Friday, January 3, 2014

Strep Throat

Please see the updated post October 2018
Strep throat is a bacterial infection caused by the Group A streptococcus germ.

This illness  is most common in people between 5-15 years of age.

Someone with strep throat will usually present with one or more of these symptoms:
*Sore throat
*body aches
*stomach ache
*a red sandpapery rash all over the body 

As a parent you can check your kids out for the following:
*Throat will usually look quite red. You may see red or white patches in the throat or on the palate ( the back part of the roof of the mouth) 
*Tongue might have red and white patches ( Known as strawberry tongue)
*glands may feel swollen
*stinky breath

Not everyone has all the symptoms.
Some folks don't even complain about a sore throat!
Some folks don't get a fever!

Strep with the rash may be referred to as Scarlet fever...sounds scary right?? Indeed it used to be. Now that we have antibiotics to treat it with Scarlet fever is no more alarming than simple strep.

It is quite contagious, but it is not uncommon for some family members to have it, while others escape. I would say that in my experience the odds are about 50/50.
(The minute someone in your family gets that sore throat I would suggest sucking on a zinc lozenge and some sambucol..maybe you will get lucky)
The incubation period ranges from 1-5 days but most of the time folks show the first symptoms about 2-3 days after exposure.
You can catch it from being in close contact with someone else who has it.
If you treat with antibiotics (which is recommended) you are not contagious once you have completed 24 hours of the medication
If you don't treat, you remain contagious and can spread the illness for about 3 weeks.
It does resolve by itself but the antibiotics absolutely shorten the severity and duration of the illness as well as significantly decreasing the risk of complications. 

The reason I tend to be watching out for it when I hear about the symptoms is because untreated Strep throat can lead to complications later on, such as rheumatic fever and heart valve problems.
It is impossible to have real statistics about this.
I imagine that there are seriously millions of untreated cases of strep out there at any given time and of course most of them will have no issues in the future. 
Of course most folks don't jump into the doctors office every time they have a sore throat...and as I mentioned, it does resolve on its own.
That being said, If we know you have a case of strep throat, we will strongly advise that you do a course of antibiotics.

When parents call and we try to decide whether or not they should come in to get tested we try to consider all of the symptoms.
For some reason is is quite unusual for babies under 2 years of age to have it, but there are always exceptions.
Be aware that children under 5 often say that their "mouth" hurts, but they are talking about their throat.

Typically the strep throat 'package' does not come along with a lot of congestion.
If I am hearing about someone with lots of coughing, clear mucous and sore throat, it is more likely viral.
On the other hand, a sore throat with fever and not a lot of congestion gets my antenna up.
I am not kidding when I mention stinky breath. A lot of the moms that I talk to can tell strep from the smell and they are almost always right!

Nausea and tummy aches are quite frequent with strep, but add some diarrhea to the mix and I am no longer as suspicious. Nausea plus loose stools is usually more of a tummy bug of sorts.

We test for strep in the office with a 5 minute quick strep test that we find fairly reliable. If the test is negative, but the symptoms scream strep, we will send a culture to the lab to double check the result.

Our test is specific for Group A strep
 There are different strains of the strep bacteria that can cause various infections 
If the in office test is negative, the lab test come back positive with another strain.  

Some folks are carriers. This means that they have a small amount of the bacteria living in their body all of the time and it doesn't make them ill. Those folks may show a very faint positive on the quick test.
Some patients also seem way more susceptible to Strep than others. I used to get it all the time until I had my tonsils out. That is not an uncommon story.  

If you do end up being treated, It is important that you finish your course of antibiotics.
If you are not seeing an improvement within 72 hours of starting the medication, make sure you check in with your doctor.
It is rare, but strep can lead to complications including abscesses on the tonsils, ear infections as well  as kidney problems.

Change your toothbrush 24 hours after starting the antibiotics so that you don't get reinfected!

Symptomatic treatments until the antibiotics kick in include
*Tylenol or Motrin (we are treating pain, not necessarily fever)
*Tea with honey (no honey for kids until one)
*Gargling with salt water
*Popsicle s
*Cold fruit nectar 
*Having a humidifier running at night. 

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