My wife has had a persistent Group B strep infection for about 18 months. She has had several courses of antibiotics, all to no avail. Her symptoms include vaginal irritation and clear, watery discharge, often heavy. She is diligent in her hygiene, drinks lots of liquids including pure cranberry juice, and avoids any irritating topical substances. Her symptoms go through better and worse periods, often stress-related, but ultimately persist. Her doctors don't seem to have many answers. How can she get rid of this infection?

--Jeff

The normal vagina contains between five and 15 different types of bacteria, including group B strep. Usually, the complex interplay among vaginal bacteria and their byproducts, estrogen and vaginal pH levels prevents any one form of bacteria from getting out of hand and causing unpleasant symptoms. It is important to remember, however, that not all discharge is infection and therefore bad -- a clear discharge without odor, that does not produce itching and burning, is most likely normal and does not need to be treated.

Group B strep certainly can be associated with infection, but this is most problematic in pregnancy, because it can infect the newborn baby. Women who are found to have group B strep in pregnancy are treated during labor to prevent transmission of the bacteria to the baby. Group B strep can also cause uterine infection after a vaginal delivery or cesarean section. In a nonpregnant woman, group B strep, unless especially abundant, is considered part of the normal vaginal flora and is not treated.

If your wife is truly having symptoms of infection; if yeast, chlamydia, gonorrhea, bacterial vaginosis are ruled out; and if the only thing found is an overabundance of strep B, then and only then should she get antibiotics to eradicate the strep. Penicillin and its derivatives are the usual choice. In order to prevent recolonization and infection, it is important to help preserve the normal vaginal ecosystem by avoiding douching, taking acidophilus supplements and reducing refined sugars in the diet. If she is postmenopausal, estrogen replacement should be considered. If she is on birth control pills, she may want to stop these as they can affect the vaginal environment. Sometimes a copious normal discharge can lead to irritation just from chronic moistness; in this case, freezing (cryosurgery) or lasering the cervix may decrease secretions and provide relief.

In some larger cities and medical centers there are clinics devoted to vulvovaginitis; your wife may want to seek an opinion from one of these specialized centers.