# GBS/Hibiclens question



## NoVaSAHM (Jul 22, 2004)

I was wondering if anyone knew with some scientific reasoning which was a more likely way for Hibiclens washes to work regarding external colonization with GBS, aside from all other controversy about its use and all speculation about how internal colonization may be reduced or eliminated.

Would it be more likely that:

-The Hibiclens greatly reduces colonization, but just enough is almost inevitably left in the vaginal area that with time the fast-growing bacteria reaches its previous significant levels even without further contamination.

-The Hibiclens eliminates the bacteria, and if intestinal colonization exists, recolonization of the vaginal area occurs from contamination (which may not be easy to avoid even with normal good hygiene, but will be less likely with extra careful hygiene, such as spot cleanings with Hibiclens after bowel movements.)

Since we cannot really determine how dietary measures have affected intestinal colonization and that "threat" is always there to some extent I'm wondering whether the risk largely persists because of the intestine or because of minimal continued presence of GBS in the vagina after Hibiclens. Obviously hygiene to avoid vaginal contamination from the intestine is important no matter what, but I'm wondering what the "threat" is from leftover bacteria flourishing in the vagina.


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## white_queen_22 (Jan 14, 2006)

GBS is not a "once colonized, always colonized" thing. They are now saying colonization can peak and diminish. So thankfully, they no longer treat as "once positive, always positive".

GBS is a slow growing bacteria which is why a negative at 36 weeks means a negative at birth....if they tested in the 1st trimester there might be a chance of being positive at birth even if you tested negative at week 5. But not by week 36.

My midwife did a study on herself after getting GBS from a public pool (actually - three of the midwives in the group got it there! *laughing*) and ran multiple GBS level tests to personally try all of the many "home remedies" out there. Garlic was the least effective for them. Hibiclens was the one thing that really knocked back the GBS infection and they found it to be highly effective.

The nurse midwife of the group also said it is common for women to cycle through GBS colonization. She has one QF mother who pretty much has a baby every two years. She's been positive, negative, positive, negative, positive, negative and just tested positive again with this next pregnancy. So her colonization cycle is every two years. She doesn't like the Hibicleans so always choose antibiotics intramuscularly which takes a bit longer than IV antibiotics (both of which my midwives can do) to take effect but her labors are always long enough.

Angela <><


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## redebeth (Apr 23, 2006)

On the issue of "once colonized, always colonized", isn't there an issue of being a 'carrier' though? Like I have had two positive swabs and two negative swabs in my pregnancies, but don't those pos. ones make me a carrier nonetheless? I believe it is once a carrier always a carrier.

As for the OP's question, can I ask why this distinction is necessary? I was told by my CNM that after a neg. swab it takes about 4 weeks to colonize enough to get a pos. result. Where the bacteria is coming from is a moot point since it can't really be contained.

Maybe it would be better to put this in the birth professionals forum, they know everything!

I personally think is has more to do with sex than what we are told, but that's just me.


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## NoVaSAHM (Jul 22, 2004)

I've only read that it's fast-growing and that is why the Hibiclens is suggested, I believe, to be done every 4 to 6 hours in labor, although I'm interested by what your CNM said, redebeth. It seems to me that if the only known decolonization has been external, then a negative swab soon after a rinse could be a very temporary result, possibly reversed as soon as there's a bowel movement (if a rectal swab is done or if vaginal contamination takes place from the BM.) If the intestinal bacteria were targeted with oral antibiotics of course that would be very different. Perhaps probiotics or other measures sometimes effectively reduce or eliminate the intestinal GBS, but the external swab won't make it clear that that has happened if there is also Hibiclens use.

I do think the reason negative at culture usually means negative at birth probably has to do with lack of exposure in everyday life. I have read that 2/3 of women who receive the oral antibiotics (after the usual testing time I suppose) will be recolonized by birth. I'd been thinking also that sex might be a big factor in that, as I've seen research showing colonization with the same strain among sex partners. A woman who was colonized vaginally may well have colonized her husband, then decolonized herself, but then been recolonized by him very quickly. I don't think Hibiclens can be used in the same way as a rinse for the male urinary tract.

It's just a question aimed at gaining a little better understanding of how managing the GBS risk during labor with Hibiclens works. Thanks for the birth pros forum suggestion, I'll have to check that out if I have time.


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## culturalcreative1 (Aug 11, 2008)

Quote:


Originally Posted by *NoVaSAHM* 
Perhaps probiotics or other measures sometimes effectively reduce or eliminate the intestinal GBS, but the external swab won't make it clear that that has happened if there is also Hibiclens use.

Just thought I'd throw in my 2 cents: I tested GBS positive in my first pregnancy at 34 weeks and in my 2nd pregnancy at 36 weeks. During my 2nd pregnancy, I immediately started a probiotic regimen (mainly Primal Defense from Garden of Life) and had another GBS test 2 weeks later which came out negative. So, it's my experience that probiotics supplementation helps to eliminate GBS. My OB still insisted that I receive IV antibiotics, but I intentionally arrived at the hospital too late to receive it and my son was not infected. Not sure if that info adds to the conversation but thought it might help.

jenn


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## NoVaSAHM (Jul 22, 2004)

Quote:


Originally Posted by *culturalcreative1* 
So, it's my experience that probiotics supplementation helps to eliminate GBS. My OB still insisted that I receive IV antibiotics, but I intentionally arrived at the hospital too late to receive it and my son was not infected. Not sure if that info adds to the conversation but thought it might help.

jenn

It's interesting anecdotal information, since you tested - just two weeks after a +. Just hard to say how it would work for most women.

I was just thinking in the short term, perhaps a woman could control her vaginal colonization rates better through such means as abstaining from sex, using an external Hibiclens spray after each bowel movement, being even more vigilant than normal about wiping hygiene, reducing excess moisture in the underpants environment. That's why my interest in whether the bacteria likely stays in some small quantity in the vaginal area that regrows quickly on its own even when the Hibiclens kills enough for a test to be negative, or whether it's generally a matter of physically transferring bacteria back from the woman's own GI output if she is intestinally colonized, or through sex.

ETA: I've found a couple of really old (c. 1980) study abstracts finding that people with + perianal and rectal GBS swabs were a lot less likely to have it in their feces than at those locations, and at least one of the studies specifically stated that the perianal colonization was higher (as in a higher GBS count) than the rectal. Both suggested that the perianal skin might be the more ordinary location of the GBS than the GI tract, even the rectum. I am really confused now. Bearing in mind my very limited understanding, and the possibility that these studies were missing something that has been uncovered since 1980, I wonder now if this indicates that the GBS mostly lives in the areas that are actually tested and either grows back from tiny remnant colonies or is reacquired easily in many + women after a treatment like Hibiclens because of some environmental/lifestyle factor.


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## white_queen_22 (Jan 14, 2006)

Nova - something else to consider in terms of women aquiring the GBS infection is that close to 80% of health care workers test positive. *grin* Now - do you REALLY want that dr's fingers in your vaginaa hundred times during your birth? No thanks!

Incidentally - you can also get it from public pools, public restrooms...etc. It seems to me like a Hibiclens douche and wash during active labor would do a pretty good job of preventing infection in the infant without the negative side effects of routine abx's.

Angela <><


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## nashvillemidwife (Dec 2, 2007)

Quote:


Originally Posted by *white_queen_22* 
Nova - something else to consider in terms of women aquiring the GBS infection is that close to 80% of health care workers test positive.

Angela, can you share your source for this?


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## NoVaSAHM (Jul 22, 2004)

I wonder how likely it is to be on health care workers' fingers. It seems like a lot more people would be colonized if it lived so well on fingers. And while all doctors and nurses may not follow hand-washing protocol perfectly, the general public seems a bigger threat in that regard.

One of the things that concerns me about Hibiclens post-ROM is exposing the baby to the mixture, the chlorhexidine itself, the alcohol, and maybe whatever else is in it, in some way that might cause harm, however dilute the solution to begin with and amidst the amniotic fluid and all. For safety's sake, perhaps especially as American consumers do not seem to have access to pure chlorhexidine to dilute with water alone or however it may have been done in the studies, perhaps the Hibiclens shouldn't be used in a way that could send it directly to the cervix, bag of waters or baby once the waters are broken?

I am interested by indications that this GBS bug might prefer to live in areas that border the inside/outside of the body, like the vaginal and anal openings, and not farther inside the body, but obviously the GBS can and does travel higher and do harm. But is there something that normally keeps it from thriving higher up in the vagina, such as pH, or something else about the environment?


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## mwherbs (Oct 24, 2004)

so how hibiclens works is it is an antibacterial wash- and if used weak enough it leaves lactobacillus alone- strong concentrations of hibiclens kills everything.
so GBS is for the most part a surface critter - it isn't usually a systemic disease - but it can be that is the concern, newborns, old folks, people with other immune problems and late in pregnancy/postpartum (can infect moms). so unless a woman already has a degree of invasive colonization like a UTI or a deeper vaginal/cervical/uterine colony the majority of the critters will be killed off with a rinse and so will not be able to increase in number through out labor if they are kept at bay -- but if they are already higher into the vagina or have gone systemic already then hibiclense will not be effective for those babies and cannot prevent their exposure/nor will it protect mom-

GBS likes to live in an alkaline environment- similar to BV they actually like the same pH 4.5/4.8 or more --- the more H2O2 producing lactobicillus strains the lower the GBS colonization rate- you need to have more than just vaginal colonies the best protection is with healthy intestinal flora as well as vaginal flora--- but there are other issues- the GBS strains that are most agressive and like to adhere to and dig in to surfaces colonize the urinary tract and are more likely to cause a systemic infection--

so when you think about tissue health, it gets to be a bit complex, there are studies that show things like what blue berries and cranberries do is combine with the mucous membrane surface and help to repel invasion- interestingly enough there are also studies on what berries in general do for the intestines as in a similar fashion (mucous membranes again). But tissue health is a complex thing right we have all sorts of known nutrients needed like vitamin A, D, zinc, B vitamins... and things like environmental exposures (soaps, detergents, dryer sheets, underwear, chairs and other surfaces we sit on, other people, antibiotics)Blood type B is more likely to get a GBS infection (just weird huh) so using the hibiclens dilute wash was shown in some studies to reduce the infection rate at about the level of treating risk factors- what it can't do is if there is already an infection that has assended

milk cows can have GBS in their teats -- dairies use betadine or hibiclens to clean with to prevent spread and to limit infection--


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## NoVaSAHM (Jul 22, 2004)

Thanks, mwherbs. I've tended to think a weaker concentration of Hibiclens for any direct application inside the vagina just makes sense. If it may leave other, helpful bacteria alone, only the better.

I found the blood type reference interesting, so did a search and found this: http://findarticles.com/p/articles/m...37/ai_94817286.

Now it's a 2002 article and I haven't found any more recent references yet, but it looks like subsequent research didn't find the blood type B-GBS link. Then there was thought to be a relationship between Rh-negativity and GBS, but as of that article, that relationship was also being called serious into question.


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## white_queen_22 (Jan 14, 2006)

Quote:


Originally Posted by *nashvillemidwife* 
Angela, can you share your source for this?

I lost of lot of my quick tab studies (saved in organized fashion) after my computer crash but let me do a quick search. There was more than one piece about health care workers having much higher than average infection rates -

....searching...

Found this on Gentlebirth.org although not all of their stuff is substantiated this one included the link to the abstract:
" Some women prone to carry strep in pregnancy [12/8/05] - Black women, health care workers, and overweight women are at increased risk for carrying group B streptococcus (GBS) during pregnancy, new research suggests.

_"Women in health care occupations with a high frequency of direct patient contact faced a 22 percent increased risk of GBS colonization"_
http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract
------
That may be the one I was thinking of but I don't think so. If 1 in 4 or 1 in 3 women carry GBS and female health care workers are 22 percent more likely to carry it that isn't 80%. So I either made that number up or that wasn't the right study. Either is very possible given my current low-iron levels and last-month-of-pregnancy-sleeplessness. *wry grin*
------

Something else I've wondered about - if a woman has intestinal colonization, as many do, but no vaginal colonization, the very act of a vaginal exam in early pregnancy could easily introduce the bacterium. Most care providers will not just enter straight into the vagina but touch the labia or perineal tissues on the way in. I wonder what a study would show on positive results wk 36 with early vaginal exams vs no internal exams during early pregnancy.
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As for dr's and nurses and cleanliness - At my sisters birth the nurse used the restroom (in her room!), came in and put on gloves, wiped her hands on her pants legs and then said "Lets do a check now". No hand washing (the bathroom was connected - there was NO HAND WASHING) and she thoroughly handled the gloves putting them on - pulling and tugging at the fingers to get them on right...and THEN contaminated them on her pants and THEN asked to do an internal.

My sister is an RN and just looked at her and said "I want to SEE YOU wash your hands. Then get a new pair of gloves and put them on right." *laughing*
After that she made all the nurses wash their hands in front of her when they entered her room, "I'd like you to wash your hands please". 
--------

Somewhere an article also recently went through the CAPPA list about an antibiotic resistant strain of GBS. Blast my computer crash and disorganization in back things up. *laughing*

Anyway - this thread is fascinating. I'm loving all the information here!

Angela <><


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## white_queen_22 (Jan 14, 2006)

Quote:


Originally Posted by *mwherbs* 
so how hibiclens works is it is an antibacterial wash- and if used weak enough it leaves lactobacillus alone- strong concentrations of hibiclens kills everything.
so GBS is for the most part a surface critter - it isn't usually a systemic disease - but it can be that is the concern, newborns, old folks, people with other immune problems and late in pregnancy/postpartum (can infect moms). so unless a woman already has a degree of invasive colonization like a UTI or a deeper vaginal/cervical/uterine colony the majority of the critters will be killed off with a rinse and so will not be able to increase in number through out labor if they are kept at bay -- but if they are already higher into the vagina or have gone systemic already then hibiclense will not be effective for those babies and cannot prevent their exposure/nor will it protect mom-

GBS likes to live in an alkaline environment- similar to BV they actually like the same pH 4.5/4.8 or more --- the more H2O2 producing lactobicillus strains the lower the GBS colonization rate- you need to have more than just vaginal colonies the best protection is with healthy intestinal flora as well as vaginal flora--- but there are other issues- the GBS strains that are most agressive and like to adhere to and dig in to surfaces colonize the urinary tract and are more likely to cause a systemic infection--

so when you think about tissue health, it gets to be a bit complex, there are studies that show things like what blue berries and cranberries do is combine with the mucous membrane surface and help to repel invasion- interestingly enough there are also studies on what berries in general do for the intestines as in a similar fashion (mucous membranes again). But tissue health is a complex thing right we have all sorts of known nutrients needed like vitamin A, D, zinc, B vitamins... and things like environmental exposures (soaps, detergents, dryer sheets, underwear, chairs and other surfaces we sit on, other people, antibiotics)Blood type B is more likely to get a GBS infection (just weird huh) so using the hibiclens dilute wash was shown in some studies to reduce the infection rate at about the level of treating risk factors- what it can't do is if there is already an infection that has assended

milk cows can have GBS in their teats -- dairies use betadine or hibiclens to clean with to prevent spread and to limit infection--

I know that even with abx there are still babies who are born infected - even babies born via C-section infected, etc. Are these infants who's mothers had these systemic type of infections you are referring to? How can you tell the difference between someone who is just - mildly infected, at the "surface" as you mentioned vs someone who is systemically infected?

I thought it was interesting that my midwives had tried about six or seven things often listed as "natural remedies" and the only thing that eliminated their public pool exposure infection was the Hibiclens douche and wash. The CNM said "Since we had access to the lab we figured - why not do the study for ourselves? I've never been one to tell my clients 'I've heard that this or this.....' I'd much rather be able to say 'that didn't work for me and I have the lab results to prove it.' "


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