Q: My friend has a marriage proposal from a lady whose ASO titre count is 400 in the initial stage. She consulted a doctor, who advised treatment, which usually takes 3 years, but due to some missed course, it took 5 years. After the treatment her count is 180. The doctor discontinued the treatment. Is there any problem in marrying her? Will there be problems related to sex or pregnancy? Can the problem return in future?

A:Rheumatic fever is a systemic disease that may occur following infection by a bacterium called group A beta hemolytic Streptococci. Acute rheumatic fever is characterised by fever, sore throat and migratory joint pains and may also manifest with heart, brain or skin symptoms. Antistreptococcal antibodies are specific antibodies to streptococcal antigens (proteins) and indicate true infection with Streptococcus. The mechanism of disease is due to these antibodies cross-reacting with body tissues. Streptococci produces hemolysins, which play an important role in tissue damage, one being Streptolysin O. This is highly immunogenic and evokes production of antibody to it called antistreptolysin O (ASO). Detection of this antibody in blood is useful in the diagnosis of recent infection. Other antistreptococcal antibodies include antideoxyribonuclease B), antistreptokinase, antihyaluronidase, and anti-DNAase. ASO titres depend on the age of the patient and the local incidence of streptoccocal infection. Levels higher than 200 IU/ml is usually taken as the upper limit of the normal range, since this value is rarely exceeded without symptoms indicative of streptococcal infection. The ASO level can be regarded as a measure of the extent and degree of infection. The levels (titres) of ASO reach the highest at the beginning of rheumatic fever but they may also be seen in some other diseases like rheumatoid arthritis and Takayasu arteritis. Thus, rising titres of ASO have a greater significance and in general, the antibodies rise during the first month after infection and then plateau for 3-6 months before returning to normal levels after 6-12 months. The main aim of treatment is to eradicate streptococcal organisms and bacterial antigens from the throat and for this penicillin is the drug of choice (in those not allergic to it). A single injection of benzathine penicillin can ensure compliance but oral cephalosporins (preferred over erythromycin) may be given to those allergic to penicillin. Oral prophylaxis is less reliable but can be used in compliant patients. This consists of phenoxymethylpenicillin (penicillin V) or sulfadiazine or oral cephalosporins. Penicillin can be given as benzathine penicillin G 1.2 million U IM every month, penicillin V 200,000 U or 250 mg (oral) twice a day, or erythromycin 250 mg oral twice a day. Most authorities suggest that prophylaxis be given for 5 years after the first attack but needs to be given indefinitely to patients with rheumatic heart disease or to those who are frequently exposed to streptococci, are less than optimal, or are difficult to monitor. I see no reason why your friend should not marry her. There is no prblem in married life or in motherhood if the infection has been treated.