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What specific test should be ordered to confirm the presence or absence of Strep B in the birth canal. My daughter keeps showing traces of protein in her urine on antenatal visits (not particularly uncommon in pregnant women -which I found out today can be - but is certainly not necessarily - an indication of Strep B).
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Generally a swab is the first test they do. They can then use that to either simply grow it on a plate, or there are some quick tests they can do to see if it's there without culturing it. Either one shouldn't take much more than a day.
Just a note--even if she's colonized now, it doesn't necessarily mean she will be when the baby is born. Here they test at around 35-37 weeks (and she's earlier than that, right?), as colonization can (and often is) fairly transient. That is to say, that (if present) she may no longer carry the bacterium when she goes into labor.
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Apparently 10% of Australian women carry Strep B in their vagina (kind of surprising that they still do VDRLs on pregnant women given just how uncommon syphillis is these days but they don't test for Strep B) but it only presents a risk under certain circumstances - most specifically premature rupture of membranes.
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Yeah. Here, if women are known to carry it, they get antibiotics once labor starts (any earlier, and they may be re-colonized). Like syphillis, it's passed on through the birth canal, so if you kill it during labor, it's not an immediate problem for the baby. (It can be transmitted as well via unwashed hands and things like that, however, so one must still be careful even after da baby has arrived).
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I know I'm being an overly concerned grandma to be here, but I'd at least like to ask at the next antenatal appointment why Strep B is not considered worthy of being a routine antenatal test here (the information I read today suggests that it's extremely simple and safe to treat it during pregnancy). From what I read today, it's also a significant causative factor in premature labours. If it can be detected from a swab, then a simple swab will put our collective minds at ease. If it can only be detected by highly invasive tests which pose their own risks of infection, then I can understand why it isn't a routine test.
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Nope, no invasive tests needed.
Here is a link to a summary of the CDC guidelines on screening for GBS (which has a link to the full guidelines, which you can print off and discuss with your daughter's doc if so inclined).
This is a nice little graph that shows the decreasing incidence of early-onset GBS disease (within the first 7 days of life; this is the one transmitted from mother to baby during birth):
(ref for graph: N Engl J Med. 2000 Jan 6;342(1):15-20).
You can see the affect that each set of recommendations had on the decline in early-onset infections. Pretty dramatic, and a pretty simple thing for doctors to do.
As for your daughter, I wouldn't worry too much at this point. Protein in urine can be caused by a ton of things, and
E. coli is much more likely if it's a urinary tract infection than GBS. But it can't hurt to discuss it with your daughter's physician.