Group B Strep positive -- advice needed

kat81

I just got a call from my midwife practice today that they found group B strep in my urine in small amounts. I was GBS positive for both of my previous pregnancies. The plan of action was to give me antibiotics during labor every 4 hours. Both times I got one dose and then had the baby just short of when I could have been given the 2nd dose. Nothing bad happened in either case.

I was half assuming I'd have it again this time so this is no shocker, nor am I concerned in any way because everything went fine the other times, and we heard some grumblings that the 2nd dose might be excessive/unnecessary. But what's different this time is that this practice, which is run through a birth center, wants to try to get rid of the GBS now. They want me to take antibiotics. I can't remember how long of a course it is, but it doesn't sit well with me. I'm someone who's strongly against taking antibiotics when they are unnecessary, because of all of the side effects (I almost always get a yeast infection, even with taking probiotics at the same time) and because of how excessive antibiotics use can lead to superbugs/antibiotic resistance in the population (not necessarily in me, but I don't want to contribute to that shit.) Moreover, I doubt it will do anything. I've taken antibiotics several times for warranted reasons since my first pregnancy 6 years ago, and yet whenever they test for it, I always seem to be GBS positive.

So I'm curious about whether you have ever been GBS positive and such action was recommended. Or not. DH and I are suspicious that it's because this is a birth center, and being GBS positive will lengthen your stay there as well as potentially increase the risk of having to be moved to the hospital, both of which they don't want. But I don't really care if either of those things happen.

I am considering pushing back on this--asking for more explanation or maybe refusing to take the drugs. But first I'm curious about your experiences.

vrj0522

I had gbs with my daughter but didn't find out until much later on. Honestly while everything was fine and baby was not affected, if I could have had the option of fighting the infection ahead of time,  I would've jumped on it to lessen the risk of infecting the baby. From what I have read, it is recommended by the AAP that women at risk of having gbs get on the antibiotic early on, even before their gbs status is determined. 

MrsFreeman2010

Most likely what they are wanting to treat you right now for is a GBS UTI (not trying to get rid of your gbs for labor). UTIs in pregnancy can be more troublesome as you are at an increased risk for kidney infections and later in pregnancy, preterm labor.  Depending on the clinic, they may test you for GBS again as you get closer to delivery.   GBS is super common in women and really has no impact on the momma, but has been shown to cause some pretty nasty infections in littles (sometimes).  Also GBS showing up is super transient, one pregnancy may be positive while your next is negative and visa versa. Even in the same pregnancy if you are tested multiple times throughout you could have different results, which is why the current recommendation is to test as close to delivery (35-36 weeks) or when presenting in labor if earlier than that. 

As for those dosing while in labor it's very interesting. The current recommendation is a dose of antibiotics at least 2 hours prior to delivery but not more than 5 (this is for penicillin, the common antiobiotic used in labor unless there is an allergy). We give it every 4 hours until you deliver because we never know when babies are going to be born so it's hard to give just one dose and know your baby will be here two hours later. 

Wow that ended up long! Sorry!!

BettyCotton

They don't test for Gbs in the UK. One of the reasons being that it is transient. If you have a positive at one point, it is still a low chance that it will get passed to the baby. It is also a very high chance that every woman will have GBS at some point during pregnancy but it doesn't mean it will always be there.
 If you choose to get tested privately then you have to go on anti biotic during labur.
 They monitor babies afterwards for signs of infection if you haven't been tested.

Kipperoo

I did not test positive for GBS with my first pregnancy, but did with this one. My doctor treated me with antibiotics at week 7 for all of the reasons mentioned above. Specifically, her immediate concern was a UTI causing other complications for the pregnancy (kidney infections, preterm labor--as MrsFreeman2010 mentioned above). She said that I will be tested again and likely will still need antibiotics during the delivery if I test positive. I am definitely not one to unnecessarily take antibiotics...I actually don't think I've taken antibiotics of any kind in the last 10 or so years. To me, it seemed reasonable based on the medical concerns to treat what we could now. 

kat81

MrsFreeman2010 said:

Most likely what they are wanting to treat you right now for is a GBS UTI (not trying to get rid of your gbs for labor). UTIs in pregnancy can be more troublesome as you are at an increased risk for kidney infections and later in pregnancy, preterm labor.  Depending on the clinic, they may test you for GBS again as you get closer to delivery.   GBS is super common in women and really has no impact on the momma, but has been shown to cause some pretty nasty infections in littles (sometimes).  Also GBS showing up is super transient, one pregnancy may be positive while your next is negative and visa versa. Even in the same pregnancy if you are tested multiple times throughout you could have different results, which is why the current recommendation is to test as close to delivery (35-36 weeks) or when presenting in labor if earlier than that. 

As for those dosing while in labor it's very interesting. The current recommendation is a dose of antibiotics at least 2 hours prior to delivery but not more than 5 (this is for penicillin, the common antiobiotic used in labor unless there is an allergy). We give it every 4 hours until you deliver because we never know when babies are going to be born so it's hard to give just one dose and know your baby will be here two hours later. 

Wow that ended up long! Sorry!!

When I heard bacteria in urine I also thought UTI but they didn't say those words and were just talking about the risks of GBS during delivery (which I've been told before from my previous pregnancies.) I've had UTIs before and they suck, but I have zero symptoms now. So I still find this puzzling. But it sounds like so far you guys are in favor of the antibiotics. I'll keep gathering responses and get more information from them before proceeding, but in general I am inclined to trust the experts (i.e. they who are telling me to take the drugs!)

ShadeofGreen816

I feel like you've had some awesome advice but just to chime in - I did some research in one of my nurse practioner apps that may be less readily available to the general public. I'll paste it below. It's wordy and somewhat science-y but not hard to understand. This is from a database called UpToDate which is very well respected among the medical community to be reliable. Good luck!!

Asymptomatic bacteriuria — Asymptomatic bacteriuria is identified by screening urine cultures that are obtained during prenatal visits. At least one screening culture should be obtained during early pregnancy [16]. Asymptomatic bacteriuria in pregnancy is as defined separately for nonpregnant adults. (See "Approach to the adult with asymptomatic bacteriuria".)

The utility of treating GBS bacteriuria at colony counts ≤105 prior to 35 weeks gestation is controversial; some favor this approach to prevent the subsequent development of pyelonephritis and to prevent preterm delivery [17]. In a prospective study of 69 women at 27 to 31 weeks of gestation with GBS bacteriuria, treatment at all colony counts significantly decreased the rates of preterm labor (5 versus 38 percent) and preterm rupture of the membranes (11 versus 53 percent) [18]. In a retrospective study of 305 women in early pregnancy (122 with bacteriuria of any colony count and 183 without bacteriuria), an association was observed between untreated GBS bacteriuria and chorioamnionitis at delivery [adjusted odds ratio 7.2; 95% CI 2.4-21.2] [13].

Treatment consists of antibiotic therapy with amoxicillin, penicillin, or cephalexin. These drugs have not been associated with an increased risk of adverse pregnancy outcome or teratogenic effects. For patients who have a severe IgE-mediated hypersensitivity to penicillins and cephalosporins, clindamycin is the only oral alternative, if the isolate is susceptible. For cases in which the isolate is resistant to clindamycin, investigation and confirmation of the nature of the allergy is critical, and ultimately desensitization may be warranted. (See "Penicillin allergy: Immediate reactions".)

The recommended duration of therapy is three to seven days [16]. Sterile urine must be documented after treatment, and periodic screening cultures should be obtained throughout the pregnancy to identify recurrent bacteriuria.

Genital colonization with GBS persists despite adequate therapy for GBS bacteriuria. Women with documented GBS bacteriuria should not be screened for GBS rectal/vaginal colonization later in pregnancy but should be considered GBS colonized and receive intrapartum chemoprophylaxis at the time of delivery. (See "Neonatal group B streptococcal disease: Prevention".)

ALC0618

If it is showing up in your urine and not from a vaginal swab then you have a uti (either symptomatic or not), or you contaminated the specimen.