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Strep throat

Definition

Strep throat is a disease that causes a sore throat (pharyngitis). It is an infection with a germ called Group A Streptococcus bacteria.

Alternative Names

Pharyngitis - streptococcal; Streptococcal pharyngitis

Causes, incidence, and risk factors

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

Strep throat is spread by person-to-person contact with fluids from the nose or saliva. It commonly spreads among family or household members.

Symptoms

Symptoms may be mild or severe. You will often start to feel sick about 2 to 5 days after you come in contact with the strep germ.

Fever may begin suddenly and is often highest on the second day. You may have chills.

You can have a red sore throat, sometimes with white patches. It may hurt to swallow. You may feel swollen, tender glands in your neck.

Other symptoms may include:

Some strains of strep throat can lead to a scarlet fever-like rash. The rash first appears on the neck and chest. Then it spreads over the body. It may feel like sandpaper.

Signs and tests

Many other causes of sore throat may have the same symptoms. Your health care provider must do a test to diagnose strep throat and decide whether you need to take antibiotics.

A rapid strep test can be done in most health care provider offices. However, it can be negative even if you have strep.

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. Results will take 1 to 2 days to come back.

Treatment

Most sore throats are caused by viruses, not bacteria.

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 a 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 these 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

In rare cases, 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.

Other complications may include:

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.

Wessels MR. Streptococcal pharyngitis. N Engl J Med. 2011;364:648-655.

Frye R, Bailey J, Blevins AE. Clinical inquiries. Which treatmetns provide the most relief for pharyngitis pain? J Fam Pract. 2011;60(5):293-294.

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


Review Date: 1/8/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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