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Group A Streptococcal Infections in Obstetrics and Gynecology

Arthur Zaltz

Lancefield Group A Streptococcus is an important global pathogen with the ability to cause significant disease and has particular implications in Obstetrics and Gynecology. Five to thirty per cent of the population are asymptomatic carriers. Invasive Group A Strep infections have become a leading cause of maternal mortality worldwide. The incidence and virulence has been increasing for the past 30 years. There are estimated to be over 75,000 deaths from puerperal sepsis annually. The highest death rates are in Asia, Africa and Latin America. The incidence of infection ranges from 3-10 per 100,000 in North America. There is a twenty fold increase risk in the risk of invasive infection in pregnancy and post-partum women. Most post-partum infections arise in the first 24-48 hours after delivery, often when the mother has been discharged from hospital. Gynecological invasive disease usually manifests as toxic shock or flesh eating disease.