I Have Strep Throat

Strep throat

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Definition

Streptococcal sore throat, or strep throat as it is more commonly called, is an infection of the mucous membranes lining the pharynx. Sometimes the tonsils are also infected (tonsillitis). The disease is caused by group A Streptococcus bacteria. Untreated strep throat may develop into rheumatic fever or other serious conditions.

Description

Strep throat accounts for between five and ten percent of all sore throats. Although anyone can get strep throat, it is most common in school age children. People who smoke, who are fatigued, run down, or who live in damp, crowded conditions are also more likely to become infected. Children under age two and adults who are not around children are less likely to get the disease.

Strep throat occurs most frequently from November to April. The disease passes directly from person to person by coughing, sneezing, and close contact. Very occasionally the disease is passed through food, when a food handler infected with strep throat accidentally contaminates food by coughing or sneezing. Statistically, if someone in the household is infected, one out of every four other household members may get strep throat within two to seven days.

Causes & symptoms

A person with strep throat suddenly develops a painful sore throat one to five days after being exposed to the streptococcus bacteria. The pain is indistinguishable from sore throats caused by other diseases.

The infected person usually feels tired and has a fever, sometimes accompanied by chills, headache, muscle aches, swollen lymph glands, and nausea. Young children may complain of abdominal pain. The tonsils look swollen and are bright red, with white or yellow patches of pus on them. Sometimes the roof of the mouth is red or has small red spots. Often a person with strep throat has bad breath.

Despite these common symptoms, strep throat can be deceptive. It is possible to have the disease and not show any of these symptoms. Many young children complain only of a headache and stomachache, without the characteristic sore throat.

Occasionally, within a few days of developing the sore throat, an individual may develop a fine, rough, sunburn-like rash over the face and upper body, and have a fever of 101-104°F (38.3-40°C). The tongue becomes bright red, with a flecked, strawberry-like appearance. When a rash develops, this form of strep throat is called scarlet fever. The rash is a reaction to toxins released by the streptococcus bacteria. Scarlet fever is no more dangerous than strep throat, and is treated the same way. The rash disappears in about five days. One to three weeks later, patches of skin may peel off, as might occur with a sunburn, especially on the fingers and toes.

Untreated strep throat can cause rheumatic fever. This is a serious illness, although it occurs rarely. The most recent outbreak appeared in the United States in the mid-1980s. Rheumatic fever occurs most often in children between the ages of five and 15, and may have a genetic component, since it seems to run in families. Although the strep throat that causes rheumatic fever is contagious, rheumatic fever itself is not.

In the 1990s, outbreaks of a virulent strain of group A Streptococcus were reported to cause a toxic-shock-like illness and a severe invasive infection called necrotizing fasciitis, which destroys skin and muscle tissue. Although these diseases are caused by group A Streptococci, they rarely begin with strep throat. Usually the streptococcus bacteria enters the body through a skin wound. These complications are rare. However, since the death rate in necrotizing fasciitis is 30-50%, it is wise to seek prompt treatment for any streptococcal infection.

Diagnosis

Diagnosis of a strep throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis, and seek information about whether the patient has been around other people with strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.


Treatment

Strep throat is treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed and not discontinue taking the medication when they feel better. Stopping the antibiotic early can lead to a return of the strep infection. Occasionally, a single injection of long-acting penicillin (Bicillin) is given instead of 10 days of oral treatment.

About 10% of the time, penicillin is not effective against the strep bacteria. When this happens a doctor may prescribe other antibiotics such as amoxicillin (Amoxil, Pentamox, Sumox, Trimox), clindamycin (Cleocin), or a cephalosporin (Keflex, Durocef, Ceclor). Erythromycin (Eryzole, Pediazole, Ilosone), another inexpensive antibiotic, is given to people who are allergic to penicillin. Scarlet fever is treated with the same antibiotics as strep throat.

Without treatment, the symptoms of strep throat begin subsiding in four or five days. However, because of the possibility of getting rheumatic fever, it is important to treat strep throat promptly with antibiotics. If rheumatic fever does occur, it is also treated with antibiotics. Anti-inflammatory drugs, such as steroids, are used to treat joint swelling. Diuretics are used to reduce water retention. Once the rheumatic fever becomes inactive, children may continue on low doses of antibiotics to prevent a reoccurrence. Necrotizing fasciitis is treated with intravenous antibiotics.

Home care for strep throat

There are home care steps that people can take to ease the discomfort of their strep symptoms.

Take acetaminophen or ibuprofen for pain. Aspirin should not be given to children because of its association with an increase in Reye's Syndrome, a serious disease.
Gargle with warm double strength tea or warm salt water, made by adding one teaspoon of salt to eight ounces of water, to relieve sore throat pain.
Drink plenty of fluids, but avoid acidic juices like orange juice because they irritate the throat.
Eat soft, nutritious foods like noodle soup. Avoid spicy foods.
Avoid smoke and smoking.
Rest until the fever is gone, then resume strenuous activities gradually.
Use a room humidifier, as it may make sore throat sufferers more comfortable.
Be aware that antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Alternative treatment

Alternative treatment focuses on easing the symptoms of strep throat through herbs and botanical medicines. Some practitioners suggest using these treatments in addition to antibiotics, since they primarily address the comfort of the patient and not the underlying infection. Many practitioners recommend Lactobacillus acidophilus to offset the suppressive effects of antibiotics on the beneficial bacteria of the intestines.

Some suggested treatments include:

Inhaling fragrances of the essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris), eucalyptus (Eucalyptus globulus), sage (Salvia officinalis), and sandalwood (Aromatherapy).
Gargling with a mixture of water, salt, and tumeric (Curcuma longa) powder or astringents, such as alum, sumac, sage, and bayberry (Ayurvedic medicine).
Taking osha root (Ligusticum porteri) internally for infection or drinking tea made of sage, echinacea (Echinacea spp.) and cleavers (Gallium aparine) Osha root has an unpleasant taste many children will not accept (Botanical medicine).

Prognosis

Patients with strep throat begin feeling better about 24 hours after starting antibiotics. Symptoms rarely last longer than five days.

People remain contagious until after they have been taking antibiotics for 24 hours. Children should not return to school or childcare until they are no longer contagious. Food handlers should not work for the first 24 hours after antibiotic treatment, because strep infections are occasionally passed through contaminated food. People who are not treated with antibiotics can continue to spread strep bacteria for several months.

About 10% of strep throat cases do not respond to penicillin. People who have even a mild sore throat after a 10 day treatment with antibiotic should return to their doctor. An explanation for this may be that the person is just a carrier of strep, and that something else is causing the sore throat.

Taking antibiotics within the first week of a strep infection will prevent rheumatic fever and other complications. If rheumatic fever does occur, the outcomes vary considerably. Some cases may be cured. In others there may be permanent damage to the heart and heart valves. In rare cases, rheumatic fever can be fatal.

Necrotizing fasciitis has a death rate of 30-50%. Patients who survive often suffer a great deal of tissue and muscle loss. Fortunately, this complication of a streptococcus infection is very rare.

Prevention

There is no way to prevent getting a strep throat. However, the risk of getting one or passing one on to another person can be minimized by:

Washing hands well and frequently, especially after nose blowing or sneezing and before food handling
Disposing of used tissues properly
Avoiding close contact with someone who has a strep throat
Not sharing food and eating utensils with anyone
Not smoking.

Terms:
Lactobacillus acidophilus
A bacteria found in yogurt that changes the balance of the bacteria in the intestine in a beneficial way.


Resources:
BOOKS
Professional Guide to Diseases. 5th ed. Springhouse PA: Springhouse Corp., 1995.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

This health encyclopedia is made possible by the Dr. Joseph F. Smith Trust Fund. Dr. Smith was a surgeon who resided in Wausau from 1908 to 1952. In addition to his surgical practice, Dr. Smith possessed a strong commitment to community service and medical education. The agreement which created the Dr. Joseph F. Smith Medical library was signed in July of 1948.

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