These days, many childhood illnesses have become extremely rare. But some, like strep throat, continue to be a rite of passage for school age children. An update by the infectious Diseases Society of America published in this September’s Clinical Infectious Diseases reviews what we know about strep and sore throats. As kids head back to school to meet their teachers and make new friends, this is a good time to review some of the key facts about a germ they might encounter along the way.
Strep throat is the most common bacterial infection of the throat and is caused by Group A Streptococcus bacteria. It’s extremely rare in children under the age of three and most common in children ages five through fifteen, although anyone can get it. It’s spread through contact with nasal secretions or saliva and usually presents with throat pain, fever, difficulty swallowing, and swollen lymph nodes in the neck. In children, headache, nausea, vomiting, and abdominal pain are also fairly common. On the other hand, typical cold symptoms, like runny nose or cough, and the absence of fever, make strep throat a lot less likely.
Although strep throat is not usually dangerous, it can sometimes lead to other infections, like ear infections or sinusitis, or more serious complications, like rheumatic fever, which can affect the heart, joints, and nervous system, and glomerulonephritis, an inflammatory condition affecting the kidneys.
A child with possible strep throat should be examined, and if strep is suspected, a rapid test can be done in the office to diagnose the infection. While a positive test is fairly reliable, a negative test is often backed up with a throat culture, which can take a few days. Strep is treatable with antibiotics, such as penicillin or amoxicillin, which can reduce the duration and severity of illness. Generally, children are no longer contagious after taking antibiotics for twenty-four hours, presuming that fever is no longer present and they are feeling better.
It’s important to realize that strep doesn’t always cause problems in our children’s throats. It can often be found “hanging out,” doing no harm at all, while a virus may be the source of their illness. In fact, the authors point out that only a small percentage of patients with an inflamed throat (20-30% of children and a smaller percentage of adults) have strep. These viral infections resolve by themselves, without antibiotics. A proper diagnosis can help prevent unnecessary antibiotics, avoiding resistance and the risk of harmful side effects.
So for most sore throats, rest, fluids and pain relief work well — I often do prescribe ice cream and popsicles. But the tricky part is figuring out which sore throats need a little bit more.
For more on strep throat:
Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America
U.S. National Library of Medicine