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Strep Questions

Q How is strep throat different from an ordinary sore throat?

A Since so many infections enter our bodies through our mouths or noses, most of the common infections that we see in children cause symptoms in the throat or nose. Sore throat itself is one of the most common presenting symptoms for physicians of both children and adults.

Most sore throats are caused by viral infections--any of a large number of viruses that we sometimes collectively call "common cold viruses" or "upper respiratory viruses." All of these cause similar illnesses that can occur hundreds of times across a person's lifetime.

Though most sore throats are caused by viruses, some are caused by one specific bacteria called Streptococcus pyogenes or 'group A strep." That's the "strep" that gives its name to "strep throat." So strep throat isn't just a more-severe sore throat, it's a specific kind of sore throat with a specific bacterial cause.

Q Are the symptoms of a viral sore throat different from the symptoms of strep throat?

A They can be, but there is a lot of overlap. Both include a sore throat that can be quite painful or severe.

People with viral sore throats usually develop other respiratory symptoms, like a runny or stuffed nose, or cough. There may be fever, but it only lasts a day or so. In contrast, people with strep have symptoms that begin more suddenly, and usually do not have much cough or nasal symptoms. Strep can sometimes cause abdominal complaints (belly ache, nausea, or vomiting), headache, and swollen lymph nodes ("glands") in the neck.

Strep throat is more common in the winter, and more common among children aged 5 through 15. Strep is fairly uncommon among adults, young children, and babies. distinguish strep from non-strep throats--we would probably only get it right about half the time. That's why it's so important to use an objective test to see if a sore throat is caused by a virus or strep. The current generation of rapid, in-office tests is quite accurate, and can be "backed up" by an overnight culture for confirmation.

Q Why is it important to know the difference?

A Both kinds of sore throats, both viral and bacterial, should be treated with pain relievers, rest, and fluids. But strep should also be treated with antibiotics, which can shorten the course of disease, prevent spread, and prevent complications. Antibiotics will not help viral sore throats, and are more likely to make a patient sicker than be of any benefit.

Q My child's day care insists that anyone with a sore throat bring a note from a doctor showing a negative strep test before returning to group care. Does that make sense?

A No. If they're trying to prevent the spread of disease, their policy is silly--both strep and viral sore throats are contagious, so excluding strep isn't going to prevent more disease than excluding all sore throats. Also, young children (the ones typically in day care) do not commonly get strep throat. The decision to exclude from group care should depend on both the comfort and health of the child, and whether excluding the child will effectively decrease disease transmission. Insisting on a strep test will not help judge whether a child should be able to attend school.

Q How quickly after starting antibiotics for test-positive strep should the child see an improvement in her symptoms? In the past, my daughter has started to improve within a few hours.

A In order to "feel better" after an bacterial infection like strep, antibiotics have to help the immune system kill the microorganisms, and the inflammatory response has to have time to subside. If antibiotics seem to help within a few hours, it's unlikely that it was the antibiotics that truly helped. More likely, it was the love and attention, plus pain reducing medication, plus the disease itself winding down on its own. Realistically, antibiotics for strep throat seem to reduce symptoms starting in a 24-48 hour window.

How soon after a child has a test-positive strep screen an started on antibiotics can she return to school?

A Children do not usually pass on the strep bacteria to other people after they've been on antibiotics for 24 hours, so that's a reasonable time to aim for a return to school or group care. However, if your child still feels very uncomfortable, she may need to stay home longer.

Q Is strep throat serious? Do I need to rush my child to the doctor with every sore throat?

A Most cases of strep throat will resolve on their own, even if untreated. However, identifying and treating strep throat can help decrease symptoms, limit contagion, and prevent some of the complications.

Though complications of strep throat are rare, they can be serious. The most common complication is the spread of the bacterial infection deeper into the throat, causing an abscess that may require surgery. Another complication of an untreated strep infection is rheumatic fever, an illness that can lead to heart damage as well as swollen painful joints. However, rheumatic fever has become increasingly rarer in the developed world, and is now seldom seen in most areas of the United States. Still, it has not completely disappeared.

Q So, bottom line, which children with sore throat really need to see the doctor?

A Any child with a severe sore throat should see the doctor, especially if it interferes with eating, drinking, or swallowing, or if there is a sensation of throat swelling. For more mild symptoms, a doctor's evaluation is a good idea for sore throats lasting more than a few days, especially those not accompanied by ordinary cold symptoms like runny nose, congestion, or cough.

Send your questions to or Pediatrics for Parents, PO Box 219, Gloucester, MA 01931. Please keep them general in nature as we can't give specific advice nor suggest treatment for your child. All such questions should be asked of your child's doctor.
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Author:Benaroch, Roy
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:May 1, 2013
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