FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[DAUGHTER'S SORE THROAT A "DOUBLE WHAMMY"!]

Question: My teenage daughter recently had a sore throat. I took her to the doctor, who diagnosed her condition as tonsillitis due to both strep and mono. Is it common to have both illnesses at once?

Answer: Every time a survey is conducted to find out why people go to the doctor, sore throat is usually ranked somewhere in the top five. Most often this sore throat symptom is caused by just one medical condition. However, your daughter's experience of having the "double whammy" of simultaneous infections from several causes isn't all that rare.

What is commonly called strep throat is actually an infection with what doctors call "group A beta-hemolytic streptococci" bacteria. This lengthy descriptive name is important because there are several other types of streptococci bacteria that cause other forms of human illness. The reason for concern about infection from the group A beta-hemolytic version is not just the sore throat it causes. Without antibiotic treatment, there is a significant risk for developing rheumatic fever, which can sometimes lead to rheumatic heart disease.

Strep throat can also be complicated by tonsil involvement, as happened to your daughter. In these cases, formation of an infected abscess in the tonsils may require surgical drainage and removal of the tonsils (tonsillectomy). This same type of infection can sometimes occur in the lymph glands of the neck. Antibiotics reduce the risk of these complications, too. Unfortunately, they're not as good at reducing the risk of a type of serious kidney damage called "post-streptococcal glomerulonephritis."

The other illness your daughter had - mono - is also called infections mononucleosis. This viral illness causes symptoms very similar to strep throat: a very sore throat, enlarged tonsils that often ooze a white-colored substance, swollen and tender lymph nodes in the neck, fever and tiredness. Because the two conditions often strike the same individual, a throat culture and blood tests are typically done to correctly identify the cause or causes of the illness.

Mononucleosis, like other viral illnesses, is not helped by antibiotics. The most commonly prescribed treatment is time. It takes time for the body's own defense system to overcome the infection. Only in rare cases when complications arise are any medicines of benefit.

Conversely, strep throat should always be treated with antibiotics. They can shorten the course of illness when started within the first two or three days, and that is a good reason for taking them. However, they are actually prescribed to reduce the risk of developing the complications I mentioned earlier.

On a related note, I want to remind you that 90 percent of sore throats are caused by viral illnesses, not bacterial ones, including strep. Therefore, there is no reason to take an antibiotic. Don't be upset with your doctor if he or she doesn't prescribe one for your next sore throat.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.