Parents Stress over Strep

By: Dr. Robert Nohle,  Chief of Pediatrics for Group Health

I’m not sure why this is but I see many parents overly concerned about strep throat, often to the point of having “streptophobia.” Ninety percent of all sore throats are just part of a routine cold. However, about 10 percent are strep throat, an infection caused by bacteria known as Group A streptococcus pyogenes.  In addition to a sore throat, some of the other symptoms your child can have include fever, headache, swollen lymph nodes in the neck, stomach pain and white patches in the back of the throat.

If your child has a sore throat and a runny nose and cough, he or she is more likely to have a standard cold which is a viral illness.  The more nasal symptoms, the less likely your child has strep. Viral illnesses do not benefit from antibiotic treatment. Giving an antibiotic when you don’t know if the child has strep can make it more difficult to figure out what’s wrong with the child if he or she becomes sicker.

Strep is a bacterial infection caused by direct contact. Here is something no one likes to think about: If you have strep, you have gotten someone else’s mucus into your mouth. I know it’s horrible to think about, but that’s how it works. The only infrequent exception to this is the “strep carrier,” which I will describe later.

If you suspect your child has strep throat, call his or her doctor. You can’t tell with certainty by looking if your child has strep. The only way to confirm the presence of strep throat is through a throat culture or rapid strep test.

The rapid test takes only a few minutes at your doctor’s office to obtain results. A negative result may need to be confirmed with the throat culture depending on the lab’s specific test sensitivity. If the tests are negative, the infection is most likely viral and antibiotics would be ineffective because they don’t work on viruses. Of note, there are other less common bacteria that can cause sore throats.

A word about home testing for strep: Rapid test strips for strep are available for home purchase. I would advise against using these to diagnose your child yourself. The tests are only as accurate as the person reading it. Even in an ideal environment, about five percent of negative tests results end up as a positive for strep after a throat culture.  When I see a child who may have strep, I develop a differential diagnosis in addition to using diagnostic tools such as the rapid test or throat culture.

If results from either test are positive, oral antibiotics will probably be prescribed. After 24 hours of antibiotics, your child is no longer contagious and can return to school if he or she is feeling up to it.  As with any antibiotic treatment, it’s important that your child completes the entire course, even after he or she feels better. The antibiotics can take up to 10 days to minimize reoccurrence. Completing the course can also help prevent complications.

Left untreated, strep usually resolves itself. Treatment with antibiotics shortens the duration of symptoms by about one day. Strep can sometimes cause more serious complications like rheumatic fever (heart disease) or kidney disease - but this is rare.

Strep throat can spread fairly easily to others in the family. Any child or adult showing signs of illness should be tested as well. Follow-up testing is generally not necessary if your child receives all of the antibiotics prescribed.

If your child has repeated cases of strep, he or she may be a carrier of strep. That sounds worse than it is: about 15-20 percent of us have the strep bacteria living in our nose or throat – even when we don’t have an infection. This is confirmed by a positive strep test when your child is well.  Being a carrier is not a problem unless that child or other family members continue to develop strep throat. When this carrier has a typical cold caused by a virus, he or she will test positive for strep even though that’s not what was causing the symptoms. Strep carriers will need to be diagnosed and treated differently, but they tend not to spread the illness.

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