I've wanted to weigh in on this all day.  We havn't mentioned what kind of strep.  If a viridans strep was present, in an otherwise healthy mom, especially in low numbers, it would most likely be baby oral flora.  If a Group A or B strep was present, even in very low numbers, they would warrant treatment.  

Along the same lines, is anyone aware of any serious research being done in these low-grade, pain-in-the-breast moms to try to determine the etiology of their problems?  By the time they come to my office, they have been treated with so much stuff that it would be nearly impossible to get a decent culture.  I also wonder what the best protocol for culturing milk would actually be?  Probably not a colony count, but maybe a sample of the milk could be centrifuged, rinsed with sterile water and re-centrifuged, and the resulting pellet plated.  Maybe that would remove some of the anti-microbial qualities and give us a qualitative result. What about looking for antibody-coated bacteria in milk?    

Anybody else out there thinking about this?  I just hate that we have so little evidence to practice by.  By far and away, it's a small percentage of what we do, most being simple management issues, but when we do get a thorny case, we just don't even know how to appropriately culture - it would be great to get some infectious disease folks interested in breastfeeding.

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