Can a person colonized with Group B strep (Streptococcus agalactiae) urinary tract infection (UTI) proceed with a hysteroscopy for uterine polyps and fibroids?

Hysteroscopy Can Proceed with GBS UTI After Treatment

A person with Group B streptococcus urinary tract infection should receive appropriate antibiotic treatment for the UTI prior to hysteroscopy, but GBS colonization alone is not a contraindication to proceeding with the procedure for uterine polyps and fibroids.

Treatment of GBS UTI Before Hysteroscopy

The key distinction is between active infection versus colonization:

• If symptomatic GBS UTI is present, treat with penicillin G (preferred) or ampicillin according to standard UTI protocols before proceeding with elective hysteroscopy 1, 2
• Complete the full antibiotic course to ensure eradication and prevent recurrence before scheduling the procedure 1, 2
• For penicillin-allergic patients, cefazolin is preferred for those without high-risk allergy symptoms, while clindamycin (if susceptible) or vancomycin should be used for those at high risk for anaphylaxis 1, 2

GBS Colonization Does Not Contraindicate Hysteroscopy

The available evidence demonstrates that:

• Asymptomatic GBS colonization is not an indication to avoid obstetric procedures when those procedures are otherwise indicated 3
• The CDC guidelines explicitly state that "asymptomatic GBS colonization is not an indication to perform any of these procedures. When such procedures are indicated for other reasons, evidence is currently not sufficient to recommend that particular procedures should be avoided because of increased risk of peripartum or perinatal infection" 3
• Hysteroscopic polypectomy has a very low infection risk overall, with only 1.42% postoperative infections (0.85% endometritis, 0.57% UTI) in a large prospective study of 2,116 procedures 4

Infection Risk Context for Hysteroscopy

Understanding the baseline infection risk helps contextualize the decision:

• No major infectious complications occurred in a 10-year prospective study of nearly 2,000 patients undergoing operative hysteroscopy 4
• The risk of early-onset endometritis was highest after lysis of synechiae (adhesions) but remained low for polyp and fibroid resections 4
• Hysteroscopic polypectomy is "feasible and safe with negligible risk of intrauterine adhesion formation" 5

Clinical Algorithm for Decision-Making

Step 1: Assess for Active UTI

• If symptomatic UTI with GBS: Treat with appropriate antibiotics and complete full course before hysteroscopy 1, 2
• If asymptomatic bacteriuria in non-pregnant patient: No treatment needed; proceed with hysteroscopy 6

Step 2: Verify Pregnancy Status

• If pregnant: GBS bacteriuria at any concentration requires treatment AND intrapartum prophylaxis during labor, but this is separate from hysteroscopy considerations 1
• If not pregnant: Standard UTI treatment principles apply 6

Step 3: Proceed with Hysteroscopy

• Once active infection is treated (if present), GBS colonization alone does not require procedure delay 3
• Standard hysteroscopic technique with attention to sterility is sufficient 4, 5

Important Caveats

Do not treat asymptomatic GBS colonization outside the context of pregnancy or active UTI, as this does not eliminate carriage, promotes antibiotic resistance, and provides no clinical benefit 1, 6

Distinguish between colonization and infection: The presence of GBS in urine culture with normal urinalysis and no symptoms represents colonization, not infection, in non-pregnant patients and requires no treatment 6

Pregnancy changes everything: If the patient is pregnant, any concentration of GBS in urine mandates treatment regardless of symptoms, but this relates to neonatal disease prevention, not hysteroscopy safety 1