Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2007, Article ID 21261, 6 pages doi:10.1155/2007/21261 Research Article Survey of Obstetrician-Gynecologists about Giardiasis Amy Krueger,1 Jay Schulkin,2 and Jeffrey L. Jones1 1 National Center Zoonotic, Vectorborne, and Enteric Diseases (NCZVED), Coordinating Center for Infectious Diseases (CCID), Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA 2 Department of Research, The American College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, DC 20024-2188, USA Received 5 February 2007; Accepted 24 April 2007 Giardiasis is one of the most common parasitic diseases in the United States with over 15 400 cases reported in 2005. A survey was conducted by The American College of Obstetricians and Gynecologists (ACOG) in collaboration with the Centers for Disease Control and Prevention (CDC) to evaluate the knowledge of obstetricians and gynecologists regarding the diagnosis and treatment of giardiasis. The questionnaire was distributed to a random sample of 1200 ACOG fellows during February through June of 2006. Five hundred and two (42%) responded to the survey. The respondents showed good general knowledge about diagnosis, transmission, and prevention; however, there was some uncertainty about the treatment of giardiasis and which medications are the safest to administer during the ﬁrst trimester of pregnancy. Copyright © 2007 Amy Krueger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. INTRODUCTION Giardiasis is a parasitic disease caused by the protozoan par- asite Giardia intestinalis (Giardia lamblia) [1]. Giardia is the most frequently reported enteric parasite in the United States and is responsible for numerous food-associated outbreaks and illnesses [2–10] as well as for waterborne disease [11– 13]. Through stool examination, the prevalence of the par- asite ranges from 2% to 5% in industrialized countries up to 20% to 30% in developing countries [14] largely due to a lack of adequate sanitation and hygiene [15, 16]. In the United States, giardiasis is responsible for the hospitaliza- tion of nearly 5000 people annually [17], and between 1992 and 1997 the Centers for Disease Control and Prevention (CDC) estimated that more than 2.5 million cases of giardia- sis occurred annually [18]. In 2005, over 15 400 cases were reported in the United States making it the most frequently reported enteric parasitic disease [19]. The reason for the dis- crepancy between estimated cases and reported cases is that many persons with milder illness do not seek medical care or are not tested for Giardia [18]. Giardia can be carried by a wide variety of hosts [12, 15] and can be found in many diﬀerent environments includ- ing water, soil, food, and surfaces that have been contam- inated with feces from an infected human or animal [11]. The main route of exposure is fecal-oral, examples include consuming water contaminated with Giardia, oral contact with an item contaminated with the parasite, eating under- cooked contaminated food [11, 13, 15], and in some cases oral-anal contact [15, 20, 21]. Giardiasis has long been as- sociated with drinking contaminated water [17] or with chil- dren and workers in daycare centers [22]. The Environmental Protection Agency found Giardia intestinalis cysts in approx- imately 81% of the raw water samples collected from streams, lakes, and ponds, and in 17% of ﬁltered water samples [23]. Fortunately most Americans do not consume raw water and are recipients of water from treatment systems that greatly decrease the chance of exposure to cysts. However, it is pos- sible to ﬁnd cysts in treated water that is inadequately ﬁltered because of a relative resistance to chlorine [1, 24]. The preva- lence of Giardia is as high as 35% in children attending day- care centers [14]. A previous study of children attending day- care centers in Denver, Colorado, suggests that attending a daycare center alone is a risk factor for contracting giardiasis [25]. Giardiasis can be diﬃcult to diagnose. The illness has symptoms that are associated with a variety of parasitic, bac- terial, and viral diseases; however, giardiasis should be con- sidered when gastrointestinal symptoms last beyond several days [1]. Symptoms can include diarrhea, malaise, ﬂatu- lence, greasy stools, stomach cramps, and nausea; diarrhea and malabsorption may lead to dehydration and weight loss [1, 11, 12, 26]. Another characteristic of giardiasis that can make the disease hard to identify is that cysts and tropho- zoites are shed on a periodic basis and stool examination may not always be performed during the time period the