Effective & Trusted Medications Guide

Definition

Strep throat is a bacterial throat infection that can make your throat feel sore and scratchy. Most sore throats are caused by viruses and usually go away on their own. Only a small portion of sore throats are the result of strep throat.

It’s important to identify strep throat for a number of reasons. If untreated, strep throat can sometimes cause complications such as kidney inflammation and rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a rash and even damage to heart valves.

Strep throat is most common between the ages of 5 and 15, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt treatment.

Symptoms

In general, signs and symptoms of strep throat include:

• Throat pain
• Difficulty swallowing
• Red and swollen tonsils, sometimes with white patches or streaks of pus
• Tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth
• Swollen, tender lymph glands (nodes) in your neck
• Fever
• Headache
• Rash
• Stomachache and sometimes vomiting, especially in younger children

It’s possible for you or your child to have many of these signs and symptoms, but not have strep throat. The cause of these signs and symptoms could be a virus, tonsillitis or other illnesses. That’s why your doctor generally tests specifically for strep throat.

It’s also possible to have the bacteria that can cause strep in your throat without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria do not make them sick.

When to seek medical advice
Call your doctor if you or your child has any of these signs and symptoms:

• A sore throat without cold symptoms such as runny nose
• A sore throat accompanied by tender, swollen lymph glands (nodes)
• A sore throat that lasts longer than 48 hours
• A fever higher than 101 F (38 C) in older children, or any fever lasting longer than 48 hours
• Rash
• Problems breathing or difficulty swallowing anything, including saliva
• A lack of improvement after taking antibiotics for 24 to 48 hours
• A fever — or pain or swelling in the joints, shortness of breath or a rash — after a strep infection, even as long as three weeks after infection. These can be indicators of rheumatic fever

Cola-colored urine more than a week after a strep infection, as this may indicate kidney inflammation (poststreptococcal glomerulonephritis)

Causes

The cause of strep throat is bacteria known as Streptococcus pyogenes, or group A streptococcus.

Streptococcal bacteria are highly contagious. They can spread through airborne droplets when someone with the infection coughs or sneezes. You can also pick up the bacteria from a doorknob or other surface and transfer them to your nose or mouth. Kitchen utensils and bathroom objects are other common modes of infection transmission.

Risk factors

Several factors can increase your risk of strep throat infection:

• Young age. Strep throat occurs most commonly in children between the ages of 5 and 15.
• Time of year. Although strep throat can occur anytime of the year, it tends to circulate in late fall, winter and early spring. Strep bacteria flourish wherever groups of people are in close contact. That’s why the infection spreads easily among family members, in schools and in child care settings.

Complications

Although strep throat itself isn’t dangerous, it may lead to serious complications if left untreated. These complications include other infections, such as:

• Tonsillitis or a collection of pus around the tonsils caused by infection (peritonsillar abscess)
• Sinus infection (sinusitis)
• Ear infection
• Scarlet fever, an illness characterized by a rash
• Inflammation of the kidney (poststreptococcal glomerulonephritis)
• Rheumatic fever

Problems with rheumatic fever
Rheumatic fever causes inflammatory deposits (nodules) to form in various tissues, including the joints, skin and muscles. These nodules also may form on the heart muscle, the lining of the heart and especially the heart valves, causing scarring that can interfere with the flow of blood inside the heart. Although surgery can sometimes repair scarred valves, the damage may be permanent. In some cases this damage may lead to heart failure. However, the risk of developing severe complications from strep throat is low in the United States.

Preparing for your appointment

If you suspect strep throat, you’re likely to start by seeing your family doctor or a general practitioner. Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be well prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Note how long you’ve had them, and if they’re worse at any particular time.
• Write down key personal information, including whether you’ve been exposed to anyone with strep throat.
• Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For strep throat, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are possible causes for my symptoms or condition?
• What kinds of tests do I need?
• I have other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Is there a generic alternative to the medicine you’re prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime
If you think you might have strep, to help avoid infecting others, keep your hands clean, cover your mouth when you cough or sneeze, and don’t share personal items.

To ease your symptoms, get plenty of rest, drink lots of fluids, eat soothing, soft foods, and take pain relievers such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others). You may also want to gargle 1/4 teaspoon (1.2 milliliters) of table salt in 8 ounces (237 milliliters) of warm water. Avoid giving aspirin to young children and teenagers.

Tests and diagnosis

Doctors usually diagnose the cause of a sore throat on the basis of a physical exam and lab tests. During the exam, your doctor looks for signs and symptoms of strep throat, such as fever and enlarged lymph nodes, and will probably use a tongue depressor to get a good look at your throat and tonsils.

Your doctor will check for redness, swelling, and white streaks or pus on the tonsils. There also may be tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth. Although these signs indicate an infection, there’s no way to accurately tell by just looking whether it’s viral or bacterial. In fact, some viral throat infections look worse than infections caused by streptococcal bacteria.

For that reason, your doctor is likely to use one or more of the following tests to check for the presence of bacteria, including streptococcal bacteria:

• Throat culture. For this test, a sterile swab is rubbed over the back of the throat and tonsils to get a sample of the secretions. It’s not a painful procedure, but it may cause brief gagging. The sample is then cultured in a laboratory for the presence of bacteria, but results may take as long as two days.
• Rapid antigen test. Because of the waiting period for a throat culture, your doctor may also order a rapid antigen test on the swab sample. This test can detect strep bacteria in minutes by looking for foreign substances (antigens) in the throat. If you or your child tests positive for strep bacteria, antibiotic treatment can begin right away. But rapid strep tests have a downside. They may miss some strep throat infections. For this reason, many doctors still use throat cultures, especially if results of the rapid test are negative.
• Rapid DNA test. Newer rapid tests use DNA technology to detect strep throat in a day or less from a throat swab. These tests are as accurate as throat cultures, and the results are available sooner.

Treatments and drugs

Medications

• Antibiotics. If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as penicillin, amoxicillin (Amoxil, Trimox), azithromycin (Zithromax), clarithromycin (Biaxin), clindamycin (Cleocin) or a cephalosporin (Keflex, Ceclor). Penicillin may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting from strep throat.These antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to classmates or family members.Once treatment begins, you or your child should start feeling better in just a day or two. Call your doctor if you or your child doesn’t feel better after taking antibiotics for 48 hours. If children on antibiotic therapy feel well and don’t have a fever, they often can return to school or child care when they’re no longer contagious — usually 24 hours after beginning treatment. But be sure to finish the entire course of medicine. Stopping medication early may lead to recurrences and serious complications, such as rheumatic fever or kidney inflammation.
• Pain relievers. In addition to antibiotics, your doctor may suggest ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to relieve throat pain and reduce fever. Because of the risk of Reye’s syndrome, a potentially life-threatening illness, don’t give aspirin to young children and teenagers. Be careful with acetaminophen, too. Taken in large doses, it can cause liver problems. Read and follow label directions. Talk to your doctor or pharmacist if you have questions.

Lifestyle and home remedies

In most cases, antibiotics will quickly wipe out the bacteria causing the infection. In the meantime, try these tips to relieve symptoms of strep throat:

• Get plenty of rest. Sleep helps your body fight infection. If you have strep throat, stay home from work if you can. If your child is ill, keep him or her at home until there’s no sign of fever and he or she feels better.
• Drink plenty of water. Keeping a sore throat lubricated and moist eases swallowing. Drinking plenty of water also helps prevent dehydration.
• Eat soothing foods. Foods that are easy on a sore throat include broths, soups, applesauce, cooked cereal, mashed potatoes, soft fruits, yogurt and soft-cooked eggs. You may even want to puree foods in the blender to make them easier to swallow. Very cold foods such as sherbet, frozen yogurt or frozen fruit pops also may be soothing. Avoid spicy foods or acidic foods such as orange juice.
• Gargle with warm salt water. For older children and adults, gargling several times a day can help relieve throat pain. Mix 1/4 teaspoon (1.2 milliliters) of table salt in 8 ounces (237 milliliters) of warm water. Be sure to tell your child to spit out the liquid after gargling.
• Use a humidifier. Adding moisture to the air can help ease discomfort. Moisture keeps mucous membranes in your throat from becoming dry and even more irritated. Choose a cool-mist humidifier and clean it daily, because bacteria and molds can flourish in some humidifiers. Saline nasal sprays also help to keep mucous membranes moist.
• Stay away from irritants. Cigarette smoke can irritate a sore throat and increase the likelihood of infections such as tonsillitis. In addition, avoid fumes from paint or cleaning products, which can be irritating to your throat and lungs.
• Plan low-key activities for a sick child. If your child tests positive for strep throat, he or she should take antibiotics for at least 24 hours before returning to school or child care. When staying home with your child, plan some low-key activities that you both can enjoy.

Prevention

To prevent strep infection:

• Clean your hands. Proper hand cleaning is the best way to prevent all kinds of infections. That’s why it’s important to clean your own hands regularly and to teach your children how to clean their hands properly, using soap and water or an alcohol-based hand sanitizer.
• Cover your mouth. Teach your children to cover their mouths when they cough or sneeze.
• Don’t share personal items. If you or your child does have strep throat, don’t share drinking glasses or eating utensils. Wash those items carefully in hot, soapy water or in a dishwasher.