Guidelines
Vulvar Abscess

Vulvar Abscess

Most Likely Pathogens

Polymicrobial genital tract organisms including aerobes and anaerobes

Management and Duration of Therapy

Treatment of vulvar abscess depends upon the lesion size and the patient's risk factors for failure of therapy or systemic infection. The general principles of management are the same regardless of the type of vulvar abscess.

Small lesions often resolve with conservative therapy (eg, warm compresses). However, incision and drainage is the mainstay of treatment of vulvar abscesses. Antibiotics are required in some cases

Lesions that are appropriate for conservative therapy (eg, warm compresses) may be treated by any primary care clinician. Incision and drainage requires a clinician who has experience with vulvar procedures.

The first line of therapy for most women with a small vulvar abscess (less than 2 cm) is conservative therapy (e.g., warm compresses or sitz baths). Antibiotic therapy may be used in combination with conservative measures.

Small vulvar abscesses (less than 2 cm) that have yet to point to the skin surface ("come to a head") are treated with warm compresses or sitz baths three to four times per day. If the lesion does not resolve after a week or if the lesion points to the skin's surface, incision and drainage will hasten resolution.

For immunocompromised women, conservative management should be used only for abscesses that are too small for incision and drainage.

Initial treatment of a small vulvar abscess with conservative therapy alone is reasonable. Antibiotic therapy should be initiated if the lesion does not improve after two days of conservative therapy or if the patient is immunosuppressed.

For women with a vulvar abscess greater than or equal to 2 cm

The role of antibiotic therapy following incision and drainage of vulvar abscesses is uncertain. Initial approach of incision and drainage combined with antibiotic therapy for women with the following risk factors for failure of therapy or dissemination of infection, including:

  • Size greater than or equal to 5 cm
  • Location makes abscess difficult to drain completely
  • Infection extends into other anatomic compartments (eg, abdominal wall or thigh)
  • Extensive or rapidly progressing surrounding cellulitis
  • High likelihood of being methicillin-resistant Staphylococcus aureus (MRSA)-positive
  • Systemic signs of infection
  • Immunocompromised patient
  • Recurrent abscess

Antimicrobial therapy should continue until surrounding erythema and edema have resolved and all systemic signs of infection are absent (usually 5 to 10 days).

Incision and drainage may be required (see above)

Suggested Regimen