Streptococcal Pharyngitis

School is starting.  While it is an exciting time, it is also a time that certain illnesses raise their ugly heads.  This is due to crowding of people into confined spaces.  During the summer when kids were running free, their interpersonal interactions were somewhat limited.  When school starts, they are crowded together and much more likely to spread an illness from one to another.  As physicians, we will see isolated instances of strep throat through out the year, but school brings them on in droves!

What is Strep?

Strep is an infection of the tonsils, pharynx and palate by certain bacteria.  The broad category is call group A strep.  There are several but the most common and virulent is called Streptococcus pyogenes.  While strep throat may seem to be an innocuous and easily treated infection of childhood, it does have some significant ramifications in terms of health in the general population.  It is estimated that there are 700 million group A strep infections worldwide each year.  These are not all strep throat infections.  I put this in here to let you know how common these bacteria are.  Group A strep are also responsible for erysipelas, impetigo, sepsis, cellulitis, scarlet fever, rheumatic fever and necrotizing fasciitis.  While strep does not cause all cases of sore throats, it does cause up to a third of all cases in children and up to 20% of all cases in adults. 

What are the symptoms of strep throat?

While the majority of sore throats are viral in origin, a large percentage of sore throats are caused by strep.  Due to the possibility of complications, adequate, accurate evaluation and treatment are advised.  The list below contains many of the common symptoms and signs.  Not all will be present.

• Sore throat
• Sudden fever (usually grater than 100.4 F)
• Swollen lymph nodes
• Swollen and reddened tonsils
• White or yellow coating on tonsils
• Red dots on roof of mouth (palatine petechiae)
• Headache
• abdominal pain
• a specific skin rash.

Following are some photos of what some of these things look like:

Palatine petechiae

Pharyngeal exudate

Enlarged lymph nodes

Scarlatiniform rash

Diagnosis

An experienced practitioner can sometimes make this diagnosis based on history and exam.  I feel it is best to get some diagnostic backup.  The gold standard would be an actual throat culture but the results of these take up to 3 days to get back.  There are many brands of rapid antigen test kits on the market.  These are usually kept in the doctors office or clinic and can give results in about 6 minutes.  These tests are not infallible but are usually accurate around 95% of the time. 

Treatment

Thankfully, streptococcal bacteria remain susceptible to a wide variety of antibiotics.  The most commonly used are penicillins (amoxicillin).  Many people feel they are allergic to penicillin so there are options : macrolides (azithromycin, erythromycin), cephalosporins (keflex), and clindamycin. 

Many years ago, routine tonsillectomy was performed.  Having your tonsils removed does not prevent you from contracting strep throat.  Studies performed have not really answered the question of it it is a treatment that will reduce the incidence of strep throat.  If I have a patient that has greater than 6 episodes of documented strep throat in a year, I will refer him/her for ENT evaluation.  This is the main reason I test for strep every time.