Periclitoral abscess: Two case studies

Abstract

Periclitoral abscesses are rare, with only a few cases reported in the literature. Although these abscesses are typically observed following surgical procedures such as female circumcision, spontaneous cases have also been documented. Despite various diagnostic and treatment approaches, recurrences are common. A 43-year-old patient applied with pain, sensitivity, and swelling on the left side of the clitoris, along with a mixed vaginal infection. Examination revealed a 2.5 cm abscess around the clitoris. The patient tested positive for human papilloma virus 18 and had a history of lichen sclerosus et atrophicus. She had previously undergone sling surgery, anterior colporrhaphy, and hysterectomy a year prior. She had received platelet-rich plasma and stromal vascular fraction treatment for lichen sclerosus and had been symptom-free for six months. Despite incision and empirical ciprofloxacin treatment for one week, the inflammation and abscess persisted. Complete excision of the abscess was performed, and tissue culture identified coagulase-positive Staphylococcus aureus. Sulbactam ampicillin (1 gram twice daily) was administered for one week based on the antibiogram results. A 43-year-old patient with diabetes mellitus and hypothyroidism, who had a copper intrauterine device for 11 years, applied with hardness, pain, and vaginal discharge on the left side of the clitoris. Examination revealed a deep-seated abscess extending from the clitoris to the urethra. The abscess was drained under local anesthesia, and empirical treatment with extended-spectrum sulbactam ampicillin (1 gram twice daily) was started. The patient was symptom-free for four months, but the abscess recurred at the same location. Drainage and excision were performed, and tissue culture revealed coagulase-negative Staphylococci. Consequently, clindamycin (300 mg twice daily) and gentamicin (800 mg twice daily) were prescribed for 10 days. The patient remained symptom-free for eight months. Periclitoral abscesses should be considered in cases of swelling, tenderness, and pain around the clitoris. Management may require not only incision and drainage but also excision and tissue culture for definitive diagnosis and antibiogramguided therapy to prevent recurrence.