GBS in Urine

[javilu]

Hello!

I've been going back and forth between stressing out about this and trying not to worry.

At 8.5 weeks, I went in to the OB/midwives office for hyperemesis and gave a urine sample, which I thought was to check for dehydration, but they did a culture on it.  It was not a clean catch by any means.  It came back as having 50,000-75,000 cfu/ml mixed urogenital flora including group B strep.  A nurse called to tell me I would need antibiotics in labor, and she asked me if I was having any UTI symptoms (I was not) and said they didn't treat GBS at this level in urine unless it was symptomatic.  So, I am tagged as being GBS positive, which I was worried about for a bit (I can't imagine having an IV in labor, plus I was only at the birth center for 2 hours before my son was born, which isn't enough time for the usual antibiotics protocol, but I'll cross that bridge when I get to it).  I wrote this off as being way too early to worry about labor at this point.

I went in for my usual prenatal testing (blood count, urine sample, etc.) at around 13 weeks (I am now 14.5).  This time I was careful to give the cleanest urine catch I could (I am admittedly bad at it, but I did follow all the steps the best I could).  My urine sample was still positive for GBS (which doesn't matter in itself, since I am already tagged GBS+ no matter what at the birth center, and I've accepted that by now), but my numbers were lower (10,000-25,000 cfu/ml mixed urogenital flora including GBS).

I started reading online, though, and there are tons of sources online saying that having GBS in my urine means I am "heavily colonized" and the infection is systemic.  There are supposedly possible ramifications for this during pregnancy, well before birth, such as an infection of the amniotic membrane, premature labor, spontaneous abortion, and other very scary things.  Every medical source I found (both for lay audiences and medical professionals) say that a GBS UTI should be treated immediately.  So, I contacted the midwives and they told me (this was via an e-message) that while I will be treated during labor, they do not generally treat levels as low as mine during pregnancy (their cut-off is 100,000 cfu/ml unless I have symptoms).

But I'm still really worried about this.  I have had two very early miscarriages as well as an unexplained bleeding episode in this pregnancy at 12 weeks, so I admit to being extra paranoid.  I will discuss this further at my midwife appointment this upcoming Tuesday, but I still feel really uncomfortable *not* being treated (which is a strange position for me to be in, as I am generally very wary of unnecessary medication/medicalization, especially in pregnancy). 

I don't think they will treat me for the GBS in my urine without symptoms (and I'm not complaining about not having symptoms).  I realize this may just be my natural flora now, but I am so darn scared by all the data I've now read.  I am wondering what *I* can do to help myself.  I am planning on asking to be checked regularly (like, monthly) to make sure the levels stay low.  I am not the type to ask for extra testing, but it would give me a little peace of mind.  I am also wondering if something like grapefruit seed extract could help and if it is safe during pregnancy.  I am not comfortable putting things in my vagina at this point (I haven't even had sex since November!), but since the infection is systemic, it seems like I should address it systemically (rather than topically) as well.  What's the deal with cranberry extract during pregnancy?  What probiotics are best to take to foster healthy bacteria?  And are these treatments safe for nursing (my 23-month old still nurses often)?

Thank you so much!

P.S. To reiterate, I am not talking about antibiotics in labor at this point.  I know they will want to give those to me and I am open to that (but unclear on the logistics of it).  I am specifically interested in treating GBS (and urine infections in general) during pregnancy.  Thanks!

[Nanette56]

Hey mama,

I was in the same situation as you- the weird part was, I had a UTI, but did not test GBS + . I took the ABX for the UTI, and when they retested me to make sure the UTI had gone away, it had, but low and behold I was GBS+ and the colonization was well over 100,000. They advised me to take ABX (Amoxicillin) for the GBS, but I refused at first. When I got a bad upper respiratory infection, I had to go on meds anyway, so they put me on amox, which brought the count down to below 10,000 and then I started a vinegar and water splash (not so much a douche, I just used a peri bottle with 3/4 water and 1/4 vinegar and sprayed it as far as it would go without sticking it in there) and when I tested again, I was negative. I don't know if it was a combo of the meds and the vinegar or whether it would have gone away on its own anyway? I'm still fighting with the neonatologists on no ABX during labor if I continue to test negative. They will have none of it, even though (to me) the science seems clear that there is more risk of fetal death from IV ABX than from the babies actually contracting and dying from GBS positive or not. But that worry is for another day!

Anyway, try not to let it stress you out (easier said than done I know!). I think it's really really really rare for side effects from GBS while you're pregnant, it's so very very common, even in urine. Good luck mama!

[javilu]

This is reassuring.  Thanks for replying!

[mylilmonkeys]

I had a GBS UTI at 17 weeks with this pregnancy.  Abx brought the colony down to 10-15,000 or something in that range, like you, too low to treat further.  I was also worried about the possibility of premature labor due to this, add to the fact that we confirmed twins at 19 weeks so an added risk of premature labor.  I decided to do a week of raw garlic treatment, as garlic has been shown to kill GBS and a bunch of other stuff. I take a crushed clove orally 1-3 times a day (however often I remember to do it).  Then, I've repeated a day every week or two.  I've read that blueberries have similar properties against UTIs like cranberries, but easier to take in whole form.  I can't get non-sweetened cranberry anything locally, so I have frozen blueberries every morning.  I have not had a repeat UTI since.  I am at 34 weeks now.  My midwife and I, out of curiosity more than anything, decided to do a repeat urine culture last Friday.  I'll update here when I get the results.  I'm like you, with a history of births too quick for typical IV abx protocol, so we are discussing alternatives.  If my culture comes back +, I may do oral abx starting near term until birth, or we may just do the hibicleans wash.  Being in an OB/midwife practice, your options for birth may be more limited.  

ETA: My midwife also recently recommended that I do Garlic, increase Vit. C, echinacea (but you can only take this for 2 weeks at a time, I believe), grape seed extract, and whatever else boosts immune to try to kill the critters, so I'm not completely out of the box. :)

[javilu]

Oh, I LOVE blueberries.  Thank you for sharing your experience!

[mylilmonkeys]

I just got a call from my midwife that my repeat culture came back completely negative.  They had messed up the first repeat by not labeling it correctly, so I had had to redo, which is why it took so long.  But, apparently the garlic, blueberry, vit. C plan I was on has been effective.  I'll keep doing a clove of garlic every several days to be sure it stays negative until birth, but I feel very good that the risk of exposing the twins to GBS is pretty much nil.