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Strep throat

Definition

Strep throat is caused by Group A Streptococcus bacteria. It is the most common bacterial infection of the throat.

Alternative Names

Pharyngitis - streptococcal; Streptococcal pharyngitis

Causes, incidence, and risk factors

Strep throat is most common in children between age 5 and 15, although anyone can get it.

Strep throat is spread by person-to-person contact with nasal secretions or saliva. It commonly spreads among family or household members.

Symptoms

Symptoms may be mild or severe. You usually start to feel sick about 2 to 5 days after you come in contact with the bacteria.

Symptoms usually begin suddenly, and can include:

  • Fever that begins suddenly and is often highest on the second day
  • Red throat, sometimes with white patches
  • Sore throat
  • Headache
  • Nausea
  • Chills
  • General ill feeling
  • Loss of appetite and abnormal taste
  • Swollen lymph nodes in the neck
  • Difficulty swallowing

Some strains of strep throat can lead to a scarlet fever-like rash. This rash is thought to be an allergic reaction to toxins made by the strep bacteria.

Signs and tests

A rapid test can be done in most health care provider offices, but misses a few of the cases.

If the rapid strep test is negative and your health care provider still thinks you or your child may have strep, a throat swab can be tested (cultured) to see if strep grows from it. However, it will take one to two days for results to come back.

Treatment

Most sore throats are caused by viruses, not strep-related bacteria. Strep cannot be accurately diagnosed by symptoms or a physical exam alone. Many of the other causes of sore throats may have the same symptoms.

Sore throats should only be treated with antibiotics if the strep test is positive. Antibiotics are taken to prevent rare but more serious health problems, such as rheumatic fever.

Penicillin or amoxicillin is usually first tried. Antibiotics should be taken for 10 days, even though symptoms are usually gone after few days.

The following tips may help your sore throat feel better:

  • Drink warm liquids such as lemon tea or tea with honey.
  • Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
  • Drink cold liquids or suck on popsicles.
  • Suck on hard candies or throat lozenges. Young children should not be given such products because they can choke on them.
  • A cool-mist vaporizer or humidifier can moisten and soothe a dry and painful throat.
  • Try over-the-counter pain medications, such as acetaminophen.

Expectations (prognosis)

Symptoms of strep throat usually get better in about 1 week. Untreated, strep can lead to serious complications.

Complications

On rare occasions, strep throat can lead to rheumatic fever if it is not treated. Strep throat may also cause a rare kidney complication called post-streptococcal glomerulonephritis.

Calling your health care provider

Call if you develop the symptoms of strep throat. Also, call if you are being treated for strep throat and are not feeling better within 24 - 48 hours.

Prevention

Most people with strep are contagious until they have been on antibiotics 24 - 48 hours. They should stay home from school, daycare, or work until they have been on antibiotics for at least a day.

Get a new toothbrush after you are no longer contagious, but before finishing the antibiotics. Otherwise the bacteria can live in the toothbrush and re-infect you when the antibiotics are done. Also, keep your family's toothbrushes and utensils separate, unless they have been washed.

If repeated cases of strep still occur in a family, you might check to see if someone is a strep carrier. Carriers have strep in their throats, but the bacteria do not make them sick. Sometimes, treating them can prevent others from getting strep throat.

References

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.

Chan TV. The Patient with Sore Throat. Med Clin North Am. 2010 Sep;94(5):923-43.

Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis andstreptococcal carriage in children: a meta-analysis. Pediatrics. 2010 Sep;126(3):e557-64.

Del Mar C, Glasziou PP, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD000023.

Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD004872.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.


Review Date: 8/31/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine (2/12/2011).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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