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Strep throat
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(or "
Streptococcal Pharyngitis ", or "Streptococcal Sore Throat") is a form of
Group A Streptococcal Infection that affects the
Pharynx .
The signs and
Symptom s of strep throat are red, sore throat with white patches on
Tonsil s, swollen
Lymph Node s in the neck,
Fever over 101 F, and
Headache .
Nausea ,
Vomit ing, and
Abdominal Pain are more common in children.
Cough is infrequent in older patients, but younger children may experience cold-like symptoms including stuffy noses and sneezing similar to many viral infections.
The illness is caused by the
Bacterium ''Streptococcus pyogenes'' and is spread by direct, close contact with patients via respiratory droplets (
Cough ing or
Sneezing ). Casual contact rarely results in transmission. Rarely, contaminated food, especially
Milk and
Milk Products , can result in
Outbreak s. Untreated patients are most infectious for 2-3 weeks after onset of infection. The
Incubation Period , the period after exposure and before symptoms show up, is difficult to establish as some people don't become symptomatic. However, it is thought to be about 1 week. Patients are no longer infectious within 24 hours of commencing treatment.
The throat of the patient is swabbed for culture or for a rapid strep test (5 to 10 min) which can be done in the doctor's office. A rapid test tests for the presence of typical bacterial
Antigens in the swab, which are detected by specific
Antibodies provided in the kit. If the rapid test is negative (that is, normal), a follow-up culture (which takes 24 to 48 hours) may be performed. A negative culture suggests a
Viral infection, in which case
Antibiotic treatment should be withheld or discontinued.
In the
UK , rapid strep testing is not available to
General Practitioner s and a clinical decision must be made whether to treat, whilst awaiting upto 7 days for a swab result to be reported. This is criticized for encouraging overuse of antibiotics (see
Antibiotic Resistance ).
Antibiotic treatment will reduce symptoms slightly, minimize transmission, and reduce the likelihood of complications. Treatment consists of
Penicillin (orally for 10 days; or a single intramuscular injection of penicillin G).
Erythromycin is recommended for penicillin-
Allergic patients. Second-line antibiotics include
Amoxicillin ,
Clindamycin , and oral
Cephalosporin s. Although symptoms subside within 4 days even without treatment, it is very important to start treatment within 10 days of onset of symptoms, and to complete the full course of antibiotics to prevent
Rheumatic Fever , a rare but serious complication.
Amoxicillin should be avoided for treatment of a sore throat if bacterial (swab) confirmation has not been obtained since it causes a distinctive rash if the true illness proves to be
Glandular Fever , better known as
Mononucleosis . This rash is harmless but alarming.
Mononucleosis itself, however, can be extremely dangerous if left untreated.
