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Very Rapid Evolution of Infection with Hepatitis C Virus Transmitted by an Accidental Needlestick

earlier in gestation [9], when such responses are absent or low. In acknowledgment of safety concerns highlighted in recent studies, the CDC no longer recommends that pregnant women with BV be treated with intravaginal clindamycin therapy, because 5 of 6 trials that have evaluated this therapy for women with (or without) BV showed significant increases in the rate of prematurity and neonatal sepsis [10]. Klebanoff et al. [1] emphasize the importance of an accurate diagnosis of BV before any antibiotic therapy is administered, and they warn that harm may result from treating women with metronidazole who do not have BV [2–4, 13]. We agree, and we included, in both the CDC guidelines and the background article, methods for the proper diagnosis of BV [9, 10]. The CDC’s STD treatment guidelines [9] are developed by a panel of experts who review published studies, rate the quality of the evidence, and determine the strength of recommendations [14]. The guidelines contain detailed information that is relevant for clinicians who must make treatment decisions. They state, “Because treatment of BV in asymptomatic pregnant women at high risk for preterm delivery (i.e., those who have previously delivered a premature infant) with a recommended regimen has reduced preterm delivery in three of four randomized controlled trials, some specialists recommend the screening and treatment of these women. However, the optimal treatment regimens have not been established” (emphasis added) [9, p. 44]. In the United States, the prevalence of prematurity has not changed appreciably during the past 20 years. It remains a leading cause of disability and infant mortality, and it disproportionately affects racial and ethnic minorities. Effective approaches to reducing prematurity are urgently needed. Infection plays a role in prematurity for some women [15]. Nevertheless, the identification of an effective strategy—involving selection of appropriate subgroups, timing of testing, and a suitable dosing regimen—for reducing the rate of prematurity has proven to be difficult. Additional data on the early treatment of BV with a recommended regimen is now available [16].