Strep throat is an inflammation and infection of the throat that is also termed pharyngitis. Bacteria called Group A Streptococci cause strep throat. There are over one hundred distinct types of Group A streptococci and certain of the types are associated with rheumatic fever, which is a rare complication of untreated strep throat. Viruses cause most cases of pharyngitis, but the symptoms and signs of strep throat may be similar to sore throats caused by viral agents.
More cases of strep throat occur in the cooler months, and this is probably related to more person-to-person contact since it is spread from one person to another by droplets. Acquisition of strep is also thought to be related to crowding which can occur in schools, homes or other institutions.
Beside rheumatic fever, untreated strep throat can lead to other complications including abscesses in or around the tonsils and infection of the lymph nodes in the neck. Early diagnosis and treatment will usually prevent complications from strep throat.
Who is likely to develop strep throat?
Strep throat is most commonly seen in children and adolescents between age five and fifteen years. Geographically speaking, strep throat is a ubiquitous problem. Individuals with strep throat are likely to spread the illness during the first three to five days of the illness, and if untreated the risk of spread decreases over weeks. For those individuals treated with appropriate antibiotics, they are no longer contagious within twenty-four hours after initiation of antibiotic therapy.
Infection with strep throat does not confer long-term immunity on the adolescent so he or she could develop more streptococcal infections at a later time. Kissing dogs or letting dogs lick you will not spread strep throat although a teen who kisses a person with strep throat may acquire the illness.
What are symptoms of strep throat?
Within two to five days after contact with an individual with strep throat a teen may develop symptoms of the illness. Most adolescents who develop strep throat complain of a sore throat. The amount of pain is variable and it could range from slight to severe in intensity. Usually the adolescent will develop swollen and tender lymph nodes in the front of his or her neck. There may be a low or moderate fever, malaise and headache. Some teens also have bad breath, chills, muscle aches and pains and nausea. If one looks into his or her throat using a mirror one may see a red throat, small red spots on the roof of your mouth and some whitish material on the tonsils.
Some types of Group A Strep bacteria can elaborate a toxin. This toxin will produce a red, fine bumpy rash, which may have the texture of gooseflesh or coarse sandpaper. It may first appear in the groin or armpits but within twenty-four hours the rash will spread throughout the skin. This complication of strep throat is called scarlet fever since the patient will have a bright red rash and associated fever.
How is strep throat evaluated?
A clinician will examine the teen with sore throat evaluating for the presence of symptoms and signs of strep throat. Since it may be difficult for the clinician to differentiate between a sore throat caused by strep from one caused by a virus, then laboratory tests may be ordered to help in the diagnosis. A swab may be used to obtain material from the throat for a rapid strep test and throat culture.
Rapid strep tests to diagnosis strep throat are reliable when properly performed. Within ten minutes, the clinician is able to determine if the teen’s sore throat is due to strep. A positive rapid strep test is highly predictive of strep throat, and many clinicians will initiate antibiotic therapy after these results are available. While a negative rapid strep test is reassuring that the individual does not have strep throat, most clinicians will send a throat culture to confirm a negative result from the rapid strep test.
Throat cultures are usually checked at twenty-four hours and forty-eight hours after they are obtained. A negative throat culture at forty-eight hours is good evidence that the adolescent does not have strep throat.
How is strep throat treated?
Strep throat is treated primarily with antibiotics. The drug of choice is penicillin unless the teen is penicillin allergic. In that case, a number of alternative antibiotics are available. Amoxicillin, a derivative of penicillin, may be used, although it has no particular advantage over penicillin.
Rheumatic fever, which is a complication of untreated strep throat, can be prevented if treatment for strep throat is begun within the first nine days after onset of the symptoms. Within twenty-four hours of treatment initiation for strep throat, the fever should be reduced and throat discomfort should be lessened. Treatment shortens the length of the illness, decreases the period of communicability to other individuals and prevents other complications. It is important that the teen take the entire ten-day course of medication even if he or she feels better very quickly. Some clinicians may prescribe an injection of penicillin instead of orally administered medication.
Most teens may prefer bed rest during the first day or so of the illness. Acetaminophen or ibuprofen will help relieve the discomfort from the sore throat and gargling with warm lightly salted water helps to stimulate circulation to the inflamed area and remove patches of material. Cool and bland foods are better than hot spicy food. Chicken soup is well tolerated and will help stimulate circulation to the infected area. If all symptoms are relieved during treatment, then it is not necessary for the teen to have another throat culture to see if he or she is cured.
How is strep throat prevented?
There is no vaccine available to prevent strep throat. To prevent a strep throat from being spread to others, teens should avoid contact with people until they have been taking the antibiotic for at least twenty-four hours. It is also advisable to use tissues when adolescents cough or sneeze.
Adolescents can help to avoid strep throat by washing their hands before touching food, dishes, glasses and silverware. Teens should also try not to let their nose or mouth touch public telephones or drinking fountains. And also teens are advised not to share glasses, drinks, food or eating utensils with others. Finally one should avoid kissing anyone who is sick with sore throat or an unexplained fever.
Some teens have recurrent strep throat despite adequate treatment and preventive measures. In certain selected cases, tonsillectomy may help to prevent recurrent strep throat. In these situations a teen may wish to consult his or her primary care physician and a specialist in ears, nose and throat diseases.
Related topics:
Bad breath, kissing, rheumatic fever
