Microbiological investigation of Bartholin's gland abscesses in urban women in Johannesburg

Bartholin's gland abscess of the female genital tract is fairly common in South Africa. Relatively few studies on the aetiology of this condition had been conducted before 1992 and even fewer after this date. Early literature suggested that Neisseria gonorrhoeae was the main cause of Bartholin's gland abscesses but it was subsequently shown that the majority of these abscesses had a polymicrobial aetiology with anaerobic bacteria featuring prominently. The study described here was conducted in 1992 and was designed to determine the aetiology of Bartholin's gland abscess in Johannesburg women admitted to the Hillbrow Hospital and at the same time establish the prevalence of genital pathogens in the endocervical canal of these women. Well established techniques were used for the culture of gonococci, Chlamydia trachomatis, mycoplasmas and other aerobic and anaerobic bacteria from properly collected pus aspirates from abscesses and endocervical swabs. Potential pathogens were found in 21 out of 33 aspirates. N. gonorrhoeae was isolated from four abscesses, two of which were in pure culture, while gonococci were also recovered from five endocervical swabs. C. trachomatis could only be isolated from one endocervical swab but not from any of the abscesses. Anaerobic bacteria were recovered in mixed culture from abscesses of nine patients and were the most common organisms found in pus aspirates. Mycoplasmas, including ureaplasmas, featured prominently. Pyogenic streptococci and staphylococci, as well as Escherichia coli and other Gram-negative bacilli were also found in abscesses while the anaerobic bacterium Fusobacterium nucleatum and the aerobic bacillus Brevundimonas vesicularis were each isolated in pure culture from an abscess of two different patients. This study confirms the polymicrobial aetiology of Bartholin's gland abscesses while pyogenic anaerobic and aerobic bacteria, the gonococcus and mycoplasmas were the predominant pathogens.