Strep throat is a common infection in the young school-aged child.  It is caused by a bacteria called Streptococcus Pyogenes (in the Group A streptococcus family).  This bacteria is highly contagious through airborne droplets, contaminated surfaces (such as a doorknob, countertop or toothbrush) and shared foods.  Strep throat  is rare under 2 years of age, is common in childhood (especially between 5 and 15 years), and can occur into adulthood.  Some people have the strep germs in their throat without any symptoms.  This person is called a carrier because he can carry the germ to someone else and cause disease in that person.

Symptoms may include (not all must be present):

• Sore throat
• Trouble swallowing
• Red tonsils (with or without white patches)
• Red spots on the roof of the mouth
• Swollen lymph nodes (glands) under the jaw
• Headache
• Fever
• Nausea, vomiting or stomachache
• Rash that can feel like sandpaper on the trunk (scarlet fever)

Many viruses have similar symptoms, and a test to verify the bacteria must be done to diagnose strep throat.  This test includes swabbing the throat and either doing a rapid strep test or a strep culture.  Studies have shown that physicians (pediatricians, family practitioners and ENTs – specialists in ears, nose and throat) are only correct 50% of the time when examining a patient to decide if they have strep or not.  A test must be done to tell the difference.

Complications: 

In addition to strep throat, the streptococcus can lead to many complications if not treated.  These include abscesses of the throat, sinus infections, ear infections, poststreptococcal glomerulonephritis (a kidney problem causing blood in the urine), rheumatic fever (damaging the heart valves, joints, skin, and muscles), and poststreptococcal arthritis. 

Testing and treatment: 

Until your child can be tested to see if it is actually the strep bacteria causing the symptoms, use symptomatic care.  Testing can be done any time after symptoms begin, but ideally are done after a minimum 24 hours of symptoms to improve the accuracy of the rapid strep test.  A back up culture can be done if the rapid test is negative, but will take 2-3 days to get results.  For this reason, we do not recommend going to an urgent care center for possible strep throat.  Waiting until normal office hours is acceptable.

Do not start left over antibiotics without first doing a test for strep, because the test is worthless after antibiotics are started.

Symptomatic treatment:

• Pain relievers such as acetaminophen or ibuprofen are recommended to be used as needed for comfort.
• Cold liquids are soothing to the throat.
• When the air is dry, adding a humidifier or vaporizer to the bedroom is soothing.

Antibiotics are recommended for everyone with a positive strep throat test.  Although most often strep symptoms resolve within 3-5 days if untreated,  antibiotics should be used to prevent some of the above mentioned complications.  Finish the entire course of antibiotic, even if symptoms go away before the antibiotic is gone.

How do we prevent spread of strep throat?

People are considered contagious until they’ve been on antibiotics for 24 hours, so should not return to work or school until they’ve been on antibiotics and are fever free for 24 hours.

After  24-72 hours on antibiotics it is recommended to change the toothbrush to avoid re-infecting the same person when antibiotics stop.

These germs live on surfaces for several days, so wash surfaces commonly touched (phones, keyboards, door knobs).

Do not share face towels.

Keep all toothbrushes at least 1 inch apart at all times, since most infections are spread before symptoms develop.

When is tonsillectomy needed?

Surgery to remove the tonsils is commonly considered if children get seven or more cases of strep throat in 1 year (some also say three cases in three months).  It is also recommended if there are complications of tonsillitis, such as sleep apnea (symptoms include snoring with pauses and grinding the teeth), choking on food, tonsillar abscess, or limitations to quality of life from recurrent infections.  Removing the tonsils has been shown to decrease the number of times one gets strep throat for the next 2 years, but since strep is less common as children get older, it is not always needed.  Discuss tonsil removal with your child’s physician if you are interested in this option.