Dec. 3, 1999 (Cleveland) -- American women should expect questions about use of herbal remedies as well as new tests for diabetes, sexually transmitted diseases, and hepatitis C when they visit their gynecologist for an annual Pap smear, according to revised screening guidelines from the American College of Obstetricians and Gynecologists (ACOG).
The new guidelines are part of an ongoing effort on the part of ACOG to sharpen the primary care skills of ob/gyn. If these doctors are to function as "the primary care physicians for America's women," they need to concern themselves with more than reproductive health, Robert Yelverton, MD, president of Tampa Bay Women's Care Group, tells WebMD. Yelverton chairs the ACOG committee that wrote the recommendations.
For instance, about four million Americans are infected with hepatitis C. The infection can be transmitted from mother to child. Therefore ob/gyns need to screen high-risk women, says Howard Minkoff, MD, professor of obstetrics and gynecology at State University of New York, Brooklyn and chairman of obstetrics at Maimonides Medical Center. Minkoff presents the background, testing, and treatment of hepatitis C in an article in the December issue of the journal Obstetrics & Gynecology. His co-author is David N. Burns, MD, of the National Institutes of Child Health and Human Development.
Minkoff tells WebMD that pediatricians say children exposed to HCV should be monitored for 18 months. "But how will they know which children to follow," Minkoff says, "if we haven't identified infected mothers?" He adds, however, that available studies indicate that maternal-fetal transmission of hepatitis C is much less common than maternal-fetal transmission of HIV.
"The natural history of these diseases is also very different," he says. "There are some data that suggest [hepatitis C] is much more benign in children, and the percentage of people who will fall ill with the disease is much lower. Additionally, the standards of treatment are much different and the treatments themselves much more toxic and less [effective]." Currently, the recommended treatment for hepatitis C is combination therapy with interferon and ribavarin, two antiviral agents, for 48 weeks, but the response rate for treatment is only about 40%.
Nonetheless, Minkoff says ob/gyns have a duty to identify and screen high-risk women. Because hepatitis C may remain hidden for as long as 30 years, it is also necessary to consider testing for women aged 40 and older, he says. Although the virus can be sexually transmitted, the most common sources of infection are IV drug abuse and contaminated blood used in transfusions. The blood supply was not screened for hepatitis C until 1992, he says.
Minkoff's commentary coincides with the release of ACOG's updated screening recommendations. The updated recommendations cover HIV, hepatitis C, other sexually transmitted diseases, incontinence, and use of alternative medications, says Yelverton.
ACOG has recommended HIV testing for all pregnant women and now expands that recommendation to cover all women seeking preconception care, says Yelverton. In addition, any woman with invasive cervical cancer should now be offered testing for HIV.
ACOG already recommended routine chlamydia testing for all sexually active adolescents and others at high risk for sexually transmitted diseases, says Yelverton. Now it is expanding that recommendation to include gonorrhea testing. In addition, hepatitis C testing should be offered as part of routine testing for high-risk groups starting at age 13.
The new recommendations state that all women should have a fasting glucose every three years after age 45. Ob/gyns are encouraged to begin asking patients about urinary and fecal incontinence beginning at age 19 rather than at age 40, as in the past.
Finally, ACOG is now asking ob/gyns to include questions about the use of complementary and alternative medicines as part of routine histories, says Yelverton.
Vital Information:
*The American College of Obstetricians and Gynecologists has issued new guidelines as part of an effort to improve the primary care skills of ob/gyns.
*The new guidelines call for testing for diabetes, hepatitis C, HIV, and gonorrhea for various subsets of patients.
*It is important to screen women for hepatitis C because the infection can go undetected for years and may be passed from mother to child.
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