Understanding and Treating Group B Strep Vaginitis

Group B Strep – Streptococcus agalactiae – can cause vulvovaginal infections, with symptoms including a loss of protective lactobacilli and inflammation.

Here at My Vagina’s vulvovaginal specialist clinic, we have observed that GBS can cause vulval and vaginal infection and inflammation, often appearing alone or with other pathogens. Streptococcus agalactiae vulvovaginal infections are considered part of a condition known as aerobic vaginitis (AV).

GBS can also be a benign element of the vaginal microflora, but if you have GBS detected and have vulvovaginal symptoms, consider it a cause and treat.

GBS a benign coloniser? Think again

GBS testing is performed in the later stages of pregnancy to determine if antibiotics need to be administered for labour, to prevent the baby from contracting GBS, which can be dangerous for a newborn.

Some practitioners believe it to be a benign coloniser only, while there is evidence that group B strep can be a cause of vaginal symptoms. Additionally, other infections or inflammation of the vagina, or a loss of lactobacilli, can result in higher levels of group B strep.

GBS may be misdiagnosed as bacterial vaginosis, a yeast infection or trichomoniasis (a sexually transmitted infection). This leaves many without effective relief, untested, because many physicians don’t believe or understand that group B strep can affect the vagina in this way. GBS is often dismissed as a transient bacteria despite evidence to the contrary.

Symptoms of vaginal group B strep

Itching
Burning
Discharge – clear or white
Red hot labia
Possible fissuring of labia
Inflammation
Reduced lactobacilli levels
Vaginal pH increase

Streptococcus agalactiae is the gram-positive bacterium responsible for vaginal and vulvar inflammation and discharge, but it also causes lactobacilli to become rarer in the vagina and cause the pH to become less acidic (which isn’t good in the vagina).

Testing and identification of GBS

Typical testing is via culture, but culture is fast becoming an old-fashioned and ineffective method of testing, compared with newer DNA/RNA-based testing methods.

A modern comprehensive vaginal microbiome test can help determine what percentage of the vaginal microflora is GBS, and therefore, what sort of impact you might see, as well as which other species are present.

Some GBS isolates are less common, contributing to misdiagnosis. Variants can behave differently, producing a variety of symptoms or no symptoms at all.

Group B Strep (GBS) in pregnancy and labour

GBS is most known for its impact on newborn babies, which can result in life-threatening infections that cause septicaemia, meningitis and pneumonia. Group B Strep can affect adults and typically causes diseases of the skin, soft tissues, urinary tract, and bones and joints.

Treatment of GBS

Botanical medicine treatments for vaginal GBS

Options for vaginal treatment for GBS are the AV Vaginal Pessary, which targets AV-related bacteria, including GBS.

GBS does not utilise fructose or galactose as an energy source, so lactulose is an option if GBS is the predominant AV-related bacteria. Thus, the Double Whammy Vaginal Pessary is also a good choice if lactobacilli levels are low as well, which in GBS vulvovaginitis, tends to be the case. GBS causes inflammation that lactobacilli aren’t very tolerant of.

The Double Whammy Vaginal Pessary contains a broader range of botanical medicines that target a wider range of microbes (BV and AV-related) while also containing lactulose to act as a prebiotic for protective lactobacilli species.

Partners may also require treatment.

Successful case study with garlic cloves vaginally

A case study¹ with eight women with vaginal colonisation of GBS were treated using half a fresh-cut clove of garlic.

Garlic contains allicin once cut, inhibiting the growth of all strains of GBS tested. The proposed mechanism of action is the interference with cysteine metabolism and the function of microtubules.²

Standard medical treatment of vaginal GBS

Medical treatment of group B Strep vaginitis is antibiotics, typically oral penicillin or clindamycin. However, there is no standard treatment, and in some cases, doubt exists in some healthcare practices regarding the significance of GBS outside of baby delivery-related positive GBS tests.

As far back as 1976, it was noted that antibiotic treatment for GBS was often ineffective once antibiotics were stopped. A 10-14-day treatment with antibiotics provided a negative culture immediately afterwards, but within several days, the vagina was usually recolonised.

References^1,3–6

1.
Cohain JS. Long-term symptomatic group B streptococcal vulvovaginitis: Eight cases resolved with freshly cut garlic. European Journal of Obstetrics & Gynecology and Reproductive Biology. Published online September 2009:110-111. doi:10.1016/j.ejogrb.2009.05.028
2.
Cutler RR, Odent M, Hajj-Ahmad H, et al. In vitro activity of an aqueous allicin extract and a novel allicin topical gel formulation against Lancefield group B streptococci. Journal of Antimicrobial Chemotherapy. Published online October 18, 2008:151-154. doi:10.1093/jac/dkn457
3.
Honig E, Mouton JW, van der Meijden WI. Can group B streptococci cause symptomatic vaginitis? Infect Dis Obstet Gynecol. Published online 1999:206-209. doi:
4.
Leclair CM, Hart AE, Goetsch MF, Carpentier H, Jensen JT. Group B Streptococcus. Journal of Lower Genital Tract Disease. Published online July 2010:162-166. doi:10.1097/lgt.0b013e3181d3d40f
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Clark LR, Atendido M. Group B streptococcal vaginitis in postpubertal adolescent girls. Journal of Adolescent Health. Published online May 2005:437-440. doi:10.1016/j.jadohealth.2004.03.009
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Boyle D, Smith JR. Group B Streptococcal Vulvovaginitis. J R Soc Med. Published online May 1997:298-299. doi:10.1177/014107689709000526