Strep throat

Answer 1

Definition

Strep throat is caused by Group A Streptococcusbacteria. It is the most common bacterial infection of the throat.

Alternative Names

Pharyngitis - streptococcal; Streptococcal pharyngitis

Causes, incidence, and risk factors

Strep throat is most common in children between the ages of 5 and 15, although it can happen in younger children and adults. Children younger than 3 can get strep infections, but these usually don't affect the throat.

Strep throat is most common in the late fall, winter, and early spring. The infection is spread by person-to-person contact with nasal secretions or saliva, often among family or household members.

There are many strains of strep. Some strains can lead to a scarlet fever rash. This rash is thought to be an allergic reaction to toxins made by the strep germ. On rare occasions, strep throat can lead to rheumatic fever if it is not treated. Strep throat may also cause a rare kidney complication.

Symptoms

Strep throat may be very mild, with only a few symptoms, or it may be severe. Often, persons with strep throat get sick 2 to 5 days after they are exposed to the bacteria that causes the illness.

Symptoms usually begin suddenly, and can include:

• Fever that begins suddenly and is often highest on the second day
• Red throat, sometimes with white patches
• Sore throat
• Headache
• Stomach ache
• Nausea
• Chills
• General discomfort, uneasiness or ill feeling
• Loss of appetite and abnormal taste
• Tender, swollen lymph nodes in the neck
• Difficulty swallowing

Some strains of strep throat can lead to a scarlet fever-like rash. This rash is thought to be an allergic reaction to toxins made by the strep bacteria.

Signs and tests

A rapid test can be done in most health care provider offices, but misses a few of the cases. A throat swab can be tested (cultured) to see if strep grows from it. However, it will take one to two days for results to come back.

If the rapid test is negative, it may be followed by a culture, to find all the cases that might have been missed. This is more likely to be needed in children.

Treatment

Be aware that most sore throats are caused by viruses, not strep. Sore throats should only be treated with antibiotics if the strep test is positive. Strep cannot be accurately diagnosed by symptoms or a physical exam alone.

Even though strep throat usually gets better on its own, antibiotics are taken to prevent rare but more serious complications, such as rheumatic fever.

• Penicillin or amoxicillin has been traditionally recommended and is still very effective. There has been resistance reported to azithromycin and related antibiotics.
• Antibiotics should be taken for the full 10 days, even though symptoms are usually gone after few days.

Most sore throats are soon over. In the meantime, the following remedies may help:

• Drink warm liquids. Honey or lemon tea is a time-tested remedy.
• Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
• Drink cold liquids or suck on popsicles to soothe the sore throat.
• Suck on hard candies or throat lozenges. This is often as effective as more expensive remedies, but should not be used in young children because of the choking risk.
• Use a cool-mist vaporizer or humidifier to moisten and soothe a dry and painful throat.
• Try over-the-counter pain medications, such as acetaminophen. Do NOT give aspirin to children.

Expectations (prognosis)

The probable outcome is good. Nearly all symptoms resolve in one week. Treatment prevents serious complications associated with streptococcal infections.

Complications

On rare occasions, strep throat can lead to rheumatic fever if it is not treated. Strep throat may also cause a rare kidney complication called post-streptococcal glomerulonephritis.

• Ear infection
• Sinusitis
• Mastoiditis
• Peritonsillar abscess
• Rheumatic fever
• Glomerulonephritis
• Scarlet fever

Calling your health care provider

Call if you develop the symptoms of strep throat, whether or not you think you were exposed to someone with strep throat. Also, call if you are being treated for strep throat and are not feeling better within 24 - 48 hours.

Prevention

Most people with strep are contagious until they have been on antibiotics 24 - 48 hours. Thus, they should stay home from school, daycare, or work until they have been on antibiotics for at least a day.

Get a new toothbrush after you are no longer contagious, but before finishing the antibiotics. Otherwise the bacteria can live in the toothbrush and re-infect you when the antibiotics are done. Also, keep your family's toothbrushes and utensils separate, unless they have been washed.

If repeated cases of strep still occur in a family, you might check to see if someone is a strep carrier. Carriers have strep in their throats, but the bacteria do not make them sick. Sometimes, treating them can prevent others from getting strep throat.

References

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.

Alcaide ML, Bisno AL. Pharyngitis and epiglottitis. Infect Dis Clin North Am. 2007;21:449-469.

Del Mar C, Glasziou PP, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD000023.

Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD004872.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.

Answer 2

Definition

Strep throat is caused by Group A Streptococcusbacteria. It is the most common bacterial infection of the throat.

Alternative Names

Pharyngitis - streptococcal; Streptococcal pharyngitis

Causes, incidence, and risk factors

Strep throat is most common in children between age 5 and 15, although anyone can get it.

Strep throat is spread by person-to-person contact with nasal secretions or saliva. It commonly spreads among family or household members.

Symptoms

Symptoms may be mild or severe. You usually start to feel sick about 2 to 5 days after you come in contact with the bacteria.

Symptoms usually begin suddenly, and can include:

• Fever that begins suddenly and is often highest on the second day
• Red throat, sometimes with white patches
• Sore throat
• Headache
• Nausea
• Chills
• General ill feeling
• Loss of appetite and abnormal taste
• Swollen lymph nodes in the neck
• Difficulty swallowing

Some strains of strep throat can lead to a scarlet fever-like rash. This rash is thought to be an allergic reaction to toxins made by the strep bacteria.

Signs and tests

A rapid test can be done in most health care provider offices, but misses a few of the cases.

If the rapid strep test is negative and your health care provider still thinks you or your child may have strep, a throat swab can be tested (cultured) to see if strep grows from it. However, it will take one to two days for results to come back.

Treatment

Most sore throats are caused by viruses, not strep-related bacteria. Strep cannot be accurately diagnosed by symptoms or a physical exam alone. Many of the other causes of sore throats may have the same symptoms.

Sore throats should only be treated with antibiotics if the strep test is positive. Antibiotics are taken to prevent rare but more serious health problems, such as rheumatic fever.

Penicillin or amoxicillin is usually first tried. Antibiotics should be taken for 10 days, even though symptoms are usually gone after few days.

The following tips may help your sore throat feel better:

• Drink warm liquids such as lemon tea or tea with honey.
• Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
• Drink cold liquids or suck on popsicles.
• Suck on hard candies or throat lozenges. Young children should not be given such products because they can choke on them.
• A cool-mist vaporizer or humidifier can moisten and soothe a dry and painful throat.
• Try over-the-counter pain medications, such as acetaminophen.

Expectations (prognosis)

Symptoms of strep throat usually get better in about 1 week. Untreated, strep can lead to serious complications.

Complications

On rare occasions, strep throat can lead to rheumatic fever if it is not treated. Strep throat may also cause a rare kidney complication called post-streptococcal glomerulonephritis.

• Ear infection
• Sinusitis
• Mastoiditis
• Peritonsillar abscess
• Rheumatic fever
• Glomerulonephritis
• Scarlet fever
• Guttate psoriasis

Calling your health care provider

Call if you develop the symptoms of strep throat. Also, call if you are being treated for strep throat and are not feeling better within 24 - 48 hours.

Prevention

Most people with strep are contagious until they have been on antibiotics 24 - 48 hours. They should stay home from school, daycare, or work until they have been on antibiotics for at least a day.

Get a new toothbrush after you are no longer contagious, but before finishing the antibiotics. Otherwise the bacteria can live in the toothbrush and re-infect you when the antibiotics are done. Also, keep your family's toothbrushes and utensils separate, unless they have been washed.

If repeated cases of strep still occur in a family, you might check to see if someone is a strep carrier. Carriers have strep in their throats, but the bacteria do not make them sick. Sometimes, treating them can prevent others from getting strep throat.

References

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.

Chan TV. The Patient with Sore Throat. Med Clin North Am. 2010 Sep;94(5):923-43.

Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis andstreptococcal carriage in children: a meta-analysis. Pediatrics. 2010 Sep;126(3):e557-64.

Del Mar C, Glasziou PP, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD000023.

Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD004872.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.

Reviewed By

Review Date: 08/31/2011

A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine (2/12/2011).

Answer 3

Sometimes when you have a sore throat, it's more than just a normal cold, especially if your throat feels raw or like it's on fire.

Most people get sore throats from a viral infection, in other words, the common cold. But, occasionally, you might come down with strep throat, which is caused by a type of bacteria called Streptococcus pyogenes. These bacteria are contagious. Like with germs that cause a cold, you can also get strep throat from handling a doorknob or other surface, then touching your nose or mouth.

How do you know for sure that you have strep throat?

You may start to feel sick a few days after you come into contact with the bacteria that causes strep throat, but usually people will start feeling sick suddenly. You will probably have a fever very quickly, and your throat will be very sore. If you look in a mirror, the back of your throat may be very red, and you might see white patches on your tonsils. You may also have a headache, be sick to your stomach, and feel chills.

Your doctor will check your throat for redness, swelling, and white patches, then rub a sterile swab over your tonsils, taking a sample of mucous. A rapid antigen test done at your doctor's office can find bacteria from the swab in minutes, so you can find out if strep throat is causing your symptoms. Your doctor will probably send the swab to a laboratory to double check your diagnosis, but this test may take a day or two.

There's another common type of bacteria that can cause throat infections, especially in young adults: The bacteria's name is Fusobacterium necrophorum. I call it F-throat. Antibiotics are important for F-throat. It doesn't show up on strep tests, so it's important to keep in mind with severe sore throats or sore throats that aren't getting better as expected.

Since strep does NOT cause most sore throats, your doctor will make sure you have it before treating you for it. If you do, your doctor will most likely ask you to take penicillin or amoxicillin for 10 days, even though you might feel much better after a few days. The reason is because strep throat can sometimes lead to more serious health problems, such as rheumatic fever. Be sure to tell your doctor if you're allergic to some antibiotics, so you can receive a different medication.

While you wait for the antibiotics to start fighting the infection, you can follow these tips to help your throat feel better:

Drink warm liquids like tea with honey; Gargle several times a day with a teaspoon of salt in a cup of warm water; Drink cold liquids, or suck on popsicles, hard candies, or throat lozenges; Keep a vaporizer or humidifier running in your room to soothe the dryness in your throat AND Take over-the-counter pain medicines

It's important to see your doctor if you think you have strep throat, because, untreated, it can lead to very serious health problems. Once you start treatment, your symptoms will probably be gone in about a week. But if you don't start feeling in a day or two, make sure you call your doctor.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.