By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

A TEST, NOT SEVERITY, IS KEY TO DIAGNOSING STREP THROAT

Question: My child has strep throat. Many of the kids in her school have it too. This seems to happen every year at this time. Is there a strep season? How can I keep her from getting this every winter? Should I worry about strep throat?

Answer: Winter is the peak of the “strep season,” which lasts from late fall to early spring. But, strep throat is not limited to these months, and you can, indeed, come down with it at any time of the year.

This illness -- known as “Group A Streptococcal pharyngitis” in doctor jargon -- is most commonly seen in elementary school-aged children, but people of any age are susceptible. It is spread by direct person-to-person contact via nasal secretions and saliva. In crowded settings, like schools, it spreads more easily. Other crowded settings are shopping malls, grocery stores and movie theaters. Generally, there is an incubation period of two to five days after exposure.

Strep throat is an infection caused by bacteria -- specifically Group A beta-hemolytic Streptococcus pyogenes. Other kinds of sore throat -- or pharyngitis -- can be caused by many different bacteria and viruses. Because strep can have much more serious, long-term health consequences than these other types of sore throat, your doctor will want to identify the cause of any sore throat that lasts for more than a day or two.

Some complications of strep throat can be pneumonia, tonsil infection (peritonsillar abscess), meningitis and middle ear infection (otitis media). Rheumatic fever sometimes develops within weeks of a strep throat and can cause permanent damage to the heart. Another complication of strep -- acute post streptococcal glomerular nephritis -- can cause kidney damage.

That was the bad news. The good news is that strep is usually very responsive to antibiotics, and a complete cure can be expected if antibiotics are started in the first nine days of infection.

Symptoms of strep are similar to those of other types of sore throat and include difficulty and pain with swallowing, fever, malaise, headaches and sometimes nausea and vomiting. Strep is frequently associated with pus on the tonsils, tender swollen glands in the front of the neck and fever but not cough.

Contrary to what many people think, a strep throat is not necessarily more severe than a “regular” sore throat. It can, in fact, be relatively mild. That’s why your doctor may do a throat swab in conjunction with the Rapid Strep Antigen Test to quickly identify the presence of strep bacteria. Sometimes a more reliable but slower traditional culture may be used, or your doctor may choose to treat your child with antibiotics based on his or her physical exam.

Strep or not, treating the pain consists of topical anesthetic throat spray and lozenges available over the counter. Smooth wet foods, like Jell-O and popsicles can be helpful. Warm salt water gargles, while resisted by most children, can ease sore throat pain. Tylenol or Ibuprofen may also be given for pain as well as fever. If your child’s throat pain is severe, your physician may prescribe stronger pain medications. If antibiotics are prescribed, make sure the entire prescription is taken as directed. That is the only way to eradicated a strep infection.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Or, e-mail Dr. Simpson at simpsonm@ohio.edu. Past columns are available online at http://www.FamilyMedicineNews.org.