Head to Toes, Part 3: Strep Throat

One of the most common reasons people seek medical attention is for a sore throat, a medical condition can be caused by many, many things. The vast majority of sore throats are self-limiting viral (80-85%) infections; the rest are caused by Strep or a wide variety of other organisms and conditions.

Streptococcal pharyngitis (Strep throat) is most common in children between the ages of five and 15 years old, but can really occur at any age. I occasionally see Strep in children under age five, and nearly all of them are in day-care or pre-school – places where pathogens are shared more freely than toys.

Most people do not realize that between 8 and 20% of children in school or day-care carry Strep in their throats all of the time. They are called asymptomatic carriers. Strep may be spread by direct contact, fomites (freshly-contaminated objects), and by airborne droplets.

In the era before antibiotics, Strep was certainly something to be feared, since it had the nasty habit of causing serious or even fatal complications in the heart, kidneys, and other organs. Another complication, acute rheumatic fever (ARF) was very commonplace during the pre-antibiotic period. When penicillin became available in the 1940s, Strep complications became much less prevalent, and they are rarely seen in the U.S., Canada, and Western Europe. However, when I tell a patient that their culture or Strep test is positive, there is still that feeling of impending doom.

Most adults have had Strep many times in our lives without knowing it, and our immune systems have quickly brought it under control. In the past, throat cultures were the only way to determine if a person had Strep. Cultures take at least two days to come back, so it was not uncommon for a person, now completely well, to be called on day four or five and informed that they have (had) Strep. Now, with the use of Rapid Strep Tests, we can find out in minutes. A throat culture is 100 percent accurate. A Rapid Strep Test is only about 85-90% sensitive. There is only one problem with rapid detection: When you find out quickly on the first day of your sore throat and immediately receive treatment, you circumvent the normal antibody response, actually making you MORE susceptible to Strep infections in the future. Your body never had a chance to fully develop its own antibody response.

Waiting a few days with a plain ‘ol sore throat before seeing your medical provider is just fine and will not put you at any unusual risk of developing complications. If your Rapid Strep Test is negative, and the medical provider strongly suspects Strep, then a culture should be taken. If the culture is negative, YOU DO NOT NEED ANTIBIOTICS. Since the vast majority of sore throats are due to viruses, antibiotics are not clinically indicated.

Seeing white stuff on the tonsils is not a reliable clinical sign of Strep. Many things, including viruses, mononucleosis, and even trapped food particles can leave white residue on the tonsils.

The most accurate clinical finding in Strep throat is petechiae – tiny, irregularly-shaped, ruptured blood vessels present on the palate (roof of the mouth) or uvula. The throat is typically beefy-red and the breath can be foul. (Actually, Strep may have a characteristic smell that many seasoned medical providers can detect.) The tonsils and neck lymph nodes are enlarged and tender. Fever is usually present and the onset of the sore throat was relatively rapid. Children with Strep often have vomiting and abdominal pain.

The cure rate for Strep is excellent if you are compliant with your antibiotics. People who stop their antibiotics as soon as they feel better, or share them with other family members are more likely to have relapses or treatment failure. Penicillin (inexpensive and still the drug of choice), amoxicillin, Keflex (cephalexin), erythromycin, Zithromax, and others will quickly cure Strep throat. You are no longer considered contagious 24 hours after starting your antibiotic treatment.

The primary reason antibiotics are prescribed for Strep is to prevent those rare complications, although people on antibiotics do seem to get better sooner.

Technorati Tags: sorethroat, strepthroat, childhoodillness, antibiotics