7 Key Symptoms of Group B Strep Disease You Should Know

Group B streptococcus (GBS), also known as Streptococcus agalactiae, is a type of bacteria that can cause serious infections, particularly in newborns, pregnant women, and individuals with weakened immune systems. While many people carry this bacteria without experiencing any symptoms, it can lead to severe complications when it causes active infection. Understanding the symptoms of Group B strep disease is crucial for early detection and prompt medical intervention.

Group B strep infections manifest differently depending on the age group affected. In newborns, the disease can appear within hours of birth (early-onset) or weeks later (late-onset), while adults may experience various symptoms depending on which part of the body is infected. This article explores the key symptoms associated with Group B streptococcal infections to help you recognize when medical attention is necessary.

1. Fever and Temperature Instability

One of the most common and earliest symptoms of Group B strep disease is fever, which presents differently across age groups. In newborns, temperature instability is a critical warning sign that should never be ignored.

In Newborns:

• Body temperature above 100.4°F (38°C) or below 97°F (36.1°C)
• Inability to maintain normal body temperature
• Cold or clammy skin despite fever
• Temperature fluctuations that don’t respond to normal warming or cooling measures

In Adults:

• High fever, often exceeding 101°F (38.3°C)
• Chills and sweating
• Persistent fever that doesn’t respond to over-the-counter fever reducers

Temperature instability in newborns is particularly concerning as their immune systems are still developing and cannot effectively fight off the infection. Any fever in a newborn under three months old requires immediate medical evaluation.

2. Respiratory Difficulties

Group B strep can cause serious respiratory complications, especially in newborns where it may lead to pneumonia or breathing problems. Respiratory symptoms are among the most critical signs requiring urgent medical care.

Key respiratory symptoms include:

• Rapid breathing (more than 60 breaths per minute in newborns)
• Grunting sounds with each breath
• Flaring of the nostrils when breathing
• Chest retractions (skin pulling in around the ribs and chest)
• Blue or pale coloring of the skin, lips, or nail beds (cyanosis)
• Pauses in breathing (apnea)
• Shortness of breath or labored breathing
• Wheezing or abnormal breath sounds

In adults, Group B strep pneumonia may cause difficulty breathing, chest pain, and a persistent cough. These respiratory symptoms indicate that the infection has spread to the lungs and requires immediate medical intervention to prevent further complications.

3. Neurological Symptoms and Meningitis Signs

Group B strep is one of the leading causes of meningitis in newborns. When the bacteria invade the protective membranes covering the brain and spinal cord, serious neurological symptoms emerge.

Neurological symptoms in newborns:

• Irritability and excessive crying that’s difficult to console
• Extreme lethargy or difficulty waking
• Poor muscle tone (appearing floppy or limp)
• Stiff neck or body
• Bulging soft spot (fontanelle) on the baby’s head
• Seizures or jerking movements
• Unusual eye movements or blank stares
• High-pitched crying

Neurological symptoms in adults:

• Severe headache that doesn’t improve with pain relief
• Stiff neck and difficulty moving the head
• Sensitivity to light (photophobia)
• Confusion or altered mental state
• Seizures
• Nausea and vomiting

Meningitis is a medical emergency requiring immediate treatment. The symptoms can progress rapidly, and any suspicion of meningitis should prompt immediate medical evaluation.

4. Feeding Difficulties and Gastrointestinal Issues

Newborns with Group B strep infection often show changes in their feeding patterns and may develop gastrointestinal symptoms. These signs are frequently among the first indicators that something is wrong.

Common feeding and gastrointestinal symptoms:

• Refusing to feed or showing no interest in nursing or bottle-feeding
• Weak sucking reflex
• Vomiting or spitting up more than usual
• Inability to keep feeds down
• Decreased wet diapers (signs of dehydration)
• Abdominal distension or bloating
• Diarrhea or changes in stool consistency
• Poor weight gain or weight loss

In pregnant women with Group B strep, gastrointestinal symptoms may include nausea, vomiting, and abdominal discomfort. These symptoms, when combined with fever, may indicate a urinary tract infection or other GBS-related complication that requires medical attention.

5. Lethargy and Decreased Responsiveness

A significant change in activity level and responsiveness is a critical symptom of Group B strep disease, particularly concerning in newborns who should be alert during certain periods of the day.

Signs of lethargy include:

• Excessive sleepiness beyond normal newborn sleep patterns
• Difficulty waking the baby for feeds
• Decreased response to stimulation
• Lack of normal movement or activity
• Weak or absent crying
• Reduced interaction with surroundings
• Floppy or limp body posture

In adults, lethargy may manifest as:

• Extreme fatigue that doesn’t improve with rest
• Weakness affecting daily activities
• Decreased alertness or confusion
• Difficulty concentrating

Any significant decrease in a newborn’s responsiveness or activity level should be evaluated immediately, as it may indicate a rapidly progressing infection.

6. Skin and Soft Tissue Symptoms

Group B strep can cause skin and soft tissue infections, particularly in adults with diabetes, obesity, or compromised immune systems. These infections can range from mild to severe.

Skin-related symptoms include:

• Redness and warmth in a specific area of skin
• Swelling or inflammation of affected tissues
• Pain or tenderness to touch
• Skin that appears tight or shiny
• Pus or drainage from infected areas
• Red streaks extending from the wound or infected area
• Development of blisters or ulcers
• Cellulitis (spreading bacterial skin infection)

In newborns, skin symptoms may appear as:

• Pale or mottled skin
• Grayish or bluish skin coloring
• Rashes or unusual skin markings
• Cool extremities despite warm core body temperature

These symptoms require prompt medical evaluation, as skin infections can spread quickly to deeper tissues and the bloodstream if left untreated.

7. Urinary and Reproductive System Symptoms

Group B strep commonly affects the urinary tract and reproductive system, particularly in pregnant women and older adults. These infections can be asymptomatic but may also cause noticeable symptoms.

Urinary tract symptoms include:

• Painful or burning sensation during urination
• Frequent urge to urinate with little output
• Cloudy, bloody, or foul-smelling urine
• Lower abdominal or pelvic pain
• Back pain, particularly on one side
• Fever and chills accompanying urinary symptoms

In pregnant women, additional symptoms may include:

• Increased vaginal discharge
• Contractions or uterine tenderness
• Signs of preterm labor
• Rupture of membranes (water breaking) before term
• Fever during labor or postpartum period

Postpartum infections may cause:

• Uterine tenderness
• Foul-smelling vaginal discharge (lochia)
• Fever in the days following delivery
• Excessive bleeding

Urinary tract infections caused by Group B strep in pregnant women are particularly concerning as they can lead to preterm labor, premature rupture of membranes, and transmission of the bacteria to the baby during delivery.

Main Causes of Group B Strep Disease

Group B streptococcal disease is caused by the bacterium Streptococcus agalactiae, which naturally lives in the gastrointestinal and genital tracts of approximately 25% of healthy adults. While carrying the bacteria doesn’t usually cause problems, certain factors can lead to active infection:

Transmission to Newborns

Vertical transmission during childbirth: The most common route of transmission occurs when a baby passes through the birth canal of a mother who carries Group B strep bacteria. The bacteria can colonize the baby’s skin, respiratory tract, and gastrointestinal system.

Early-onset disease: This occurs within the first week of life, usually within hours of birth, when bacteria are transmitted during delivery. Risk factors include:

• Premature birth (before 37 weeks)
• Prolonged rupture of membranes (water breaking more than 18 hours before delivery)
• Maternal fever during labor
• Previous baby with GBS disease
• GBS bacteriuria during current pregnancy

Late-onset disease: This develops between one week and three months after birth and can be acquired from the mother during delivery or from environmental sources after birth.

Adult Infection Causes

Compromised immune system: Adults with weakened immune systems are more susceptible to developing active GBS infections. This includes:

• People with diabetes
• Cancer patients undergoing chemotherapy
• HIV/AIDS patients
• Elderly individuals (65 years and older)
• People taking immunosuppressive medications

Chronic medical conditions: Certain health conditions increase the risk of GBS infection:

• Heart disease
• Liver disease (cirrhosis)
• Kidney disease
• Obesity
• Neurological impairments

Pregnancy-related factors: Pregnant women are more vulnerable to GBS infections due to changes in the immune system and urinary tract during pregnancy.

Skin breakdown: Open wounds, surgical sites, ulcers, or other breaks in the skin can provide entry points for GBS bacteria.

Prevention Strategies

While Group B strep bacteria are common and often harmless, several strategies can help prevent serious infections, particularly in high-risk groups.

Prenatal Screening and Treatment

Universal screening: Pregnant women should be screened for Group B strep between 36 and 37 weeks of pregnancy. This involves a simple swab test of the vagina and rectum.

Intrapartum antibiotic prophylaxis (IAP): Women who test positive for GBS or have other risk factors should receive antibiotics during labor to prevent transmission to the baby. This approach has significantly reduced early-onset GBS disease in newborns.

When antibiotics during labor are recommended:

• Positive GBS screening test during current pregnancy
• GBS bacteria found in urine during pregnancy
• Previous baby with GBS disease
• Unknown GBS status with risk factors (preterm labor, fever, prolonged membrane rupture)

General Prevention Measures

Good hygiene practices:

• Regular handwashing, especially before handling newborns
• Proper wound care and keeping cuts clean and covered
• Maintaining good personal hygiene

Managing chronic conditions:

• Keeping diabetes well-controlled
• Following treatment plans for chronic illnesses
• Maintaining a healthy immune system through proper nutrition and lifestyle

Prenatal care:

• Attending all scheduled prenatal appointments
• Discussing GBS screening and prevention with healthcare providers
• Reporting any signs of urinary tract infections or unusual symptoms promptly
• Following medical advice regarding GBS-positive status

For adults at high risk:

• Seeking prompt treatment for urinary tract infections
• Proper care of chronic wounds or skin conditions
• Regular medical check-ups to monitor chronic conditions
• Discussing vaccination status and infection prevention with healthcare providers

Postnatal monitoring:

• Closely observing newborns for any signs of infection in the first weeks of life
• Ensuring proper follow-up care for babies born to GBS-positive mothers
• Seeking immediate medical care if any concerning symptoms develop

Healthcare Setting Prevention

Healthcare facilities implement specific protocols to prevent GBS transmission:

• Following evidence-based guidelines for screening and prophylaxis
• Proper sterilization of medical equipment
• Infection control measures in maternity wards and neonatal intensive care units
• Education of healthcare staff about GBS prevention protocols

Frequently Asked Questions

Can Group B strep go away on its own?

Group B strep colonization can come and go naturally without treatment, as it’s part of the normal bacterial flora in many healthy adults. However, active infections require medical treatment and will not resolve on their own. Pregnant women who test positive for GBS need antibiotics during labor to prevent transmission to the baby, even if they have no symptoms.

How quickly do Group B strep symptoms appear in newborns?

Early-onset GBS disease typically appears within the first 24 hours after birth, with most cases developing within 6-12 hours. However, symptoms can emerge anytime during the first week of life. Late-onset disease develops between one week and three months after birth. Any concerning symptoms in a newborn should be evaluated immediately, regardless of timing.

Is Group B strep contagious between adults?

Group B strep is not considered highly contagious between adults in everyday situations. It is primarily transmitted from mother to baby during childbirth. While the bacteria can be present in the genital and gastrointestinal tracts, person-to-person spread in adults is uncommon. However, proper hygiene practices are always recommended.

Can you have Group B strep without symptoms?

Yes, approximately 25% of healthy adults carry Group B strep bacteria in their gastrointestinal or genital tracts without any symptoms. This is called colonization, and most carriers never develop an active infection. However, pregnant women who are carriers can transmit the bacteria to their babies during delivery, which is why prenatal screening is important.

What’s the difference between early-onset and late-onset GBS disease in babies?

Early-onset GBS disease occurs within the first week of life, usually within hours of birth, and is transmitted from mother to baby during delivery. It commonly causes sepsis, pneumonia, and meningitis. Late-onset disease develops between one week and three months after birth and may be acquired from the mother or environmental sources. Late-onset disease more frequently causes meningitis and has different risk factors than early-onset disease.

Who is most at risk for Group B strep complications?

Newborns are at highest risk, especially those born prematurely, with prolonged membrane rupture, or to mothers with fever during labor. Among adults, the highest risk groups include pregnant women, adults over 65, people with diabetes, those with compromised immune systems, individuals with chronic medical conditions like heart or liver disease, and those with obesity.

Should I be concerned if I test positive for Group B strep during pregnancy?

Testing positive for Group B strep during pregnancy is common and doesn’t mean you have an infection. It simply means you carry the bacteria. With appropriate antibiotics during labor, the risk of transmitting GBS to your baby is significantly reduced from 1 in 200 to 1 in 4,000. Follow your healthcare provider’s recommendations, and your baby will be monitored after birth for any signs of infection.

Can Group B strep recur after treatment?

Colonization with Group B strep can recur even after treatment, as the bacteria may return to the gastrointestinal or genital tracts. This is why pregnant women are tested during each pregnancy, typically between 35-37 weeks. Active infections that are properly treated usually resolve, but individuals with risk factors may develop new infections if they remain colonized with the bacteria.

How long after birth should I watch for GBS symptoms in my baby?

Parents should closely monitor their newborns for signs of infection during the first week of life for early-onset disease, and continue general vigilance through the first three months for late-onset disease. Any concerning symptoms such as fever, feeding difficulties, lethargy, breathing problems, or unusual irritability should prompt immediate medical evaluation, regardless of when they appear.

References:

• Centers for Disease Control and Prevention – Group B Strep (GBS)
• Mayo Clinic – Group B Strep Disease
• NHS – Group B Streptococcus
• World Health Organization – Group B Streptococcus
• American College of Obstetricians and Gynecologists – Group B Strep and Pregnancy