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    Straight Talk About Strep Throat

    Katy Ekstrom, MD Deaconess Clinic Henderson - Internal Medicine & Pediatrics 10/09/2019
    Strep throat is one of the most common reasons I see children in my office, especially during winter and through early spring. In most cases, it’s easily diagnosed and resolved with antibiotics, but sometimes strep throat can be serious--and confusing.

    To help you understand more about the condition, I’m going to answer some of the most common questions I get from patients and parents.
      
    What is strep throat, and what causes it?

     
    We see many patients who complain of a sore throat—there are an estimated 15 million doctor visits per year in the US just for this problem! Most of the time, sore throats are caused by viruses; however, they can also be caused by bacteria.
     
    Strep throat is one of those bacterial infections; in this case, the infection caused by the bacteria Group A Streptococcus that causes swelling and pain in the throat.
     
    Between 5-15% of sore throat visits in adults, and 20-30% in children, end up being diagnosed as strep.
     
    Who is most at risk?
     
    Strep throat is most common in children between the ages of 5 and 15 years old, and is more common during winter and early spring.
     
    Adults can be affected, especially parents of school-age children and people who work around children.
     
    Children under the age of 3 are less likely to get strep throat, unless they have school-aged siblings or attend daycare.
     
    If a person in your house has strep throat, there is about a 1-in-4 chance that you will get it, too.
     
    Strep throat signs & symptoms, and when to see a doctor
     
    In people over the age of 3, strep usually causes a sudden onset of sore throat, painful swallowing and fever. Children often get headache, abdominal pain, nausea and vomiting as well.
     
    The tonsils and throat usually appear red, sometimes with white patches of pus, small red spots on the roof of the mouth, and swollen glands in the neck. The uvula (the dangly piece of tissue you see in the back of your mouth) can also be red and swollen.
     
    Strep can also cause a rash—usually a reddish rash with many tiny bumps that make it feel like sandpaper.
     
    Strep does NOT typically cause ulcers in the throat, runny nose, cough, hoarseness, or pinkeye—these symptoms are usually due to a viral infection.
     
    Children under the age of 3 with strep tend to present a little differently—they will often have fever, runny nose, congestion, and enlarged lymph nodes, rather than the throat symptoms that are seen in older children and adults.
      
    Diagnosing and treating strep
     
    If you have symptoms of strep throat, you should see your primary care provider or other immediate care provider and be tested. Testing for strep is very important because your provider cannot tell for sure if you have strep throat just by looking at your throat. He or she will need to take a sample from your tonsils and throat with a swab to determine if your symptoms are due to strep or something else.
     
    In most cases, the provider will do a rapid strep test on the sample from your tonsils and throat.
     
    A rapid strep test identifies bacterial infection within a few minutes and is the test most often used in a doctor’s office. The rapid test is very reliable when it comes back positive, but it only catches about 70-80% of strep throat cases, so some people with a negative rapid strep test result are “falsely negative” – meaning they actually do have strep.
     
    To account for “false negatives,” part of the sample from your tonsils and throat is sent to the lab for a second test called a culture. Results from this test take a couple of days, but are more accurate than the rapid test (catching about 95% of strep throat cases).
     
    If you do have a positive diagnosis of strep throat, you will receive a prescription for an antibiotic (usually a penicillin type of medication). Within a day or two of starting antibiotics, most patients feel better. However, patients with strep throat shouldn't return to school or work until any fever has gone away and until antibiotics have been taken for at least 24 hours.
     
    It’s important to remember that the majority of sore throats and throat infections are not caused by strep, but instead are due to viruses. We don’t treat viruses with antibiotics.

    Complications of strep
     
    Interestingly, strep throat will usually improve on its own within 3-5 days even without treatment. However, it is extremely important to treat strep throat with an antibiotic because dangerous complications can occur if an antibiotic is not given.

    These complications can include:
    • Ear infections and sinus infections are common complications of strep throat.
    • Sometimes cellulitis or an abscess of the tonsils/throat can develop.
    • Acute rheumatic fever is an autoimmune disease that can occur if strep throat is not treated with an antibiotic. It usually presents 2-3 weeks after an untreated strep throat infection, and can cause a rash, arthritis, nodules under the skin, heart problems, and involuntary movements. 
      • Over half of all people with rheumatic fever will end up developing problems with their heart valves, often requiring heart surgery. That’s why acute rheumatic fever is one of the most worrisome complications of strep throat.
    • Post-streptococcal reactive arthritis is an arthritis involving one or more joints that can happen within a month following an episode of strep throat.
    • Streptococcal toxic shock syndrome is a rare complication of strep throat. It involves a severe strep infection that leads to shock and organ failure. 
    • Post-streptococcal glomerulonephritis is a kidney problem that can happen after a strep infection and seems to be more common in children under age 7. The presentation varies—sometimes it causes microscopic blood in the urine and no symptoms, and other times it causes red to brown urine, swelling, high blood pressure, and even kidney failure.
    • PANDAS syndrome is an autoimmune, neuropsychiatric disorder associated with strep throat which seems to cause obsessive compulsive disorder or tic disorder symptoms. The National Institute of Mental Health has more information about PANDAS.  
     
    What to do for repeated cases of strep
     
    It can be difficult to tell if someone is having repeated strep infections, or if they are “carriers” of strep. Some people will test positive for strep even when they are not having any symptoms of strep throat—these people are considered “carriers” of the strep bacteria. If these carriers get a sore throat from a viral infection, and then go to the doctor and are tested for strep, they will likely have a positive test. However, their symptoms are actually due to the virus, rather than the strep bacteria that they chronically carry.
     
    Because of the positive testing results, it can be hard for a doctor to determine if a person is having frequent strep infections, or if they are having several viral infections and are just carriers of strep. The best way to sort this out is by asking detailed questions about the symptoms, documenting clearly in the medical record, and testing appropriately for strep rather than prescribing an antibiotic based on the exam findings alone.
     
    Deaconess works hard to address antibiotic resistance and prescribe antibiotics appropriately. That’s why we don’t give antibiotics to patients with a virus. It doesn’t get rid of the virus and it can cause future problems. You can learn more from the CDC about proper antibiotic usage.  
     
    When to consider tonsil removal
     
    Sometimes a tonsillectomy (surgery to remove tonsils) is recommended for people having frequent strep infections.
     
    The current industry recommendation says surgery should be considered if someone has:
    • at least 7 episodes of strep throat in a year, or
    • at least 5 episodes per year for 2 years, or
    • at least 3 episodes per year for 3 years. 
    As with all medical recommendations, this decision should be made on a case-by-case basis and guided by your doctor.

    In conclusion, if you or a loved one develop symptoms of strep throat, be sure to see your primary care provider or visit any of our Deaconess immediate care locations.
     
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