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Understanding Group B-Streptococcus in Pregnancy

Monday, April 14th, 2014

Group B β-Streptococcus (GBS or GBBS ) is a bacterium commonly found in the rectum, and vagina. Group B Β Streptococcus  should not be confused with the bacteria that causes strep throat (Group A); these are two different types of bacteria. Group B β-Streptococcus  infection is not generally serious for women and can usually be treated easily with antibiotics. But things change when a woman becomes pregnant.

There isn’t a surefire way to keep from passing Group B β-Streptococcus  from mother to baby during delivery. Group B β-Streptococcus  infection can be fatal to a newborn, and although this is rare, it does happen. That’s why it’s so important to do everything possible to minimize the risk.

Group B β-Streptococcus is one of those bacteria that a woman can carry without realizing it. Although it is transmitted sexually, it is not considered to be a sexually transmitted disease, like gonorrhea or syphilis. The chances of passing the bacteria on to the baby during delivery are high, but most babies are not affected. However, a small number will develop a Group B β-Streptococcus  infection, which can cause problems ranging from the mild to the severe, perhaps death.

Screening for Group B β-STREPTOCOCCUS

Some doctors choose to routinely test every pregnant patient for Group B β-Streptococcus between 35-37 weeks of gestation and treat the ones who test positive for the bacteria with antibiotics at the beginning of labor. This is the method that has been shown to be the most effective at catching Group B β-Streptococcus  colonization and preventing infection in newborns.  Because the urine in the bladder is sterile, any Group B β-streptococcal infection found on a urine culture indicates that the mother is a “colonizer” and she will need antibiotics during her labor.

Some doctors, however, choose to treat only mothers who are at high risk for passing Group B β-Streptococcus on to their babies. These women include those who go into labor prematurely, those whose membranes rupture early and labor looks like it will be long, those with unexplained fever, those who have had a baby with Group B β-Streptococcus  infection before, and those who have or have had a kidney or bladder infection caused by Group B β-Streptococcus.

The test itself is simple and painless, and involves inserting a special cotton swab into the woman’s vagina and rectum. The swab is then placed in a solution in which the bacteria will grow if present. This is called a culture.

Treatment for Group B β-STREPTOCOCCUS

When an expectant mother tests positive for Group B β-Streptococcus , or is at high risk for passing it on to her baby, she is given antibiotics when she goes into labor. Giving the antibiotics earlier on, during pregnancy, is not as effective, as this allows the bacteria time to re-grow before delivery.

As for babies, they can develop one of two types of infections. The most common (and most dangerous) is early-onset disease, wherein the baby is infected while moving down the birth canal. Symptoms of this type of infection appear during the first week of the baby’s life, and the infection can be severe and difficult to treat. Antibiotic treatment during labor is designed to prevent this type of Group B  β-Streptococcus  infection in the baby.

The other type of Group B β-Streptococcus  infection is late-onset disease, and babies do not show symptoms of this until after their first week. These babies may have contracted the disease from their mothers during delivery or from contact with her or someone else carrying the disease after birth. This type of infection is not prevented by antibiotic use during labor, but can be treated with antibiotics after the baby is born.

However, whether early- or late-onset, Group B β-streptococcus is an infection not to be taken lightly and could result in disastrous results for your newborn.  So, make sure you keep your prenatal visits during the last weeks of your pregnancy in order to be tested for Group B β-streptococcus.

– Yvonne S. Thornton, M. D., M. P. H

Recurrent Yeast Infections: Causes, Solutions

Monday, October 7th, 2013

Unfortunately, it seems every vaginal discharge has been diagnosed as a “yeast infection” by the patient and she runs off to the drug store to get an over-the-counter antifungal medication to treat her “yeast” infection when in actuality it may be chlamydia, bacterial vaginosis or trichomoniasis.  The truth of the matter is that every vaginal discharge is NOT a yeast infection and needs to be diagnosed by a physician or a person who is well-versed in microscopy and wet mounts and who is able to tell the difference between a “yeast” infection and other infections that are causing the vaginal discharge.  However, for the purpose of this installment yeast infections and if the yeast infection has been properly diagnosed, the following applies:

If you suffer from recurrent yeast infections, you know how imperative it is to pinpoint an underlying cause, or at least a way to stop the infections from occurring. Yeast infections are not bacterial infections at all, and as such, antibiotics will not cure them and may actually cause them in some cases. Yeast infections are caused by a type of fungus, and therefore a medication or treatment with antifungal properties must be used.

At some point, three out of four women will suffer from a yeast infection; interestingly, between 1980 and 1990 the incidence of yeast infections doubled.  Why?  Because the patient was self-diagnosing and calling every discharge a “yeast” infection and coincidently, that is the time period when anti-fungal treatments  (creams and vaginal suppositories) were allowed to be sold over-the-counter without a prescription. The symptoms include itching, irritation, redness, and a cottage cheese-like discharge. One yeast infection is enough for most women, but many women are unlucky enough to endure them repeatedly. To get a handle on your recurrent yeast infections, first consider what may be causing them.


Despite the fact that most doctors and the American College of Obstetrics and Gynecologists recommend not douching, some 20 to 40 percent of American women do it anyway. It is important to understand that douching is completely unnecessary at best, and at worst, is connected to a host of problems like yeast infections, bacterial vaginosis, sexually transmitted infections, and pelvic inflammatory disease. Douching upsets the balance of vaginal flora and acidity and pushes bacteria farther into the vagina, worsening existing infections rather than helping them. If you douche for any reason other than that your doctor told you to for a specific problem, stop – especially if you have recurrent yeast infections.


The reason why antibiotics can cause yeast infections is not rocket science: antibiotics kill bacteria. That means not only the “bad” bacteria, but the “good” bacteria as well. When the level of good bacteria drops too low, it cannot protect you against fungal infections. Antibiotics are valuable, often life-saving drugs, but they should be reserved for times when no other treatment will work.

Other Causes

Diabetic women are more likely to get recurrent yeast infections. Yeast thrive on sugar, and the elevated blood sugar in diabetics affects the whole body. If you are diabetic and have recurrent yeast infections, getting your blood sugar under control may help. In addition, pregnancy is a condition that makes yeast infections more likely. The dramatic chemical changes in the vaginal area during pregnancy make it hard for your body to keep up. There may also be more sugar in your vaginal secretions, which, similar to diabetes, can encourage yeast overgrowth.

Further Steps You Can Take To Eliminate Yeast Infections

Bathe daily and keep your genital area clean and dry. Use condoms to help you avoid catching or spreading a sexually transmitted infection. Avoiding the use of products like feminine hygiene sprays and fragrances can help, as can using pads instead of tampons (especially scented tampons). Also, your underwear should be cotton; materials like silk or nylon are problematic because they restrict air flow to the area.

Additionally, you will probably need to take a medication prescribed by your doctor in order to cure an acute yeast infection. There are several effective options available today; ask your doctor if you aren’t sure what the best option is. Finally, if none of the above causes apply to you and none of the suggested treatments work, talk to your doctor about the possibility of a more serious underlying issue. For more information, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.