Women Can Expect More Questions From Gynecologists
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.