Strep throat

A sore throat is a very common condition that can affect any individual at any stage of life. It is characterized by pain, irritation, or itchiness of the throat that can lead to difficulty in swallowing and speaking. It is usually due to infection of the throat either by viruses or by bacteria.

Streptococcal pharyngitis or strep throat is a specific type of sore throat that is caused by the bacteria Streptococcus pyogenes. This type of sore throat is very common among school-aged children and is the cause of sore throat in 3 out of 10 children.

Among the various causes of sore throat, the streptococcal bacteria are of particular importance because of its potential to cause long-lasting and even life-threatening complications. These complications include acute rheumatic fever, which can cause inflammation of the joints (arthritis) and inflammation of the heart valves (rheumatic heart disease). A streptococcal infection can also cause inflammation of the kidneys (glomerulonephritis) that can end up in kidney failure. Thus, it is important to be able to identify if the etiologic agent of a sore throat is Streptococcus.

Symptoms

Although the signs and symptoms of viral and bacterial sore throat overlap, most streptococcal infections are characterized by the following:

• Severe pain in the throat
• High-grade fever (higher than 38C)
• Enlarged neck lymph nodes
• White patches or pus on the tonsils
• Headache
• Rash
• Muscle aches

In addition, in contrast to viral sore throat, most streptococcal infections are NOT usually associated with a runny nose, itchy eyes, or cough. Strep throat is also uncommon, although not unheard of, in children below 5 years old.

Diagnosis

A visit to the doctor is warranted if a person is suspected of having strep throat. After a thorough history and physical examination, the doctor will obtain a sample from the throat of the patient using a cotton swab. The sample will be sent to the laboratory for analysis and for confirmation of the diagnosis of strep throat.

Treatment

If a sore throat is proven to be caused by Streptococcus, antibiotics have to be started. Although most sore throats resolve spontaneously, antibiotics are still given for 7-10 days to prevent the development of complications. Left untreated, strep throat can spread to the tonsils, sinuses, ear, middle ear, skin, and blood. Strep infection can also lead to inflammatory illnesses affecting the joints, heart, kidneys, and more.

In addition, antibiotics can shorten the symptomatic period of sore throats and prevent the spread of infection to other people. In cases wherein an abscess or a collection of pus has formed in the throat, surgical drainage might be needed.

The pain in the throat can be relieved by various means like sucking on cough drops, popsicles, or candies. Gargling with salt water is also helpful in soothing the pain. If it is difficult to feed, foods with softer consistency (like soup or gelatin) and warm or cold drinks are encouraged, especially in children who can easily get dehydrated from refusal to feed.

Over-the-counter pain medications like acetaminophen and ibuprofen are also available. However, for children, the dosage of these medications is dependent on weight, so a doctor’s advice might be beneficial. Aspirin, a common pain medication, should not be given to children because it can cause Reye’s syndrome. Reye’s syndrome is a rare but potentially fatal condition that is characterized by rashes, seizures and confusion due to the swelling of the brain and the liver.

Recovery

Antibiotics have to be taken for at least one day before going back to work or to school to prevent the spread of infection. Work and other activities can be resumed as soon as an individual feels better. If fever develops, resumption of work or other activities can be done 24 hours after the last episode of fever.

Prevention

The streptococcal infection is spread by direct contact to the saliva of an infected patient or by the air droplets exhaled by an infected patient. Transmission is usually higher in small, enclosed areas and in individuals who share eating utensils or drinking glasses. Transmission in children can be higher because of their hand-to-mouth habits and their sharing of toys.

The spread of strep throat infection can easily be prevented by frequent handwashing with soap and water. In children, especially in toddlers, teaching them to avoid putting their hands into their mouths can protect them from spreading and/or getting the infection.