Invasive disease secondary to Streptococcus agalactiae (GBS) remains the leading cause of neonatal sepsis. Consensus guidelines published in 1996 recommended two preventions strategies: maternal testing for carriage at 35-37 weeks gestation and treatment of those positive in labor or  treatment of patients in labor with risk factors for early onset disease. This led to an almost 70% decline in the incidence of early onset disease in the late1990s.  In 2002 the recommendation was changed to favor the screening and treatment strategy alone as it was anticipated this would lead to a further reduction in the incidence of disease. Since implementation, the incidence of disease has remained stable. Potential explanations for this discrepancy include inadequate specimen collection, suboptimal timing of specimen collection and the method of diagnostic testing. Improvement in specimen quality emphasizing anorectal collection as well as improvements in diagnostic testing utilizing nucleic acid amplification technologies may further reduce the incidence of early onset GBS in the newborn.