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The Sore Throat - when is it Strep?

Kurt M. Bloomhuff, MD, June 27, 2000

The sore throat, or pharyngitis, is a very common patient complaint. In fact, it is the fourth most common symptom seen in medical practice. The biggest concern among patients and physicians alike is whether or not the sore throat is caused by Group A Streptococcus, or the dreaded "Strep throat." The concern regarding Strep throat is not due to the throat itself- infection of the throat with this bacteria poses no long-term health threat. The concern with Strep infection is the potential for developing Acute Rheumatic Fever, abscesses, or kidney problems, and reducing transmission of this bacteria to others. Therefore the challenge for the medical provider is determining whether the sore throat is caused by Streptococcus or not.

Only a minority of patients with sore throat are infected with Group A Streptococcus. Most cases of Strep throat occur in persons 5-15 years of age in the winter and early spring. If you have a sore throat associated with cough, runny nose, congestion, hoarseness, diarrhea, or do not have a fever, it is unlikely that your sore throat is caused by Strep. A rapid Strep test in the doctors office is unlikely to be of any help in this case. Blood tests are also of no value in the diagnosis of Strep throat. In this case, sore throat sprays or lozenges, warm saltwater gargles, Ibuprofen or Tylenol for the pain, along with rest and plenty of fluids are your best treatment options. Antibiotic treatment is not indicated in this situation. In fact, antibiotic therapy is of no proven benefit in any sore throat other than those caused by Streptococcus.

If you have a sore throat (especially sudden onset) with fever, pain upon swallowing, and tender lymph nodes on the front part of the neck, then Strep throat infection is more likely, although not certain. In this case, all of the above interventions (lozenges, gargles, Ibuprofen) will be of benefit, and a call or trip to the physician is probably warranted. The physician will check your temperature, feel for lymph nodes, and look for pus on your tonsils. A rapid office Strep test may be helpful in this circumstance. A positive test with the above symptoms and clinical signs would warrant being treated for Strep infection. A negative test should be sent to the lab for culture results, and if they return (usually within 2 days) positive for infection, should also be treated. Waiting a couple of days for these results will not increase your risk for a more serious infection or organ damage. In fact, studies have shown that treatment of Streptococcal pharyngitis can safely be postponed for up to 9 days after the onset of symptoms and still prevent complications.

The first line treatment for Strep throat is still tried and true Penicillin. This is because of it works, it's safe, and it is inexpensive. This can be given as a one-time injection in the office, or a pill taken four times a day for ten days. Other options for antibiotic treatment are available, and of course, the entire course of medication should always be taken. A routine culture of the throat after treatment is not necessary.

One problem that concerns patients is contact with people who have been diagnosed with Strep throat. Routine testing or treatment for Strep is not necessary for household or other close contacts if they do not have symptoms. If you have been in contact with a person diagnosed with Strep throat and then develop symptoms yourself, a trip to the physician for the evaluation described above is appropriate. The best way to prevent spread of Strep or any infection is frequent hand washing. This means washing your hands before and after meals, when using the bathroom, and with any contact with other people.

Another dilemma is that many people carry the Strep infection in the back of their throats without actually being infected. Such people are termed carriers. If you are a carrier of the Strep infection without symptoms, testing for infection or treatment with antibiotics is not necessary. An exception to this rule is when outbreaks occur in closed groups, such as schools. In these situations, throat cultures should be performed on all individuals, and only those with positive results should be treated.

The sore throat is an annoying and sometimes confusing symptom for patients. By following some of these approved guidelines and recommendations, patients can have a better understanding of the symptoms, causes, and treatment of the sore throat. Both patients and physicians can identify Strep throat, thereby appropriately treating those with Strep throat infections. We can also avoid unnecessary overuse of antibiotics, which can be costly, cause adverse reactions, and promote the development of dangerous resistant organisms.