Can vaginal group B strep (GBS) cause abdominal pain?

Group B Streptococcus and Abdominal Pain

Vaginal Group B Streptococcus (GBS) colonization alone typically does not cause abdominal pain, as most women with vaginal GBS colonization are asymptomatic.

Understanding GBS Colonization and Symptoms

GBS is a common commensal organism that colonizes the gastrointestinal tract (which serves as the natural reservoir) and vagina in approximately 10-30% of pregnant women 1. Important characteristics of vaginal GBS colonization include:

• Most women have no symptoms associated with genital tract colonization 1
• GBS colonization can be transient, chronic, or intermittent 1
• The gastrointestinal tract is the likely source of vaginal colonization 1

When GBS Can Cause Abdominal Pain

While asymptomatic colonization is the norm, GBS can cause clinical infections that may present with abdominal pain in specific circumstances:

1. Urinary Tract Infections (UTIs):

   • GBS urinary tract infections complicate 2-4% of pregnancies 1
   • UTIs can present with abdominal or pelvic pain
   • GBS in urine is considered a surrogate for heavy maternal colonization 1

2. Pregnancy-Related Infections:

   • During pregnancy or postpartum, women can develop:
     • Amnionitis (infection of amniotic fluid)
     • Endometritis (infection of the uterine lining)
     • Sepsis
   • These conditions typically present with abdominal pain 1, 2

3. Ascending Infection:

   • GBS can ascend from the vagina to the amniotic fluid after labor onset or membrane rupture 2
   • This ascending infection can cause inflammation and pain

Clinical Implications and Management

If a patient presents with abdominal pain and vaginal GBS colonization:

1. Rule out UTI:

   • Laboratory personnel should report any presence of GBS bacteriuria in specimens from pregnant women 1
   • GBS in urine culture specimens should be reported when present at concentrations of ≥10⁴ colony-forming units/ml 1
   • GBS urinary tract infections should be diagnosed and treated according to current standards of care 1

2. Consider pregnancy-related complications (if pregnant):

   • Assess for signs of amnionitis, endometritis, or other pregnancy complications
   • Intrapartum antibiotic prophylaxis is recommended for women with GBS bacteriuria during pregnancy 2

3. Remember that asymptomatic colonization does not require treatment:

   • In the absence of GBS urinary tract infection, antimicrobial agents should not be used to treat asymptomatic GBS colonization before the intrapartum period 1

Important Considerations

• GBS is not a sexually transmitted disease, despite the fact it can be transmitted sexually 3
• GBS cannot reliably be eradicated by antibiotic treatment outside of specific clinical indications 3
• The primary concern with GBS is the risk of vertical transmission to infants during delivery, not maternal abdominal pain 2

Conclusion

If a patient has abdominal pain and vaginal GBS colonization, the clinician should investigate other causes of the pain, as asymptomatic colonization alone does not typically cause abdominal symptoms. Only when GBS causes specific infections like UTIs, amnionitis, or endometritis would it be associated with abdominal pain.