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%.