Strep throat

Overview

Strep throat, an infection caused by group A Streptococcus bacteria, can result in significant inflammation and sore throat (pharyngitis). Strep throat can impact individuals of any age, with children being more susceptible.

If strep throat is left untreated, it can lead to complications like kidney inflammation or rheumatic fever, which may result in painful and inflamed joints, a distinctive rash, or damage to the heart valves.

Seeking prompt medical attention for a proper diagnosis and treatment is essential. With appropriate care, strep throat usually clears up within seven to 10 days.

Symptoms

Strep throat usually starts abruptly with a sore throat and a rapid onset of fever, peaking on the second day. Other common signs and symptoms include:

• Swollen, red tonsils, occasionally with streaks of pus or white patches.
• Tiny red spots on the soft or hard palate
• Difficulty or discomfort when swallowing
• Tender, swollen lymph nodes in the neck
• Body pain
• Rash
• Headache
• Nausea with vomiting
• Decreased appetite
• Stomach pain

In some cases, people may have strep throat without showing any symptoms at all.

Strep throat typically does not cause a cough. If a person has one along with other cold symptoms, it is more likely a viral infection.

Having symptoms like a sore throat does not always mean one have strep throat. It could be from a virus or another illness. In some cases, a person may catch strep from someone who does not show any symptoms themselves.

If an individual, including children, experiences a sore throat accompanied by swollen lymph glands persisting beyond 48 hours, along with symptoms like fever, rash, or difficulty breathing or swallowing, urgent medical attention is warranted. Furthermore, if diagnosed with strep throat, and there’s no improvement within 48 hours of starting antibiotic treatment, seeking medical advice is imperative.

Causes

Strep throat stems from a bacterium known as group A Streptococcus, or Streptococcus pyogenes. This bacterial infection is highly contagious, allowing transmission even when individuals are asymptomatic. However, those displaying symptoms or appearing unwell are more prone to spreading it to others. Transmission occurs through respiratory droplets and direct contact.

Risk factors

The risk factors for strep throat include:

• Age: Strep throat is most frequently seen in children aged 5 to 15, but it can also affect family members, teachers, and caregivers who come into contact with infected children.
• Season: It usually spreads in the winter and early spring, although it can strike at any time of the year.
• Group settings: The risk of strep throat transmission increases with group settings like households, daycares, schools, including colleges, and military barracks.

Diagnosis

The diagnosis of strep throat involves asking about one’s symptoms, conducting a physical exam, and doing several tests. Since viral illnesses can mimic strep throat symptoms, confirming the presence of group A Streptococcus bacteria in the throat is crucial.

Tests that may be ordered include:

• Rapid strep test: This test, which often takes about 20 minutes, can identify strep bacteria. If it is positive for Streptococcus bacteria, a person likely has a strep throat. If negative, further testing with a throat culture might be done to confirm the results. The strep test involves a swab of the back of the throat using a specialized cotton swab.
• Molecular test: A throat swab sample is used for this test. This is also known as a polymerase chain reaction, or PCR.
• Throat culture: This process takes one to two days for results. Throat cultures are more sensitive than rapid strep tests and can detect bacteria that the rapid tests might miss. During a throat culture, the back of the throat and tonsils are swabbed to collect a sample of secretions, which is then cultured in a dish to check for Streptococcus bacteria growth.

Treatment

There are medications used to cure strep throat, alleviate its symptoms, and mitigate the risk of complications and transmission. With appropriate medications, improvement typically begins within a day or two.

Treatment options include:

• Antibiotics: Common antibiotics like penicillin or amoxicillin are usually prescribed for strep throat. If allergic to penicillin, alternatives are available. Antibiotics may be given as a shot or in pill/liquid form, typically taken for 10 days. If taken within 48 hours from the onset of symptoms, it can lessen symptom severity, duration, and complications, and reduce the spread of infection.

Children without fever and feeling better on antibiotics can usually return to school or child care after 24 hours, but it is crucial to complete the entire course of medication to prevent recurrences and severe complications like rheumatic fever or kidney inflammation.

• Symptom relievers: Ibuprofen and acetaminophen are over-the-counter pain relievers that can help soothe a sore throat and lower fever. While it is okay for children over 3 years old, those recovering from chickenpox or flu-like symptoms should never take aspirin as it can cause serious complications like Reye’s syndrome.