Streptococcal Pharyngitis

Streptococcal Pharyngitis (Strep Throat, Strep Tonsillitis)

Most sore throats accompany a cold or flu and are caused by viruses. They are usually somewhat painful and annoying but last only 2 to 4 days and go away on their own without antibiotics. "Strep Throat" is a throat infection caused by Streptococcus bacteria. If left untreated, it can lead to more serious problems such as rheumatic fever, a disease causing inflammation of the joints (arthritis), heart or other tissues. Sometimes strep throat is followed by inflammation of the kidneys (nephritis). Fortunately both conditions are very uncommon.

Strep bacteria are spread by infected nose or throat mucus, either through the air with coughing or sneezing or by direct contact. Illness begins from 12 hours to 5 days after exposure.

A sore throat caused by strep can be mild with just a "tickle," or very painful, especially upon swallowing. It is often, but not always, accompanied by fever (101°F or greater), headache, stomach ache and sore, swollen lymph nodes (glands) in the neck. Some children complain only of headache or stomach pain. When earache is present it is caused, in most cases, by throat pain extending up to the ear.

On examination of the throat, the tonsils are usually swollen and bright red and may have white or yellow patches of pus visible on the surface. The roof of the mouth may also be red or contain small red spots. A distinctive bad breath is common. When strep throat is accompanied by a red rash and fever, it is called scarlet fever.

If strep throat is left untreated, the discomfort lasts about 2 to 5 days; with antibiotic therapy it lasts about 1 to 3 days. The rash of scarlet fever fades after several days but is often followed by flaking or peeling of the skin, especially around the fingertips, 1 to 3 weeks later. This is nothing to worry about.

A throat culture or rapid strep test can tell us if your child has strep throat. The rapid strep test results are available within a few minutes while you are in the office; however, a strep culture test result takes 2-3 days.

Never give your child an antibiotic without first checking with our office. Even one dose can cause a throat culture to be falsely negative, making it difficult or impossible for us to diagnose your child's illness.

Antibiotic treatment for strep throat may be given either by mouth or as an injection. Oral antibiotics must be taken for a full 10 days to prevent complications or recurrences. If you miss a dose, double the next one. You should not miss an entire day. Once your child has received antibiotic therapy for a few days and is feeling better, it is easy to forget to continue and finish the treatment. Failure to complete the full course may well result in a relapse of the infection and return of the illness, sometimes within hours of the last dose of antibiotic.

Be sure to discard and replace the child's old toothbrush after a few days on antibiotics.

Children with strep throat are contagious until 24 hours after the start of antibiotic therapy. Children may return to school or day care 24 hours after beginning antibiotics and when temperature and activity level are normal.

Call us during regular office hours if your child complains of an earache, neck glands become very tender, swollen or red, fever develops, or the illness lasts more than 5 days. Also call the office if someone else in the family has developed sore throat symptoms (after a strep diagnosis has been made).