4 Infectious Diseases in Obstetrics and Gynecology Table 2: Frequencies and conﬁdence intervals for giardiasis survey questions, sample of obstetrician-gynecologists in the American College of Obstetricians and Gynecologists, 2006. Question Number (%) Symptoms of giardiasis (choose two): N = 988 (all choices) Can lead to malabsorption: N = 493 Contracted from: N = 477 Classic method for diagnosis (microscopy) may miss the organism (even after 3 stool specimens): N = 497 Laboratory diagnosis is often made by which test: N = 493 Most common reason pregnant women with giardiasis are hospitalized: N = 498 Medications used for giardiasis: N = 472 Safest medication to use in ﬁrst trimester: N = 463 Should wait two weeks after giardiasis before swimming: N = 481 Most common enteric parasitic disease in US: N = 488 Toddlers, mothers, and care takers most at risk: N = 489 Incubation period is 1–4 weeks: N = 489 Treatment of asymptomatic carriers is not usually recommended: N = 491 ∗Correct answer ∗Abdominal cramps ∗Diarrhea Edema Bloody diarrhea ∗True False Drinking untreated water Swallowing water while swimming in pools Another person, toddlers, children in daycare Contaminated food ∗All of the above ∗True False Blood smear Serum antibody test ∗Enzyme immunoassay (to detect antigens in stool) Anemia ∗Dehydration Amniocentesis Premature rupture of membranes Tinidazole Metronidazole Nitazoxanide Mebendazole ∗all except Mebendazole Tinidazole Metronidazole Albendazole ∗Paromomycin ∗True False ∗True False ∗True False ∗True False ∗True False 468 440 0 80 454 39 159 0 4 7 307 453 44 8 45 440 11 480 0 7 1 234 0 21 216 31 351 6 75 295 186 387 99 384 105 434 55 163 328 asymptomatic persons because people often become recol- onized [1], and even with intensive investigation and treat- ment in daycare centers outbreaks can recur [44]. However, it may be necessary to treat if the disease contributes to un- derdevelopment in children. In the United States, most chil- dren have good nutritional status and in turn may not have any adverse health eﬀects from colonization; however, treat- ment should be considered if spread of the disease is likely, for example, in a household when it has spread from per- son to person [1]. Resistance is another consideration for not treating asymptomatic carriers. The overuse of a drug may cause resistance [1] which could aﬀect treatment courses in the future. 8. LIMITATIONS One limitation of the survey results is the low response rate (42%). Respondents who are more knowledgeable about gi- ardiasis may have been more likely to complete the question- naire, leading to an overestimate of knowledge. Nevertheless, 47.4 44.5 0.0 8.1 92.1 7.9 33.3 0.0 0.8 1.5 64.4 91.1 8.9 1.6 9.1 89.2 2.2 97.8 0.0 1.4 0.2 49.6 0.0 4.4 45.7 6.7 75.8 1.3 16.2 61.3 38.7 79.3 20.3 78.5 21.5 88.8 11.2 33.2 66.8 95% conﬁdence interval (%) 44.3, 50.5 41.4, 47.6 — 6.4, 9.8 89.3, 94.3 5.5, 10.3 29.1, 37.8 — 0.2, 2.1 0.6, 3–3.0 60.1, 68.7 88.3, 93.5 6.4, 11.4 0.5, 2.7 6.59, 11.7 86.5, 92–72.0 0.9, 3.5 94.8, 98–98.0 — 0.4, 2.4 0.0, 0.6 45.1, 54.1 — 2.6, 6.3 41.3, 50.3 4.4, 9–4.0 71.9, 79.7 0.3, 2.3 12.8, 19.6 56.8, 65.7 34.3, 43–43.0 76.1, 83.1 16.8, 24–24.0 74.9, 82.2 17.8, 25.1 85.6, 91.4 8.5, 14.1 29.0, 37.4 62.6, 71–71.0