Vaginal GAS (not vaginal farts)

Even though I retired from Public Health three years ago, people still contact me from time to time with personal issues about their sex lives, their kids’ sexual health, STI queries and so on.  I found the following story intriguing.

“Lorrie’s” vagina had started running like a tap.  One night it got so bad, she kept waking up to wipe it, as if her vagina had a cold.  She reported no (fishy) odour, no itching and no pain.  She had recently started having sex again; but since she and her new partner had both been tested for the usual culprits, an STI could be pretty much ruled out.  It occurred to me that she might have a herpes sore on her cervix but her doctor didn’t see one.  She swabbed Lorrie’s vagina and cervix.  A few days later, the test results were in: Group A strep (GAS); and it required a ten day course of penicillin.

Lorrie’s doctor had never seen vaginal GAS before in an adult woman and had few answers to Lorrie’s questions, which is what led Lorrie to me.  I started to do an online search and came up with some interesting facts.

  • Unlike strep B, it is not commonly found in adult women’s vaginas.
  • People can be carriers; for example, in the gut, without having an infection.
  • GAS can cause necrotizing fasciitis (yikes!) but is more commonly the cause of strep throat.
  • GAS can live on surfaces up to six months (yikes, again!).

So how did it find its way into her vagina in the first place?  What were the implications for her partner?  Did he need to be swabbed and/or treated prophylactically?

I speculated that if she was a carrier and it was in her gut, vaginal bruising during sex may have helped move the bacteria into her vagina causing an infection the way E. coli can cause a bladder infection.  But there was no way of proving this theory.

I called a former colleague at Toronto Public Health who minimized the risk to her partner since he didn’t have symptoms.  She said it was a common cause of infection, for example on babies’ bums – painful, but treatable.  Yet Lorrie’s concern over recurrence and transmission remained.  So I called Infection Control at Toronto Public Health.

They sent me to the PHAC web-site (I had already downloaded the information sheet below) with scary information about how long these bacteria can survive outside the body.  They also underlined the distinction between being a carrier and having the infection.  However, they disagreed with their colleague’s opinion about testing and treating her partner.  They wrote:

As you know, the pathogen can be found in its carrier state in the anus, vagina, skin and pharynx and contact with these surfaces can spread the infection, so good hand hygiene is important to stop the spread of the bacteria, especially after using the bathroom. Not sharing towels, and sex toys can also help.

Usually when antibiotics are used, the infective period is reduced to 24 hours. A person can be retested to make sure the antibiotics were effective. Also, sexual partners should be tested (and treated), because if they are a carrier, they can re-infect their partner(s).

The bacteria can live on surfaces for 3 days to 6 months.  They are susceptible to moist heat (121 ºC for at least 15 minutes) and dry heat (170 ºC for at least 1 hour), so the high drying cycle on dryers depending on high the temperature gets, should inactivate the bacteria. 

What that means for Lorrie is that there will be laundry.  And she will have to ensure that her partner gets swabbed and treated.  Perhaps he is the carrier and had shed bacteria during intimate contact.  Testing him is the only way to solve the mystery.

Not a very sexy conversation to have with your lover, but then again, dealing with this kind of nitty gritty is a good test of a relationship.

I wonder what the next phone call or e-mail will bring.

Resources:

PHAC http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/strep-pyogenes-eng.php

Case studies: http://cid.oxfordjournals.org/content/44/5/e43.full

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