Natick Pediatrics, PC

Is it Strep?
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

Your third-grader has a sore throat and a fever. Here’s the good news: chances are it’s not strep throat. Only about 1 out of 8 sore throats with fever are caused by infections with Group A Streptococci, the bacteria responsible for strep throat. Here’s more good news: your child’s sore throat and fever do not require urgent attention from a doctor. You don’t need to go to an emergency room if it’s Saturday and your doctor won’t be in again until Monday. And your child doesn’t need medical attention if he’s had a sore throat and a fever for only a couple days.

Symptoms
The sore throat caused by Group A strep is different from sore throats caused by cold viruses. With colds, there is usually nasal congestion, sneezing, and coughing. With strep throat there is usually only very painful throat and fever. The child will have a lot of pain when trying to swallow. Some children have difficulty eating and drinking. The throat will look bright red and the tonsils will be swollen ("swollen glands"). The back of the throat may have white dots on it, but sometimes there will be red dots at the back of the roof of the mouth (the soft palate). Often the child will have stomach pain and headache. Often the fever will go away in 2-4 days but the sore throat will linger on.

Some children with strep throat get a rash the color of salmon. The rash sometimes has the texture of fine sandpaper. This is "scarlet fever". Scarlet fever is nothing more than strep throat with a rash. The expression "scarlet fever" probably should not be used any more. The name makes the illness sound scarier than it ought to sound. And it’s confusing, since most people don’t know that it’s caused by Group A strep, and therefore they might not remember to use precautions to avoid getting strep throat.

How to get strep (and how not to get it)
If your child has strep throat, she probably got it from a classmate or family member who already has it. Like many infections, Group A strep is passed from person to person in saliva and mucus. Perhaps your child shared a glass, drinking straw, juice box, or soda can with a friend with strep throat? Or maybe she shared a toothbrush or face towel with her brother who had strep throat last week? Most often, the child simply got a small amount of a sick person’s saliva or mucus on her hand, and then touched her mouth. Kissing a person with strep throat is not a good idea.

What to do about a sore throat
Keeping in mind that most sore throats are not strep throats, and that strep throat is not an emergency, there are things you can do at home to make your child feel better. Acetaminophen (Tylenol) and Ibuprofen (Motrin), in appropriate doses, can be helpful. Cool things to drink may be soothing and will help keep your child hydrated. Acidic drinks, such as orange juice, will sting an already swollen throat. These should be avoided. Older children who are able to do so can gargle and spit warm salt water.

If after three to four days the sore throat is not better, or is getting worse, you might consider making an appointment to see the doctor. The doctor will probably perform a throat swab. This is like tickling the tonsils with a large Q-tip. It isn’t the most pleasant experience: I usually ask the child to sit on his hands while I swab his throat, in case he is tempted to "help" me. Most doctors use two swabs at a time: one for a "rapid strep" test, the other for a throat culture to be sent to the laboratory incubator.

If the rapid test is positive, the child most likely has strep throat, and the doctor writes a prescription for an antibiotic. However, the rapid test is not 100% sensitive. If the test is negative, the second swab is sent to the laboratory. If the child really has strep throat the culture will turn positive and the doctor will write a prescription for an antibiotic to take for about a week.

The best antibiotic for strep throat is Penicillin. If the child is allergic to penicillin, the doctor will choose an antibiotic in a different class. Fortunately, Group A strep is very easily killed by Penicillin. Nevertheless it is very important to finish the entire antibiotic prescription. You should never stop taking an antibiotic the moment you child starts feeling better. On the other hand, if your child becomes suddenly worse, or develops a rash while taking the antibiotic, you should contact the doctor right away.

Do you have to treat strep throat?
Unfortunately, you do. Unlike most ear infections, strep throat is best treated as soon as it is discovered. This is because strep throat can lead to nasty consequences. One of the more ominous consequences of strep throat is Rheumatic Fever, a chronic disease of heart valves and joints. Prior to the discovery of Penicillin, rheumatic fever was common. Today it is very rare. Group A strep in the throat can also lead to more serious infections like throat abscesses. There is one complication that cannot be prevented, even with antibiotics, and that is an inflammatory condition of the kidney. Fortunately, this complication is rare, but if it occurs, close contacts of the patient should be identified and should see a doctor soon.

The future of strep throat
The best way to deal with strep throat is not to get it in the first place. With this goal in mind, several research groups and pharmaceutical houses are working on a vaccine against the bacteria that cause strep throat. Last August, researchers at the University of Maryland published a preliminary study showing that a new vaccine was safe used when used in adults. Further studies are needed, and the researches predict that widespread availability of a strep vaccine may be 10 years away.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

Natick Pediatrics, PC
Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
(508) 655-2984 fax

Posted: November 23, 2004