Data back bacterial vaginosis testing before surgery. (Low Infection Rates Misleading).

ST. LOUIS -- The data supporting the value of screening for and treating bacterial vaginosis before ob.gyn. surgery are not merely indicative of a trend or an association.

"They're fact," Dr. Sebastian Faro maintained at the 11th International Pelvic Reconstructive and Vaginal Surgery Conference. Yet even in hospitals that specialize in ob.gyn. care, screening for bacterial vaginosis (BV) is not routine preoperative practice, and the reported postoperative infection rates aren't always what they appear to be.

Take Dr. Faro's hospital. At the Woman's Hospital of Texas in Houston, the reported general postoperative rate on the gynecologic surgery side is under 5%, which "is wonderful." Yet the post-operative antibiotic usage rate is more than 50%, indicating something was askew.

"We never see a diagnosis of postoperative infection, but when I review the charts I see a lot of antibiotics being given during the first 24-48 hours. ... I think what we have here is infection that's unrecognized and being treated as febrile morbidity

"We have got to remember that most of our [ob.gyn. surgery] patients are going home the next day, and we may not be recognizing that they have got infections," echoed Dr. Sheldon Weinstein of the University of Texas, Dallas.

And if the infection doesn't become obvious until after discharge, patients usually go to another hospital. The surgeon usually never learns about it, added Dr. Marvin H. Terry Grody of Robert Wood Johnson Medical School at Camden (N.J.).

The data are very strong that BV contributes to postoperative infection after both cesarean section and vaginal hysterectomy Dr. Faro said at the conference, jointly sponsored by the Society of Pelvic Reconstructive Surgeons and Emory University.