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

STREP MUST BE DIAGNOSED WITH LAB TESTS, TREATED WITH ANTIBIOTICS

Question: I was diagnosed with a strep throat last week. I didn’t think I could get this as I am 52 years old and had my tonsils out when I was a kid. Can I give this to my grandchildren? Is my doctor right, do I really have strep? My wife says I should get a new toothbrush. Is she right?

Answer: While streptococcal pharyngitis -- strep throat -- is fairly common in children, it can occur at any age. Also, you do not need tonsils to get this bacterial infection in your throat. Strep throat is common in the late fall and has its peak incidence in the winter. This infection is spread by direct person-to-person contact via nasal secretions and saliva. In crowded settings, like many schools, it spreads more easily. Other crowded settings are shopping malls, grocery stores and movie theaters. Yes, you could give it to your grandchildren.

The incubation period for this infection is relatively short at two to five days after exposure. Frequently, sufferers experience a sudden onset with sore throat, fever, headache, nausea or stomachache. The person may also have trouble swallowing and have tender, swollen lymph glands on the side of the neck. Sometimes, though, the only symptoms are a relatively mild sore throat and a slightly “out of sorts” feeling.

The most accurate way to diagnose strep throat is to do a throat culture and wait a few days for the results. Most doctors’ offices, urgent care facilities and hospital emergency departments also have the newer rapid strep tests. These take about 10 minutes to run. If the results are positive, the doctor can be quite confident in the diagnosis of strep. However, if the rapid test comes back negative, the doctor’s interpretation must be more guarded. A negative result means the patient probably doesn’t have strep, though a false negative result is possible since the rapid test can miss about 20 percent of cases where strep is actually present. That is why a negative rapid test is usually followed with a throat culture that is sent to a laboratory.

Since your diagnosis was strep throat, I’m sure your doctor prescribed antibiotics. One of the reasons that it’s so important to treat strep with antibiotics is to prevent serious complications. Rheumatic fever, for example, sometimes develops within weeks of a strep throat and can cause permanent damage to the heart. Other complications of untreated strep can include pneumonia, tonsil infection, meningitis, middle ear infection, kidney damage and scarlet fever.

As with any antibiotic, make sure you take all of the medication that’s prescribed. Also, limit your close contacts with others for a few days after starting treatment. Good hand washing is always helpful.

It’s important that everyone keep a couple of things in mind. No one can diagnose this infection by physical exam. A mildly inflamed throat can be strep and a severely inflamed throat may not be strep. The tests I mentioned are necessary for a diagnosis. Most sore throats are caused by viruses and these do not need antibiotics. Viral sore throats can sometimes take a bit longer to get better than strep after treatment.

As for the toothbrush, your wife has a point -- it can harbor bacteria. Get a new toothbrush a few days after starting your antibiotic but before the medicine is completed. Also, drink plenty of fluids, gargle with warm salt water and use over-the-counter medications for temperature and body aches.

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 via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.