Case records and commentaries in obstetrics and gynaecology
Abstract
Background
The magnitude of Bartholin's gland abscess locally is undetermined despite the fact that
it's an important cause of morbidity especially among women of reproductive age.
Bartholin's gland abscess occurs due to primary infection of the gland by pathogenic
bacteria. Globally the incidence of Bartholin's gland abscess is 2% and the age
commonly affected is between 20-29 years. Literature shows that the incidence of
Bartholin's gland abscess at Kenyatta National Hospital (KNH) is 1.9% with a recurrence
rate of 17%. Most infection occurred between 15-39 years with a mean age of 23.5 years.
It is worthwhile noting that the abscesses are also occurring in extremes of age locally
and this should raise concern. It seems to be a problem of the young and sexually active
women who are also affected more by the HIV /AIDS. Though a simple gynecologic
malady it causes untold marital, psychological and social distress to the patient Treatment
options available include marsupialization, insertion of word catheter, insertion of silver
nitrate, carbon dioxide laser, alcohol sclerotherapy, surgical excision of the entire gland
and antibiotics. Treatment at KNH is by marsupialization and antibiotics; other methods
have not been attempted. The high recurrence rate of Bartholin's gland abscess locally is
noted with concern and this may warrant review of our method and technique of
treatment.
Study objective
The study objective was to review Bartholin's gland abscess as seen at KNH between
January 2005 and December 2005. The specific objectives were to analyze the
prevalence, socio-demographic characteristics, HIV status, site of Bartholin's gland
abscess, mode of treatment and postoperative complications.
Study design and methodology
This was a retrospective descriptive study carried out at the records department at KNH.
It involved review of files of patients who were treated for Bartholin's gland abscess
between January 2005 and December 2005. The patient's name and file number were
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obtained from coded data in the records department and the records staff retrieved the
files. The data was entered into a data collection form then entered into the computer for
analysis.
Results
The mean age of the Bartholin's abscess study subjects was 26.2 years with a median of
26 years and a standard deviation of 6.66. The youngest study subject was 14 years and
the oldest was 42 years. Most 24 (53.3%) were aged between 20 and 29 years. Majority
22 (48.9%) were married, 12 (26.7%) had an education of only primary school and 13
(28.9%) were housewives. The mean parity was 1.57 with a mode and a median of 1.
Majority 28 (62.2%) had had between one and three pregnancies. Those pregnant while
having the Bartholin's abscess were 9 (20%) with of which 4 were in the third trimester.
10 (22.2%) of the study subjects were on modem contraceptives, 12 (26.7%) had
previously had Bartholin's abscess and 4 (8.9%) were HIV positive. 27 (60%) of the
study subjects had Bartholin's abscess on the right side. All the abscesses were treated by
Marsupialization. The prevalence rate was 0.4% and the recurrence rate was 26.7%. All
the Bartholin's abscesses were treated by way of marsupialization and antibiotics. HIV
positive women were 27 times more likely to develop Bartholin's abscess compared to
HIV negative ones (p<0.0001) and patients with previous history of Bartholin's abscess
and were HIV positive were almost 92 times more likely to present with a recurrence
compared to HIV negative ones (p<O.OOOI).
Conclusion
The prevalence of Bartholin's gland abscess was 0.4% with a recurrence rate of 26.7%.
The Bartholin's gland abscess affected mostly the young women of low parity and low
socioeconomic status and HIV was associated with its development and recurrence
(p<O.OOOI).
Citation
Master of Medicine (Obstetrics and Gynaecology)Sponsorhip
University of NairobiPublisher
Department of Paediatrics, College of Health Sciences, University of Nairobi, Kenya.