Strep Throat

      Now that school is in session again, parents will find themselves dealing with strep throat.

     Strep throat is an infection with Group A streptococcus that occurs commonly in children from about a year of age (if in daycare) to fifteen years. However, strep is not the most common cause for a throat infection. The most common cause for sore throat is a viral infection (see “Sore Throat” Oct 2012). Viral sore throat often comes along with runny nose, cough or other viral symptoms. As with any other viral infection, it needs no treatment.

       Strep throat brings sore throat and fever for up to three days without other cold symptoms. There are many misconceptions about strep throat. It is often said that strep throat causes white areas or “spots” on the tonsils.  This isn’t true. Strep infection often causes bright red spots on the back of the throat and the roof of the mouth. When there is a lot of white material on the tonsils, the cause is usually mononucleosis – another viral infection.  Another misconception about strep is that you won’t get over a strep throat without antibiotic treatment. While it is true that a strep infection can cause more serious infections in the throat and neck that do need antibiotic therapy, most cases of strep throat are self-limiting (your body’s immune system fights off the strep by itself). People with strep throat usually start to feel better in about three days – with or without antibiotics. The problem with a Group A streptococcal infection is that the same immune response that destroys the streptococcus in the throat can turn around and attack the valves in the child’s heart. This is called rheumatic fever. By treating every strep throat, doctors believe that they are preventing the immune response from getting started and, therefore, preventing rheumatic fever.  This is why your doctor treats you with antibiotics if a throat culture turns positive on the third day of the illness, even if you are feeling better. The doctor doesn’t give you the antibiotics to make you feel better, he gives you the antibiotics to prevent rheumatic fever.

     To make the diagnosis of strep throat in children, a rapid strep test is done at the time the child is in the clinic. That test can often tell whether the child has a strep throat within minutes. If the rapid test is negative, a throat culture for strep is taken and the results are known sometime within three days (throat cultures are not usually done on adults). During that time, the child doesn’t need antibiotics, but, as with ANY sore throat, the child shouldn’t share food or drink or have any oral contact with anyone else in order not to spread whatever infection they have. As mentioned earlier, if the throat culture becomes positive within three days, the child is treated with antibiotics, even if they no longer have symptoms.

     If strep throat has been treated with antibiotics, the fever and the pain should improve within 48 hours. If the fever and pain do not resolve, the infection may be more serious. If there is swelling on one side of the back of the throat but not on the other, especially if it moves the uvula (the “hangy-down thing” in the back of the throat) over to one side, the infection is worrisome. If, along with the pain in the back of the throat, there is pain or swelling in the neck, the child needs to be examined. Finally, if the sore throat causes child to have difficulty talking, swallowing or breathing, the child needs to be seen immediately.