When I was growing up, my mother was consistently kind, loving and patient. She was also consistently insensitive to physical ailment. A gushing wound was just a scratch. A throbbing headache was met with, “Everyone gets some aches and pains now and then.” Band-aids were given reluctantly and Dimetapp was coveted like lidocaine on a battlefield. In this way, I am her daughter through and through. “You’ll be fine” and “You need to go to bed earlier” are my go-to responses to any of my children’s complaints.
Last week, my 7 year old had a sore throat. I assumed she was thirsty and prescribed more water and sleep. A week later, when it persisted, I took her for a strep test just to cross it off my list. The rapid in-office test was negative. I shooed her back to school immediately, so her teacher, not me, could deal with the whiny face. The next morning, right after drop-off, I got the call. The strep bacteria grew out overnight. I rushed back to the school immediately to save her classmates from her germs and to get the first dose of antibiotic into her system.
What is strep throat, and why do we take it so seriously?
1. A sore throat is a general term to describe inflammation of the throat and the surrounding tissues, including the pharynx, tonsils, larynx and the top of the esophagus and trachea. The most common cause of a sore throat, other than screaming at your kids, is a virus. Less commonly, it can be caused by bacteria. The most common bacteria to affect the throat is Streptococcus pyogenes which is part of the Group A Streptococcus family. (The bacteria a pregnant woman is tested for at 36 weeks is Group B Streptococcus.)
2. Strep throat is a short name for Streptococcal Pharyngitis. It is not the same as a simple sore throat, tonsillitis or laryngitis. About 15-30% of “sore throats” in the 5 -15 year old age range is caused by Strep. In the adult population, it is the culprit about 5-10% of the time. It is contagious and is usually passed through the air. If someone in your family has strep, there is a 40% chance for the other members to get it.
3. Symptoms usually start within 4 days of infection and include:
– a red, swollen, sore throat often with white pus or exudate present
– swollen lymph nodes
– stomach ache
– rash — the bacteria release toxins into the bloodstream which cause the rash, a rash is not indication that the bacteria itself has infected the skin. Presence of the rash, which is red, raised and feels like sand paper, is called Scarlet Fever. About 10% of kids with Strep throat will have this complication, and it does not make the Strep throat more dangerous.
Alternatively, the following symptoms make one think the sore throat is not caused by strep:
– cough, runny nose, conjunctivitis and cold symptoms
– general weakness and fatigue
Symptoms vary by age and individual characteristics. Adolescents usually suffer the most. Some parents will know their child has strep because he or she always gets a stomach ache and fever with strep. Some kids have a fever with no sore throat. Past history and a gut feeling is a good indicator of when to get tested.
4. Strep throat is usually diagnosed with a throat swab. The rapid test done within minutes in the office is usually very accurate, especially if it is positive. In certain cases, the bacteria need 24-48 hours to grow in culture before they reveal their ugly selves. Strep throat is treated with antibiotics, the choice of which is a discussion to have with your doctor.
5. Why do we treat?
– early treatment reduces duration of symptoms
– early treatment reduces rate of transmission
Most importantly, untreated strep can result in throat abscesses, ear infections, pneumonia, meningitis, glomerulonephritis (inflammation of the kidneys) and toxic shock syndrome. The most well-known serious complication is acute rheumatic fever. Essentially, the immune system starts to attack the organs of the body, specifically the joints and the heart, potentially causing serious destruction.
As I mentioned, I am a non-alarmist. As I write this though, I am chastising myself for not getting Lorelei treated earlier. My defense is she was behaving normally and had no fever or other telltale symptoms — she’s also a bit of a hypochondriac. I hate prescribing antibiotics unnecessarily, but Strep is the exception. If you are suspicious you or your child has strep, don’t wait. Get tested.