GROUP B STREP FAQs

Few babies get infected, but moms who have a risk factor have a higher chance of having a sick baby. One of the major risk factors for having a sick baby is GBS in the urine. This is because there is a link between having high numbers of GBS in the vagina and having it in the urine. Women with higher levels of GBS in the vagina are more likely to have a sick child if they are not treated with antibiotics.

Women with GBS bacteriuria during pregnancy usually are heavily colonized with GBS and appear to be at increased risk for perinatal transmission

CDC, MMWR May 31, 1996 / 45(RR-7);1-24 Prevention of Perinatal Group B Streptococcal Disease: A Public Health Perspective

Wood EG, Dillon HC. A prospective study of group B streptococcal bacteriuria in pregnancy. Am J Obstet Gynecol 1981;140:515-20.

Moller M, Thomsen AC, Borch K, Dinesen K, Zdravkovic M. Rupture of fetal membranes and premature delivery associated with group B streptococci in urine of pregnant women. Lancet 1984;ii:69-70.

Liston TE, Harris RE, Foshee S, Null DM. Relationship of neonatal pneumonia to maternal urinary and neonatal isolates of group B streptococci. South Med J 1979;72:1410-2.

Persson K, Christensen KK, Christensen P, Forsgren A, Jorgensen C, Persson P. Asymptomatic bacteriuria during pregnancy with special reference to group B streptococci. Scand J Infect Dis 1985;17:195-9.

Because of the known relationship between GBS in the urine and higher chances for infecting baby, it's important to get rid of GBS in the urine any time it's found there.

Regardless of which preventive strategy is used, a) women with symptomatic or asymptomatic GBS bacteriuria detected during pregnancy should be treated at the time of diagnosis

CDC, MMWR May 31, 1996 / 45(RR-7);1-24 Prevention of Perinatal Group B Streptococcal Disease: A Public Health Perspective

2. Small amounts of GBS were found in my urine, but my doctor says he won't treat because there aren't enough.

Many doctors seem to make this statement, but it's not correct. When GBS is found in the urine (no matter how few), oral antibiotics are recommended to clear the infection. You also need to be tested after treatment to be sure GBS is no longer in the urine.

The reason doctors sometimes fail to treat low number of GBS is that they are assuming GBS is like other bacteria that women sometimes get in the urine. With OTHER bacteria, doctors only treat when a certain number of bacteria (or more) are found. In the case of GBS, however, it's important to treat mom with oral antibiotics when GBS is found in the urine NO MATTER HOW FEW. This comes directly from the experts at the Centers for Disease Control in Atlanta.

Asymptomatic bacteriuria during pregnancy is generally treated even when the count is less than 105 cfu/mL, especially when the organism is E. coli, Klebsiella pneumonia, Proteus mirabilis, Enterococcus, Pseudomonas, or group B Streptococcus or if the organism was identified on a catheterized specimen.

Urinary Tract Infections: Epidemiology, Detection, and Evaluation Scott A. Gallagher, MD Robin R. Hemphill, MD

Goldaber KG. Urinary tract infection during pregnancy. Hosp Med 1997;33:14-16, 19-20, 22-24

Centers of Disease Control and Prevention (contact number coming shortly)

3. What if I don't have symptoms of urinary tract infection? Do I still need antibiotics?

In the majority of cases, GBS urinary tract infection causes NO symptoms. This means that you have to ask to be tested to know if GBS is present, and it means that you don't wait for infection signs before treating GBS in the urine. If GBS is cultured in the urine, get oral antibiotics as soon as possible.

Regardless of which preventive strategy is used, a) women with symptomatic or asymptomatic GBS bacteriuria detected during pregnancy should be treated at the time of diagnosis; because such women are usually heavily colonized with GBS, they should also receive intrapartum chemoprophylaxis

CDC, MMWR May 31, 1996 / 45(RR-7);1-24 Prevention of Perinatal Group B Streptococcal Disease: A Public Health Perspective

Untreated asymptomatic bacteriuria leads to the development of symptomatic cystitis in approximately 30 percent of patients and can lead to the development of pyelonephritis in up to 50 percent.6 Asymptomatic bacteriuria is associated with an increased risk of intrauterine growth retardation and low-birth-weight infants.9

American Familiy Physician, Urinary Tract Infections During Pregnancy, JOHN E. DELZELL, JR., M.D., and MICHAEL L. LEFEVRE, M.D., M.S.P.H., University of Missouri-Columbia School of Medicine, Columbia, Missouri, February 1, 2000

4. If GBS is in my urine and it's treated now, will my baby get sick anyway?

Most likely, no. If you are proactive in getting oral antibiotics each time GBS is found in the urine and get IV antibiotics in early labor (continuing until delivery,) most babies will be healthy.

If you have a urinary tract infection and it isn't treated, it may lead to a kidney infection. Kidney infections may cause early labor. Fortunately, asymptomatic bacteriuria and bladder infections can usually be found and treated before the kidneys become infected. If your doctor treats a urinary tract infection early and properly, it won't hurt your baby.

American Familiy Physician, Urinary Tract Infections During Pregnancy Patient Handout, JOHN E. DELZELL, JR., M.D., and MICHAEL L. LEFEVRE, M.D., M.S.P.H., University of Missouri-Columbia School of Medicine, Columbia, Missouri, February 1, 2000

5. What happens if I'm not treated but GBS is in my urine?

In some cases, untreated GBS urinary tract infection (u.t.i.) can lead to problems for baby. GBS u.t.i. has been linked to preterm labor, kidney infection in mom, preterm rupture of membranes and preterm birth. In rare cases, GBS in the urine is linked to serious illness or death for baby, since moms who have GBS in the urine also often have high levels in the vagina. While MOST moms won't have these complications, treating GBS in the urine is very important

In addition to the inherent risks of pyelonephritis to the mother, including septic shock, ARDS, and death, bacteriuria has been associated with many other adverse outcomes to the mother and fetus. The incidence of gestational hypertension, preeclampsia, anemia, and amnionitis are increased in the presence of bacteriuria.

Infections in Urology, Urinary Tract Infections During Pregnancy, Jodi K. Maranchie, MD,* Carl C. Capelouto, MD,† Kevin R. Loughlin, MD, * Harvard Program of Urology, Longwood Area, Boston, Mass. † Atlanta Urological Clinic, Atlanta, Ga.

Schieve MS, Handler A, Hershow R, et al: Urinary tract infection during pregnancy: Its association with maternal morbidity and perinatal outcome. Am J Public Health 84:405-410, 1994.

Schaeffer AJ: Infections of the urinary tract, in Walsh PC, Retik AB, Stamey TA, et al (eds): Campbell's Urology. Philadelphia, W.B. Saunders Company, 1992, pp 789-795.