Doc: Does group B strep status span pregnancies?
Dear Dr. Roach: My daughter tested positive for group B streptococcus while pregnant with her first child, who had no medical problems after delivery. She’s almost 36 weeks along with her second and just tested negative for GBS.
I’ve read that a carrier can test positive sometimes and negative others, but if she’s been positive once, wouldn’t any pregnancy actually be at risk? What is the usual protocol in this type of situation?
Dear A.T.F.: Group B streptococci are a type of bacteria commonly found in a pregnant woman’s vagina, rectum or urine. It can predispose the infant to serious illness, including meningitis, sepsis and pneumonia. For this reason, women are screened between weeks 35 and 37 of pregnancy, and those who test positive are treated with antibiotics during delivery to protect their child from illness. Antibiotics reduce the risk of GBS-associated disease from 1 in 200 to 1 in 4,000.
A woman, like your daughter, who has been positive in the past may be at higher risk for being positive again, but since she is negative, her child is not at an increased risk and she does not need the antibiotics. However, women whose children had early GBS disease, or who had a positive GBS culture of urine anytime in pregnancy, still should receive the antibiotics.
Dear Dr. Roach: I would like your thoughts on vitamin E vaginal suppositories. I have vaginal atrophy after a full hysterectomy in 1996. My doctor prescribed Estrace cream suppository, which I do not want to use. I have no personal cancer, but I do have a family history of breast and ovarian cancer.
Dear C.M.: Vitamin E suppositories have been studied as a treatment for vaginal atrophy, a condition caused by loss of estrogen that can happen after surgical removal of the ovaries (oophorectomy) or from natural menopause. Symptoms may include vaginal dryness and discomfort, recurrent urine infections and painful sexual intercourse. Advanced cases can lead to structural changes of the vagina. It is underdiagnosed, especially by internists.
One well-done study compared vitamin E suppositories to estrogen cream. Although the estrogen cream worked faster (and a little better), the vitamin E did improve vaginal atrophy as proven by biopsy. The authors suggested the use of vaginal vitamin E in women who couldn’t or didn’t want to use hormone treatment, although low-dose Estrace cream is usually considered safe, even in women with a history of uterine or ovarian cancer.
The dose in the study was 100 mg, which is higher than the dosages I found in an online pharmacy.
Dr. Roach writes: A recent column about a woman with breast cancer who waited six months for a primary care appointment, unable to speak to her doctor directly, generated some letters. Most of these concerned my naivete about how hard it is for a patient to speak with his or her physician or get a timely appointment in 2018. Others asked a very reasonable question: If the woman couldn’t get through to get an appointment, how could she talk directly to her doctor to clear up the misunderstanding?
A colleague of mine, Dr. Will Harper in Chicago, posted some excellent advice on my Facebook page (facebook.com/keithroachmd) that I wish I had said: In this particular case, the patient could have had her oncologist call the doctor’s office.
As naive as I might be, I know that doctors take phone calls from colleagues very seriously, and I bet this suggestion would yield rapid results.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.