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Is My Sore Throat Strep?

Strep throat is one of the most common infections seen in a pediatrician’s office. With all the viruses that cause sore throats, the challenge for parents is to know which sore throats to take in for testing. I’m going to endeavor to help you decipher when to go into the office and when to stay home. There are a couple simple differences.

  1. Viral sore throats usually have many other associated respiratory symptoms, like cough and runny nose.
  2. Strep sore throats have limited other symptoms (headache, and/or stomachache).
  3. Both can cause red, sore throats +/- white patches, painful swallowing, swollen lymph nodes (bumps in the neck), and/or fever.

So why is it so important to know if it’s actually strep? Strep throat is caused by a bacteria Streptococcus pyogenes (a.k.a. group A streptococcus). Because it’s caused by a bacteria, it needs to be treated with an antibiotic. While it is technically possible that one’s body could clear the illness on its own, most people will require treatment. First line treatment is with Penicillin (most docs prescribe Amoxicillin, a derivative of penicillin, because it is convenient to dose and generally well tolerated). Treatment decreases the risk of serious complications including Scarlet fever—prominent rash, poststreptococcal glomerularnephritis (kidney inflammation), or Rheumatic fever (affecting the heart and joints).

Strep throat is highly contagious. It is spread through respiratory droplets in the air. This happens when the infected person coughs or sneezes, touches and contaminates surfaces, or shares food or drinks. If you’re still reading, here’s a piece of strep trivia that no one knows. The reason docs make you swab every symptomatic person in a household instead of just treating everyone is due to rates of transmission. The transmission rate in a household is 25%. Now I know, you would think that if one of your kids has strep and a second gets a sore throat the risk of it being strep would be like 95%, but it simply isn’t the case. The risk is 25% (way higher than the general population, but not nearly as high as one would think).

So don’t get mad at your doc if she insists on testing every one of your sick children before treating. She is just trying to be responsible about antibiotic prescribing and not expose your child unnecessarily to antibiotics and increase your child’s risk of antibiotic resistance.

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