Fever | Ear Infections | Strep Throat | Antibiotics | Vaccines STREP THROAT In contrast to fever, common colds, and ear infections, each of which are caused by many different germs, including different strains of viruses and bacteria, strep throat is a one germ disease caused by Streptococcus pyogenes, also known as “group A strep”. (To be completely honest, there are actually more than 100 different strains of Streptococcus pyogenes, but they all have the same name and method of attack, and are considered by doctors as if they were all the same.) Strep paranoia is perhaps second only to fever paranoia among parents and, especially, among grandparents. The basis for the anxiety rests with strep’s notorious associations with rheumatic fever, severe scarlet fever, and kidney disease. Although rheumatic fever and severe scarlet fever still occur, and there have been brief resurgences of those diseases in recent years, they are no longer the menace that they were during our kids’ grandparents’ era. It is thought that the germ has changed over time to make it less likely to cause those complications, although the true reason for the comings and goings seen with many infectious diseases is unknown. Strep throat has created its own cottage industry of doctor visits, throat cultures, high and low tech lab tests, antibiotic prescriptions, and school nurse employment opportunities. Untreated strep gets better on its own, but takes several days longer to resolve than if treated with antibiotics. The risk of rheumatic fever and kidney problems is virtually eliminated by antibiotic treatment during the acute episode of strep throat; as a result, treatment of proven strep throat is warranted. The symptom of severe sore throat is accompanied by a characteristic appearance in the throat which many doctors feel confident in diagnosing even without testing; the availability of rapid (minutes) testing in the doctor’s office, however, means that most kids with sore throats are tested regardless of what their throats look like to the doctor. That’s a big part of the difficulty for doctors and parents in dealing with strep – strep can remain on the throats, tonsils, and adenoids of kids long after the actual infection is gone – the germ establishes a “carrier” or “colonization”, living harmlessly in low numbers. But, when the next viral infection occurs and causes a viral sore throat, the test in the doctor’s office is still positive for strep, a leftover of the child’s previous true strep infection. Therefore, finding strep in your child’s throat doesn’t necessarily mean your child has strep throat. To bypass this confusion, doctors will frequently ask kids with “recurrent strep throat” to come in for testing when feeling well. If the strep is still there, confirming colonization, they may give your kids special medicines to try and eradicate the colonization, or “carriage” of strep and prevent future over-diagnosis of strep throat. One clue that a positive strep test reflects carriage and not actual infection is if your child’s sore throat comes with runny nose, cough, and other cold symptoms – strep throat usually lacks these more common signs of a viral cold. Another clue is that strep throat is less common in kids prior to school age, although younger kids may catch it in day care. How contagious is it?
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Copyright 2007, Dr. Harley A. Rotbart. Guidelines for Parents from the new book, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, 2008). Read Dr. Rotbart’s GERMBlog for frequent updates on important germ issues for your kids |
