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Symptoms, tests signal strep throat

The Baltimore Sun

Late winter is high season for scratchy, itchy or sore throats, and most of us know how miserable having one can be. But how do we know when a sore throat is simply part of a common cold and when it is a symptom of the potentially more serious strep throat?

It's wise to take note of your symptoms, says Alan Oshinksy, otolaryngologist-in-chief at Northwest Hospital Center and Sinai Hospital. Strep throat, left untreated, can not only be painful but can also lead to a more serious condition.

What is strep throat?

Strep throat is a bacterial infection involving either the tonsils or the back of the throat. The most common symptoms are a fairly significant sore throat and a fever. It's called "strep" because the infection is caused by a kind of bacteria known as streptococcus.

When you have a sore throat, how do you know when to consult a doctor?

If you have a sore throat plus other symptoms of a cold, such as stuffy nose or a cough, it is likely that your sore throat is not being caused by strep throat, but by a cold. [The common cold is caused by a virus and typically will go away within a few days.] But if you have a sore throat and fever, it is good to consult a doctor. You may have strep throat.

How is strep throat diagnosed?

The gold standard is the culture. There are two kinds: a rapid strep test, which takes three to five minutes, and a throat culture.

The rapid tests have a high degree of specificity, which means that if the test is positive, then you have strep. But the test also is only about 90 percent sensitive, which means it may produce false negatives. So if your doctor tests you with a rapid test, and it is positive, he can treat you immediately for strep throat. But if it is negative, he may follow it with a throat culture.

How does a doctor decide whether to test for strep throat?

Strep throat will cause a visible coating on the tonsils, an exudate. By the way, you can get strep throat even if you have had your tonsils out. And typically your lymph nodes - commonly people call them swollen glands - are swollen.

Also, if the patient knows he has been exposed to someone who had strep throat in the past few weeks, this is taken into consideration.

Is strep throat more apt to affect children?

In children, a sore throat will be the result of strep throat upward of 30 percent of the time. In adults, strep is the cause about 5 to 10 percent of the time.

Other than being painful, what are the risks of having strep throat?

The main risk we worry about in patients with strep is that they could wind up with rheumatic fever, and that could cause rheumatic heart disease.

The far bigger health problem, though, is that, unfortunately, most doctors and patients have a predisposition to want to use antibiotics. And since only about 10 percent of cases [in adults] are strep, then we are overtreating patients. That means we are exposing them to antibiotics they don't need and are running the risk of having resistant organisms develop in the body.

So if you have a patient who has the symptoms, do a rapid strep test and if they are positive, treat them. And if it is negative, but they have all the symptoms, do a throat culture and in 24 to 48 hours you will know for sure.

You have about nine to 10 days to treat someone before they are at risk for developing rheumatic fever, which can lead to rheumatic heart disease, which is a serious health problem.

Is strep throat contagious?

It is very contagious. It typically is spread by droplets or body fluids usually from the mouth or nose; any secretions, whether drops or vapor from the nose, or if you touch your nose, can spread it. Typically, doctors prescribe penicillin or amoxicillin, and the treatment should be for 10 days.

On the other hand, within 24 hours of starting antibiotics, you are no longer contagious. So that is a good reason to start promptly. Also, the sooner you start treatment, the quicker you are going to be better.

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