin gland abscess and cyst are:

• Bacteroides species.

• Escherichia coli.

• Chlamydia trachomatis.

• Streptococcus pneumonia.

• Neisseria gonorrhoeae.

• Salmonella panama.

• Pasteurella bettii.

• Brucella melitensis.

• Neisseria sicca.

• Hypermucoviscous Klebsiella pneumonia.

How to Diagnose Bartholinitis?

Diagnosis includes:

• Physical Examination: A pelvic examination is done by a healthcare provider. The gland is tender and enlarged.

• Magnetic Resonance Imaging (MRI) And Computed Tomography (CT): A scan is advised to examine the gland and the presence of Bartholin’s duct cysts.

• Laboratory Tests: Any pus discharge or vaginal discharge, or drained abscess is sent to the laboratory for testing.

• Blood Tests: Complete blood pictures may be asked to check total leukocyte count, hemoglobin content, PCR (polymerase chain reaction), red blood cells count, white blood cell count, platelet count, etc.

• Biopsy: Biopsy is recommended for histological examination to eliminate the occurrence of carcinoma.

• Ultrasound imaging is also used to examine the presence of cysts.

What Is the Differential Diagnosis?

The Bartholin gland infection imitates various lesions of the vagina and labia. Differential diagnosis includes:

• Syphilis.

• Vaginitis.

• Warts or Bartholin gland cysts.

• Chancroid.

• Cancer.

• Lipomas.

• Hernia.

• Leiomyomas fibroma.

• Hematomas.

• Folliculitis.

• Urethral diverticula.

What Is the Treatment of Bartholin Gland Infection?

Treatment is not required in asymptomatic cases. But the abscess, infections, and cysts can be managed by self-care, sitz baths, and analgesics. In addition, antibiotic medications help to treat the infection.

• Sitz Bath: It is a procedure in which three to four inches of water is filled in a bathtub and sat in to soak the perineum for pain relief and itching. It is recommended for abscesses that rupture spontaneously.

• Catheter: Catheterization is a conservative method to treat Bartholin’s abscess or cyst and helps to prevent a recurrence. A catheter contains an inflatable balloon tip filled with saline solution. A small incision is made at the infected area, and a catheter is placed inside the abscess cavity and left for four to six weeks, along with a sitz bath to aid in healing.

• Marsupialization: It is an alternative procedure for cyst drainage. A vertical incision is made to drain the cyst contents, and the cavity is rinsed with saline. It is not advised for abscess formation.

• Antibiotic Therapy: Antibiotics are given in complicated immunocompromised cases. It includes Ciprofloxacin, Doxycycline, Ceftriaxone, and Azithromycin. In addition, topical or local anesthetics such as Bupivacaine or Lidocaine are used to treat the abscess.

• Surgery: Surgery may be required in case of large cysts or carcinomas, followed by vulvectomy or radiotherapy.

Conclusion

The Bartholin gland is a vital part of the female reproductive system that lubricates the vagina and secretes mucus. Any blockage or obstruction to the ducts of the glands leads to cyst formation resulting in infection and abscess development. Several bacteria may be involved in the abscess development and can be left untreated if asymptomatic. In large and symptomatic cases, medical attention and treatment are necessary. The treatment includes a sitz bath, marsupialization, incision and drainage, catheterization, antibiotic therapy, and surgery. The infection can be prevented by following good hygiene, safety measures during sexual intercourse, and a healthy lifestyle.