Group B strep infection | March of Dimes

Group B streptococcus (also called Group B strep or GBS) is a common type of bacteria (tiny organisms that live in and around your body) that can cause infection. Usually GBS is not serious for adults, but it can hurt newborns.

Many people carry Group B strep bacteria and don’t know it. It may never make you sick. GBS in adults usually doesn’t have any symptoms, but it can cause some minor infections, like a bladder or urinary tract infection (UTI).

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

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

How do you get GBS?

GBS bacteria live in the intestines and the urinary and genital tracts. It lives in the body naturally. As an adult, you can’t get it from food, water or things you touch. You can’t catch it from another person, and you can’t get it from having sex.

How do you know if you have GBS?

Your provider tests you for GBS at 35 to 37 weeks of pregnancy. Testing for GBS is simple and painless. Your provider 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 provider also can use some quick screening tests during labor to test you for GBS. But these should not replace the regular GBS test that you get at 35 to 37 weeks of pregnancy.

How can you protect your baby from GBS?

If your GBS test at 35 to 37 weeks shows you have the infection, your provider 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 GBS and you don’t know your GBS 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 GBS, 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 GBS 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 GBS. The bacteria can return quickly, so you could have it again by the time you have your baby.

If you have GBS, what are the chances that you can pass it to your baby?

If you have GBS 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 GBS infection.
• You had a UTI during your pregnancy that was caused by GBS.

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

If your baby gets GBS, do signs of infection or other problems show up right after birth?

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

1. Early-onset GBS: Signs like fever, trouble breathing and drowsiness start during the first 7 days of life, usually on the first day. Early-onset GBS can cause pneumonia, sepsis or meningitis. If you have GBS, 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 GBS infections in newborns are early-onset.
2. Late-onset GBS: 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 GBS can cause sepsis or meningitis. If you have GBS, 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 GBS. After birth, your baby also can get GBS from other people who have the infection.

What problems can GBS cause in newborns?

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

GBS infection may lead to health problems later in life. For example, about 1 in 4 babies (25 percent) who have meningitis caused by GBS 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

If your baby has a GBS infection, how is he treated?

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

If you’re treated for GBS during labor, does your 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 GBS. Your baby’s provider can treat your baby with antibiotics while you wait for the test results.

Can GBS cause problems for mom during and after pregnancy?

GBS 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 provider 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 GBS during labor and birth, you probably won’t get a uterine infection after your baby is born.

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

If you have a UTI caused by GBS, your provider 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 GBS in your body.

Is there a vaccine for GBS?

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

More information

Centers for Disease Control and Prevention (CDC)

Last reviewed: November, 2013

What Is Group B Strep?

I’M PREGNANT – HOW DO I KNOW IF I HAVE GBS?
Although most people do not have any symptoms, GBS can cause vaginal burning/irritation and/or unusual discharge. GBS can also cause bladder infections. Consult your healthcare provider if any of these symptoms occur.

Your provider should do a urine culture for GBS and other bacteria at the first prenatal visit. GBS in your urine means that you may be heavily colonized. If you have a significant level of GBS in your urine or urinary symptoms, your provider should prescribe oral antibiotics at the time of diagnosis. If your urine tests positive, your provider should consider you as “GBS colonized” for this pregnancy.
​
It is now the standard of care in several countries for all pregnant individuals to be routinely tested for GBS with a vaginal/rectal swab test during the 36th or 37th week during each pregnancy unless their urine already cultured positive in the current pregnancy.

WHAT IS THE GBS SWAB TEST?
It is a culture of a swab that has been inserted in both the vagina and rectum. Inform your provider if you are using antibiotics and/or vaginal medications which may cause false negative results.

WHAT IF I TEST NEGATIVE?
It’s important to know that: 1) A pregnant individual may test negative if their GBS colonization level at the time of the test was below the level of detection. 2) A pregnant individuals GBS status can change so a person could test negative but be colonized later in pregnancy. 3)Test results are only considered to accurately (95%-98%) predict a pregnant individuals colonization status at delivery if they deliver within 5 weeks of their test. 4) A pregnant individual may need to be retested if they have not yet given birth within 5 weeks of being tested. 5) Once born, a baby can become infected with GBS by sources other than the birthing parent. Learn more.

WHAT IF I TEST POSITIVE?
If your urine or swab tests are positive, your provider should consider you as “GBS colonized” for this pregnancy so that you receive IV antibiotics for GBS when labor starts or your water breaks. Plan ahead if you have short labors or live far from the hospital. The IV antibiotics you receive in labor generally take 4 hours to be optimally effective. Ask your provider to not strip your membranes if you test positive for GBS, as it may push bacteria closer to your baby.

It is also important to know the signs of infection in unborn babies and of preterm labor! Learn more.

CAN MY GBS STATUS CHANGE?
Yes, GBS colonization can be transient which means that a pregnant person could test negative, but be colonized later in pregnancy and vice versa. It is possible for your GBS status to change between testing and the time you go into labor although test results are considered to accurately (95%-98%) predict a pregnant person’s colonization status at delivery if they deliver within 5 weeks of the test.

WHAT ARE THE SYMPTOMS THAT I HAVE GBS?
Most people do not have any symptoms. Although, GBS can cause vaginal burning/irritation and/or unusual discharge which may be mistaken for a yeast infection and treated incorrectly. If you have “vaginitis” symptoms, see your care provider promptly for an exam and possible GBS testing. GBS can also cause bladder infections, with or without symptoms.

Because most do not experience symptoms, pregnant women should get tested for GBS in their urine early in pregnancy and also tested with a vaginal/rectal swab test during the 36th or 37th week if the current pregnancy’s urine culture was negative. ​

CAN GBS CAUSE BABIES TO BE MISCARRIED OR STILLBORN?
​Yes. Is it rare? For many years, the prevailing thought has been that GBS-caused miscarriages and stillbirths are rare or very rare. However, there wasn’t surveillance data to support that until recently. According to one study, an estimated 57,000 fetal infections/stillbirths occur each year. Another study found that GBS causes up to 12.1% of stillbirths, but more research is needed. According to the World Health Organization (WHO), an estimated 2.6 million stillbirths occur annually worldwide.

HOW IS GBS TREATED DURING PREGNANCY?
It is not standard to treat individuals for GBS during pregnancy unless found at a significant level in their urine or GBS is causing urinary or vaginitis symptoms.

In some cases, if a pregnant person is heavily colonized or has had a baby previously infected by GBS, they may be treated with oral antibiotics during pregnancy, although this is not a standard routine.

IF I’VE HAD GBS IN A PAST PREGNANCY, WHAT SHOULD I DO IN A CURRENT OR FUTURE PREGNANCY?
If you have already had a baby with iGBS or have had GBS in your urine in this pregnancy, you should receive IV antibiotics  for GBS during labor and delivery even if you later test negative for GBS in your urine or in a vaginal/rectal swab test for GBS in a current or future pregnancy. Please note that once you have tested positive in your urine during this pregnancy, your provider may not do a routine vaginal/rectal  swab test for you later in this pregnancy since you should already be considered “GBS colonized.”

Whether or not you have had a baby with iGBS, please check with your provider about having your urine cultured for GBS early in this pregnancy (not standard in all countries). ACOG issued new guidance in 2019 regarding Bacteriuria (GBS in urine) in regards to early-onset disease prevention. Studies have also shown that treating asymptomatic bacteriuria can reduce the risks of preterm birth.   

If you have not had a baby with GBS disease, you should ask to have a vaginal/rectal swab test for GBS during the 36th or 37th week of gestation (also not standard in all countries) regardless of any past pregnancy results for GBS. (Please note that once you have tested positive in your urine during this pregnancy, your provider may not do a routine vaginal/rectal  swab test for you later in this pregnancy since you should already be considered “GBS colonized.”)

Plan ahead if you have short labors or live far from the hospital. ​Avoid unnecessary, frequent, or forceful internal exams which may push GBS closer to your baby.

WHAT ARE THE SIGNS MY BABY MAY HAVE PRENATAL-ONSET GBS DISEASE (POGBSD)?
POGBSD can cause babies to be miscarried, stillborn, or born very sick. Know the signs of infection in unborn babies! Contact your provider immediately if you experience any of these signs.
​Reasons to contact your provider immediately:

• Decreased or no fetal movement after your 20th week
• Frenzied fetal movement 
• You have any unexplained fever  ​
• Any signs of preterm labor or your water breaks before your 37th week

WHAT ARE THE SIGNS OF PRETERM LABOR?
GBS can cause preterm labor as well as cause a woman’s water to break too soon, also known as preterm premature rupture of membranes (PPROM).  It’s important to know the warning signs and symptoms of preterm labor. Call your healthcare provider right away if you experience any of the following:

• Your water breaks
• You have more vaginal discharge than usual or your vaginal discharge changes
• Vaginal bleeding
• Increased pressure in your pelvis or vagina
• Cramping in your lower abdomen or period-like cramps
• Nausea, vomiting, or diarrhea
• Dull lower backache
• Regular or frequent contractions

Group A streptococci in children: how the infection is transmitted and when to contact the pediatrician

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Group A Streptococcus (GAS), also known as Streptococcus A or Streptococcus pyogenes , is a common bacterium. It is usually found in the throat and on the skin and may be present without causing symptoms.

Group A streptococcus is responsible for common infections such as pharyngitis, scarlet fever, impetigo and phlegmon which are easily treated with antibiotics. Rarely, this bacterium invades the lungs, blood, or skin, deep into the muscles, causing serious infections known as invasive GAS infection . In exceptional cases, the disease can lead to 90,009 deaths.

Although GAS infections are rare, infections have increased in recent months in the United Kingdom, the Netherlands, France, Ireland and Sweden , especially among children under the age of 10 and, unfortunately, in some cases fatal. Until now, the reason for this increase in the number of cases of streptococcal infection is unknown.

How is group A streptococcal infection transmitted?

CHA infection is spread by direct (close) contact with an infected person, by coughing and sneezing, or by contact with broken skin.

Some people can carry bacteria without getting sick or showing symptoms of infection, and although they can pass the infection on to others, this is less of a risk than when a person is sick GAS infection.

Mild group A streptococcal infections

CHA infection causes skin and respiratory problems. The most frequent infections are pharyngitis, tonsillitis, scarlet fever, impetigo and cellulitis. These infections may cause discomfort and be accompanied by fever and malaise, but rarely cause complications. With 90,009 antibiotic treatment, 90,010 people with mild disease stop being contagious within 24 hours of starting treatment and get better within 24-72 hours.

A person with GAS pharyngitis or tonsillitis has a sore throat, often accompanied by fever.

Scarlet fever is a skin rash consisting of very small, pinkish bumps that usually start on the chest and abdomen and then spread throughout the body. They don’t usually itch, but make the skin rough, like sandpaper.

Invasive streptococcal infection (group A)

When the bacterium enters the bloodstream, lungs, or deep under the skin, it can cause a serious infection. This infection is known as Invasive GAS infection (iSGA). The most common manifestations of iSGA are necrotizing fasciitis, pneumonia, sometimes accompanied by pleural effusion and lung necrosis, streptococcal toxic shock and streptococcal sepsis.

When to go to the pediatrician?

You should contact your pediatrician if your child has some of the signs and symptoms of suspected GAS infection:

• high fever and sore throat without sputum or cough.
• skin rash resembling scarlet fever, with or without fever and sore throat.
• sore or pimple that seems inflamed and is accompanied by severe pain.
• high fever and redness of the skin (erythroderma).
• high fever, deterioration in general condition and difficulty in breathing.

Who needs to take antibiotics?

Antibiotics are not generally recommended as a prophylactic treatment and should only be taken in confirmed cases tonsillitis, scarlet fever or other GAS infection.

If your child is diagnosed with tonsillitis or scarlet fever at school and has the above symptoms, they should be examined by a doctor and given antibiotics if necessary. Within 24 hours of starting treatment, children are no longer contagious and can return to school if they feel well.

How to prevent the spread of infection?

Good respiratory and hand hygiene is important to prevent the spread of many microorganisms, including invasive streptococcal infection (group A)

Teach your child to properly wash hands with soap and warm water for 20 seconds and use a tissue when coughing or sneezing. These measures reduce the spread and risk of many respiratory infections.

Microbiological testing for streptococci

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Streptococcal infection is extremely widespread among the population. Every third person is a carrier of hemolytic streptococcus on the mucous membranes of the mouth, genitals, and less often on the skin.

Group A hemolytic streptococcus is responsible for infectious diseases such as tonsillopharyngitis, tonsillitis, scarlet fever, erysipelas. There is evidence that streptococcus often causes the usual for all acute respiratory infections. Streptococcus can affect various organs and tissues of the human body. It causes inflammatory diseases of the kidneys (nephritis), skin and subcutaneous tissue (pyoderma), bone tissue (ostymyelitis), joints (arthritis), etc.

Streptococcal infection is highly contagious and is transmitted mainly by airborne droplets.

Streptococcus is cunning and causes damage to the immune system, thereby contributing to the development of autoimmune diseases. Therefore, “non-serious” tonsillitis and acute respiratory infections can become a starting point for more severe diseases with a long course, such as rheumatism and pyelonephritis.