Group B strep

Group B strep or group B Streptococcus are bacteria that come and go naturally in your body. Group B Strep is very common – up to 2 in 5 people have group B strep living in their body, usually in the rectum or vagina. Most of the time the group B strep bacteria are not harmful and most people won’t realize they have it, but they can cause serious illness in people of all ages. Group B strep doesn’t usually cause problems in healthy adults. Most of the people who get sick from group B strep are newborns who are exposed to the bacteria during birth. In fact, group B strep disease is a common cause of severe infection in newborns and the rates of serious group B strep infections are higher among newborns than among any other age group. However, serious group B strep disease can occur in other age groups in both men and women.

Many people carry group B strep bacteria and don’t know it. It may never make you sick.

Group B Strep is usually only a problem if it affects:

pregnant woman – it could spread to the baby
young babies – it can make them very ill
elderly people or those who are already very ill – it can cause repeated or serious infections

Group B strep in adults usually doesn’t have any symptoms, but it can cause some minor infections, like a bladder or urinary tract infection (UTI).

While group B strep may not be harmful to you, it can be very harmful to your baby. If you’re pregnant, you can pass group B strep to your baby during labor and childbirth.

About 1 out of 4 healthy pregnant women (25 percent) carry group B strep bacteria in their bodies. The best way to know if you have group B strep is to get tested. If you do have group B strep, though, there’s good news: your health care provider can give you treatment during labor and birth that protects your baby from group B strep.

The rate of serious group B strep disease among non-pregnant adults increases with age. The rate of invasive disease is about 10 cases out of every 100,000 non-pregnant adults. However, 25 out of every 100,000 adults 65 years or older will get group B strep disease each year.

Group B strep facts

In the United States, group B strep bacteria is a leading cause of meningitis and bacteremia in a newborn’s first week of life (early-onset disease). Meningitis is an infection of the tissue covering the brain and bacteremia is a bloodstream infection.
About 1 in every 4 pregnant women carry group B strep bacteria in the rectum or vagina.
Newborns are at increased risk for group B strep disease if their mother tests positive for group B strep bacteria during pregnancy.
Doctors should test pregnant woman for group B strep bacteria when they are 35 to 37 weeks pregnant.
Doctors can prevent most early-onset group B strep disease in newborns by giving pregnant women antibiotics through the vein (IV) during labor.
Pregnant women should get antibiotics during labor if:
- They test positive for group B strep bacteria during their current pregnancy
- They have group B strep bacteria in their urine anytime during their current pregnancy
- They had a previous baby that developed group B strep disease
A pregnant woman who tests positive for group B strep bacteria and gets antibiotics during labor has only a 1 in 4,000 chance of delivering a baby who will develop group B strep disease. If she does not receive antibiotics during labor, her chance of delivering a baby who will develop group B strep disease is 1 in 200.
The antibiotics used to prevent early-onset group B strep disease in newborns only help during labor. Pregnant women cannot take them before labor, because the bacteria can grow back quickly.
Group B strep bacteria may come and go in people’s bodies without symptoms.
The rate of serious group B strep disease increases with age. The average age of cases in non-pregnant adults is about 60 years old.

Group B strep pregnancy

About 1 out of 4 pregnant women (25 percent) carry group B strep bacteria and rarely causes any problems. Group B strep is not routinely tested for, but may be found during tests carried out for another reason, such as a urine test or vaginal swab.

If you have group B strep while you’re pregnant:

your baby will usually be healthy
there’s a small risk it could spread to your baby during labor and make your baby ill – this happens in about 1 in 1,750 pregnancies
there’s an extremely small risk you could miscarry or lose your baby

The best way to know if you have group B strep is to get tested. If you do have group B strep, though, there’s good news: your health care provider can give you treatment during labor and birth that protects your baby from group B strep.

A woman who has group B strep is said to be “colonized” with this germ. If you are colonized with group B strep, your baby can become infected with these germs while being born and can get sick. There is less than a 1% chance that this will happen. But because group B strep infection is so dangerous for babies, it’s important to find out if you’re colonized while you’re pregnant.

Your doctor will test you for group B strep at 35 to 37 weeks of pregnancy. Testing for group B strep is simple and painless. Your doctor takes a swab of your vagina and rectum and sends the sample to a laboratory. Your test results are usually available in 1 to 2 days.

Your doctor also can use some quick screening tests during labor to test you for group B strep. But these should not replace the regular group B strep test that you get at 35 to 37 weeks of pregnancy.

Babies with a group B strep infection can have one or more of these illnesses:

Meningitis, an infection of the fluid and lining around the brain
Pneumonia, a lung infection
Sepsis, a blood infection

Pneumonia and sepsis in newborns can be life-threatening.

Most babies who are treated for group B strep do fine. But even with treatment, about 1 in 20 babies (5 percent) who have group B strep die. Premature babies are more likely to die from group B strep than full-term babies (born at 39 to 41 weeks of pregnancy).

Group B strep infection may lead to health problems later in life. For example, about 1 in 4 babies (25 percent) who have meningitis caused by group B strep develop:

Cerebral palsy (A group of disorders that can cause problems with brain development. These problems affect a person’s ability to move and keep their balance and posture.)
Hearing problems
Learning problems
Seizures

How can I protect my baby from group B strep?

If your group B strep test at 35 to 37 weeks shows you have the infection, your doctor gives you medicine called an antibiotic during labor and birth through an IV (through a needle into a vein). You also may be treated if you have any risk factors for group B strep and you don’t know your group B strep test results or you haven’t been tested yet. Treatment with antibiotics helps prevent your baby from getting the infection.

Penicillin is the best antibiotic for most women. Another antibiotic called ampicillin also can be used. These medicines usually are safe for you and your baby. But some women (up to 1 in 25 women, or 4 percent) treated with penicillin have a mild allergic reaction, like a rash. About 1 in 10,000 women have a serious allergic reaction that needs to be treated right away. If you’re allergic to penicillin, your provider can treat you with a different medicine.

If your test shows you have group B strep, remind your health care providers at the hospital when you go to have your baby. This way, you can be treated quickly. Treatment works best when it begins at least 4 hours before childbirth.

If you have group B strep and you’re having a scheduled cesarean birth (c-section) before labor starts and before your water breaks, you probably don’t need antibiotics.

It’s not helpful to take oral antibiotics before labor to treat group B strep. The bacteria can return quickly, so you could have it again by the time you have your baby.

If I have group B strep, what are the chances that I can pass it to my baby?

If you have group B strep during childbirth and it’s not treated, there is a 1 to 2 in 100 chance (1 to 2 percent) that your baby will get the infection. The chances are higher if you have any of these risk factors:

Your baby is premature. This means your baby is born before 37 weeks of pregnancy.
Your water breaks (also called ruptured membranes) 18 hours or more before you have your baby.
You have a fever (100.4 F or higher) during labor.
You’ve already had a baby with a group B strep infection.
You had a UTI during your pregnancy that was caused by group B strep.

If you have group B strep and you’re treated during labor and birth, your treatment helps protect your baby from the infection.

If my baby gets group B strep, do signs of infection or other problems show up right after birth?

Not always. It depends on the kind of group B strep infection your baby has. There are two kinds of group B strep infections:

Early-onset group B strep (<7 days old): Signs like fever, trouble breathing and drowsiness start during the first 7 days of life, usually on the first day. Early-onset group B strep can cause pneumonia, sepsis or meningitis. If you have group B strep, you can pass this kind of infection to your baby. But treatment with antibiotics during labor and birth can help prevent your baby from getting it. About half of all group B strep infections in newborns are early-onset.
Late-onset group B strep (7-90 days old): Signs like coughing or congestion, trouble eating, fever, drowsiness or seizures usually start when your baby is between 7 days and 3 months old. Late-onset group B strep can cause sepsis or meningitis. If you have group B strep, you can pass this kind of infection to your baby during or after birth. Treatment with antibiotics during labor and birth does not prevent late-onset group B strep. After birth, your baby also can get group B strep from other people who have the infection.

Both can manifest as bacteremia, sepsis, pneumonia, and meningitis. In adults, severe infections can manifest as bacteremia (including sepsis) and soft tissue infections. Pregnancy-related infections include:

Bloodstream infections (including sepsis)
Amnionitis
Urinary tract infection
Stillbirth

If my baby has a group B strep infection, how is he treated?

It’s important to try and prevent a newborn from getting group B strep. But if a baby does get infected with early-onset group B strep or late-onset group B strep, he is treated with antibiotics through an IV.

If I’m treated for group B strep during labor, does my baby need special treatment?

Probably not. But if you have a uterine infection (an infection in your uterus) during labor and birth, your baby should be tested for group B strep. Your baby’s provider can treat your baby with antibiotics while you wait for the test results.

Can group B strep cause problems for mom during and after pregnancy?

Group B strep can cause a uterine infection during and after pregnancy. Symptoms of a uterine infection include:

Fever
Pain in your belly
Increased heart rate (During pregnancy, it also can cause your baby’s heart rate to increase.)

If you have a uterine infection, your doctor can give you antibiotics, and the infection usually goes away in a few days. Some women have no symptoms, so they don’t get treatment. Without treatment, infection during pregnancy may increase your chances of:

Premature rupture of the members – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts
Preterm labor – Labor that happens too early, before 37 weeks of pregnancy
Stillbirth – When a baby dies in the womb after 20 weeks of pregnancy

If you’re treated for group B strep during labor and birth, you probably won’t get a uterine infection after your baby is born.

Group B strep also can cause a urinary tract infection (UTI) during pregnancy. A urinary tract infection (UTI) can cause fever or pain and burning when you urinate. Sometimes a urinary tract infection (UTI) doesn’t have any symptoms. If you have a urinary tract infection (UTI), you may find out about it from a urine test during one of your prenatal visits.

If you have a urinary tract infection (UTI) caused by group B strep, your doctor gives you antibiotics to take by mouth during pregnancy. You also get antibiotics through an IV during labor and birth, because you may have high levels of group B strep in your body.

Group B strep UTI

Health care professionals routinely test pregnant women for bacteria in the urine because a group b strep UTI during pregnancy is more likely to become a kidney infection.

Complications from group b strep UTI are rare when you work with your health care provider to find the best treatment and complete it. If your infection is treated with antibiotics, it’s important to follow directions carefully and finish all the medicine, even after you start to feel better. If you stop taking antibiotics too soon, you may get another infection that is harder to treat.

Symptoms of an UTI may include:

Pain or burning when you urinate
Fever, tiredness, or shakiness
An urge to urinate often
Pressure in your lower belly
Urine that smells bad or looks cloudy or reddish
Pain in your back or side below the ribs

How can I prevent a UTI?

Changing some of your daily habits and lifestyle choices may help you prevent repeated bladder infections.

Drink enough liquids

Most people should try drinking six to eight, 8-ounce glasses of liquid a day. Talk with a health care professional if you can’t drink this amount due to other health problems, such as urinary incontinence, urinary frequency, or heart or kidney failure.

Be aware of your bathroom habits

Urinate often and when you first feel like you need to go. Bacteria can grow when urine stays in the bladder too long and can cause an infection. Urinate shortly after having sex to flush away bacteria that might have entered your urethra during sex.

After urinating or having a bowel movement, always wipe from front to back. This step is most important after a bowel movement to keep from getting bacteria into your urethra.

Wear loose-fitting clothing

Consider wearing cotton underwear and loose-fitting clothes so air can keep the area around the urethra dry.

Consider switching birth control methods if you have repeat bladder infections

If you have trouble with repeat bladder infections, talk with a health care professional about your birth control. Consider switching to a new form of birth control if you use diaphragms, unlubricated condoms, or spermicide, all of which can increase your chances of developing a bladder infection. Consider using lubricated condoms without spermicide or using a nonspermicidal lubricant.

Group B strep UTI treatment

Doctors usually treat group B strep UTI with penicillin or other common antibiotics.

The length of treatment depends on:

how severe the urinary tract infection (UTI) is
whether your symptoms and infection go away
whether you have repeated infections
whether you have problems with your urinary tract

Follow your health care professional’s instructions carefully and completely when taking antibiotics. Although you may feel relief from your symptoms, make sure to take the entire antibiotic treatment.

If needed, a health care professional may prescribe other medicines to relieve any pain or discomfort from your bladder infection.

At-home treatments

Drink a lot of liquids and urinate often to speed healing. Water is best. Talk with a health care professional if you can’t drink a lot of liquids due to other health problems, such as urinary incontinence, urinary frequency, or heart or kidney failure.

A heating pad on your back or abdomen may help you manage pain from a kidney or bladder infection.

How do you get group B strep?

The sources of disease caused by group B strep bacteria are unknown. Group B strep bacteria are common in the gastrointestinal, the urinary and genital tracts of men and women. The gastrointestinal tract is the part of your body, including the stomach, intestines and rectum. Since the group B strep bacteria are so common, their presence in the gastrointestinal tract could be a source of some infections.

Group B strep lives in your body naturally. As an adult, you can’t get group B strep from food, water or things you touch. You can’t catch group B strep from another person, and you can’t get group B strep from having sex.

In healthy adults, group B strep doesn’t usually cause any problems. Certain groups are more likely to have complications from group B strep:

Infants who have group B strep can develop serious or life-threatening infections, such as meningitis, pneumonia, or sepsis.
Some pregnant women who have group B strep may develop an infection of the urinary tract (also called a UTI), placenta, amniotic fluid, or bloodstream.
Older adults and people who have a chronic illness or a weak immune system are more likely to develop problems due to group B strep infection. These problems may include infections of the skin, bloodstream, urinary tract, lungs, bones and joints, heart valve (called endocarditis), or the fluid around the brain and spinal cord.

Risk factors for group B strep

In adults, most cases of group B strep disease are among those who have other medical conditions. Other medical conditions that put adults at increased risk include:

Diabetes
Heart disease
Congestive heart failure
Cancer or history of cancer
Obesity

Risk for serious group B strep disease also increases as people get older. Adults 65 years and older are at increased risk compared to adults under 65 years old.

Rates are also substantially higher among African Americans and the elderly.

For neonatal disease, risk is higher among infants born to women with:

Group B strep colonization
Prolonged rupture of membranes
Preterm delivery

Is there a vaccine for group B strep?

No. But researchers are making and testing vaccines to prevent group B strep infection in mothers and their babies.

Are there alternative prevention strategies?

The following strategies are NOT effective at preventing group B strep disease in babies:

Taking antibiotics by mouth
Taking antibiotics before labor begins
Using birth canal washes with the disinfectant chlorhexidine

To date, receiving antibiotics through the vein during labor is the only proven strategy to protect a baby from early-onset group B strep disease.

What causes group B strep?

The group B strep bacteria come and go naturally in people’s bodies. If a pregnant woman has the bacteria in her body, she can pass it to her baby during labor and delivery. A group B strep infection happens when a baby is exposed to the bacteria while it’s being born. The bacteria can cause the baby to get sick. The most common illnesses caused by the bacteria in newborns are:

Pneumonia (infection in the lungs)
Meningitis (infection of the tissue covering the brain and spinal cord)
Bacteremia or sepsis (infection in the blood)

There are some factors that increase a pregnant woman’s risk of having a baby who develops group B strep disease. These include:

Testing positive for the bacteria late in pregnancy (35-37 weeks)
Having the bacteria found in your urine anytime during your pregnancy
Having the baby early (before 37 weeks)
Developing a fever during labor
Going a long time between when your water breaks and when you deliver (18 hours or more)
Having had a baby before who developed group B strep disease

Can group B strep be prevented or avoided?

Pregnant women can’t avoid having group B strep in their bodies. But passing it along to their babies is preventable. The two ways to prevent your baby from getting an early-onset group B strep infection is to:

Get tested for the bacteria late in pregnancy (35-37 weeks).
Get antibiotics during labor and delivery if you are at increased risk. This includes women who tested positive for the bacteria.

Currently there is not a way to prevent your baby from getting late-onset group B strep disease.

Group B strep symptoms

Group B strep doesn’t usually cause symptoms in healthy adults and group B strep symptoms depend on the part of your body that is infected. Listed below are common diseases caused by group B strep bacteria in adults and newborns and their symptoms.

Babies who have group B strep may develop symptoms during their first week of life. This is called early-onset disease. Or they may develop symptoms from 1 week to 3 months of life. This is called late-onset disease.

The symptoms of group B strep infection in newborns may include:

Fever
Difficulty feeding
Lethargy (the baby is tired, hard to wake up, limp, or inactive)
Difficulty breathing (with severe breathing problems, the baby’s skin, lips, or nails may turn blue)

If you notice these symptoms in your newborn, call your doctor right away.

Group B strep symptoms in adults

Bacteremia (bloodstream infection) and sepsis (the body’s extreme response to an infection) symptoms include:

Fever
Chills
Low alertness

Pneumonia (lung infection) symptoms include:

Fever
Chills
Cough
Rapid breathing or difficulty breathing
Chest pain

Skin and soft-tissue infections often appear as a bump or infected area on the skin that may be:

Red
Swollen or painful
Warm to the touch
Full of pus or other drainage

People with skin infections may also have a fever.

Bone and joint infections often appear as pain in the infected area and might also include:

Fever
Chills
Swelling
Stiffness or inability to use affected limb or joint

Sometimes group B strep bacteria can cause urinary tract infection (UTI or bladder infections).

You may have a UTI if you notice

Pain or burning when you urinate
Fever, tiredness, or shakiness
An urge to urinate often
Pressure in your lower belly
Urine that smells bad or looks cloudy or reddish
Pain in your back or side below the ribs

People of any age or sex can get UTIs. But about four times as many women get UTIs as men. You’re also at higher risk if you have diabetes, need a tube to drain your bladder, or have a spinal cord injury.

Group B strep bacteria can cause meningitis in adults, but this is very uncommon. Meningitis is an infection of the tissue covering the brain and spinal cord.

Group B strep complications

Serious group B strep infections, such as bacteremia, sepsis, and pneumonia, can be deadly for adults. On average, about 1 in every 20 non-pregnant adults with serious group B strep infections die. Risk of death is lower among younger adults and adults who do not have other medical conditions.

Group B strep test

If doctors suspect an adult has a serious group B strep infection, they will take samples of sterile body fluids. Examples of sterile body fluids are blood and spinal fluid. Doctors look to see if group B strep bacteria grow from the samples (culture). It can take a few days to get these results since the bacteria need time to grow.

Doctors use a sample of urine to diagnose urinary tract infections.

If you’re pregnant, your doctor can do a test to see if you are “group B strep positive.” This test usually is done when you are 35 to 37 weeks pregnant. To perform the test, your doctor will swab your vagina and your rectum and will send the swabs to a lab to see if the strep bacteria grow.

If you have group B strep, it’s important to understand that you aren’t sick. Also, you probably will not make your baby sick. Knowing that you carry the bacteria just helps you and your doctor make decisions that can protect your baby from infection.

Diagnosis in newborns

Doctors check on all babies after birth, including babies born to women who tested positive for group B strep bacteria. If a doctor suspects a baby has group B strep disease, they can confirm the diagnosis by:

Taking a sample of the baby’s blood or spinal fluid
Ordering a chest x-ray

Doctors look to see if group B strep bacteria grow from the samples (culture). It can take a few days to get these results since the bacteria need time to grow.

Group B strep treatment

Doctors usually treat group B strep disease with penicillin or other common antibiotics. Sometimes people with soft tissue and bone infections may need additional treatment, such as surgery. Treatment will depend on the kind of infection caused by group B strep bacteria. Patients should ask their doctor about specific treatment options.

Group B strep infection during labor

If you test positive for group B strep or are at increased risk of having it, your doctor will give you antibiotics during labor. These will be given intravenously (through an IV) to kill the germs. Because the bacteria grow quickly, the antibiotics are only effective if they are given during labor. Penicillin is the most common antibiotic that doctors prescribe to treat group B strep.

If you get antibiotics while you’re in labor, the chances are very good that your baby won’t get an early-onset group B strep infection.

Pregnant women should receive antibiotics through the vein (IV) during labor if:

They test positive for group B strep bacteria during their current pregnancy
They have group B strep bacteria in their urine anytime during their current pregnancy
They had a previous baby who developed group B strep disease

Pregnant women who do not know if they are positive for group B strep bacteria when labor starts should receive antibiotics if they have:

Labor starting at less than 37 weeks (preterm labor)
Prolonged membrane rupture (water breaking 18 or more hours before delivery)
Fever during labor

Giving antibiotics to pregnant women during labor helps protect their babies from infection. The antibiotics help during labor only — because the bacteria can grow back quickly; doctors cannot give antibiotics before labor begins. Penicillin is the most common antibiotic that doctors prescribe, but they can also give other antibiotics to women who are severely allergic to penicillin. Women should tell their doctor or nurse about any allergies during a checkup and try to make a plan for delivery. When arriving at the hospital, women should remind their doctor and any staff if they have any allergies to medicines.

Penicillin is very safe and effective at preventing the spread of group B strep bacteria to newborns during birth. About 1 in every 10 women have mild side effects from receiving penicillin. There is a rare chance (about 1 in every 10,000 women) of having a severe allergic reaction that requires emergency treatment.

What if my baby has group B strep?

If your baby gets group B strep, he or she will be treated with IV penicillin or ampicillin to kill the bacteria. Your baby will stay in the hospital until your doctor is sure your baby is better.