Strep Throat

What is strep throat?  Strep throat is a very common throat infection in children and adults.  It is caused by a bacteria called Group A Streptococcus.  Unfortunately, strep throat is present year-round and is spread easily and quickly through schools and day care.  It occurs most commonly in kids over 3 years of age but is also common in adolescence. Strep throat is spread through saliva and nasal secretions.  Children commonly pass it to each other through sharing drinks or utensils and sneezing or coughing close to others.   

Signs and Symptoms  Strep throat routinely causes a sore throat which causes discomfort when swallowing along with decreased appetite.  You may also see enlarged tonsils and redness to the back of the throat. Additionally, some children can have exudate on their tonsils which looks like a white coating or white patches.  Other common symptoms are fever, enlarged and tender lymph nodes in the neck, headache, and stomach ache.  Typically, runny nose, nasal congestion, and cough are not part of the strep throat infection but can sometimes be present if there is a concurrent viral upper respiratory infection.  A rash on the trunk of the child can occasionally accompany strep throat as well. 

How is the diagnosis made?  We can easily diagnose strep throat in our office.  We suspect strep throat due the child’s symptoms and the way his/her throat looks on examination, and we diagnose it using a test called a rapid strep test.  This test is performed by rubbing a long q-tip back and forth along the back of the throat and tonsils. Obtaining fluid from the throat allows us to determine if Group A Streptococcus is present.  When a rapid strep test is positive, the child has strep throat. When a rapid strep test is negative, we double check that Group A Streptococcus is not present by performing a culture in our lab.  This culture is read 24 hours after the rapid strep test.  If the throat culture remains negative, then the patient does not have strep throat and the sore throat is likely caused by a virus.

Treatment  After a positive result is found on the rapid strep test or throat culture, it is important to take an oral antibiotic.  The most common antibiotic given for strep throat is Penicillin or Amoxicillin.  When a child has an allergy to one of these medications, different antibiotics are chosen.  We always prescribe antibiotics for strep throat, not only so that the child will feel better, but also to help prevent potential complications.  Strep throat that is not treated with the full 10-day antibiotic course has a chance of causing rheumatic fever, a disease that can affect the heart, joints, skin, and brain. When the 10-day antibiotic course is taken, children typically heal completely, and feel better as soon as 24 hours after starting antibiotics.

Care and Prevention  It is important to complete the full 10 days of antibiotics, even if all symptoms go away before that time.  Taking Ibuprofen (Motrin or Advil) is often very helpful for sore throat, fever, and headache.  It is common to have a decreased appetite due to sore throat, nausea, and stomach ache; this is okay if the child is continuing to drink clear liquids and is not dehydrated. To protect others in the household, make sure there is no sharing of food, drinks or utensils.  Unlike influenza, preventative medication (antibiotics) for close contacts are not recommended. If a close contact begins with signs and symptoms of strep throat, he/she should be evaluated before medication is prescribed.  Make sure that tissues used to blow the nose are thrown directly into the trash and not left on a counter where germs can be picked up by others.  Encourage your child to cover his/her mouth with coughing or sneezing.  Lastly, after the child has been fever free for 24 hours and on antibiotics for 24 hours, replace your child’s toothbrush with a new one.  Your child can return to school when he/she has been fever free for 24 hours and on antibiotics for 24 hours.