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Sore Throat: Is it Strep?

Having a sore throat is not only a literal pain in the neck; it is also often a mystery. Is it the beginning of a cold? The flu? Are you allergic to something in your home or workplace? Is it a sign of something more serious? Will it go away on its own or should you call the doctor? One of the many causes of sore throat is infection with streptococcal bacteria, a condition commonly known as strep throat. Strep throat does require medical treatment, and there usually are some subtle differences in how it presents itself.

“The most common causes of sore throat are viruses, which include colds, influenza and mononucleosis; allergies; and a change in the environment like the dry conditions created by having heat on in the winter,” says John David Hackett, MD, family physician at Beth Israel Deaconess HealthCare-Waltham. “Throat pain may also occur with ear infections or dental abscesses. Although there is no one symptom that tells individuals they have strep, there are some telltale signs.”

The symptoms of strep throat include sudden sore throat, a fever higher than 100.4 degrees, a white patch at the back of the throat, and redness of the flap of tissue that hangs in the back of the throat. Less common symptoms include headache and stomach pain. “Generally, people who have strep throat do not have cold symptoms like a cough, runny nose or congestion,” says Dr. Hackett. “The only exception is children under five years old, who are also less likely to be infected with strep.”

Strep throat is spread by exposure to the secretions (saliva or mucous) of someone who is already infected, so having a sore throat and knowing that strep has been going around in the workplace, at home, or at a child’s school or daycare center is another clue that you may have step. The incidence of strep throat is less prevalent in the summer months and generally peaks in winter.

“Patients who think they might have strep should call their healthcare providers,” Dr. Hackett says. “If it sounds like strep or something more serious than a common virus that simply needs to run its course, we’ll want to see them as soon as possible.” The only way to diagnose strep is with a throat culture, which entails the provider swabbing the back of the throat with a cotton swab and conducting either a rapid or regular strep test. If the test is positive, a ten-day course of antibiotics is generally the prescribed treatment.

“We need to make an accurate and timely diagnosis for a few different reasons. We need to make sure we’re not overusing antibiotics, so if it’s not a bacterial infection, another treatment plan will be more appropriate,” says Dr. Hackett. “Early diagnosis and treatment also reduces the risk of spreading the infection to family members, friends and colleagues. In addition, it reduces the possibility of developing complications such as ear infection, sinus infection, abscess and scarlet fever.”

Following a diagnosis of strep throat, individuals need to stay home from school, work and places that expose them to other people until they are no longer contagious – usually for 24 hours after beginning treatment with antibiotics and being fever-free. Many workplaces, schools and child care providers have specific guidelines.

Taking all of the antibiotics exactly as prescribed is essential. “I tell my patients that not completing the full course of treatment may squish the infection and make them feel better, but it won’t kill it,” Dr. Hackett says. He also emphasizes the importance of taking proper precautions to reduce the risk of getting or spreading strep. These include frequent handwashing with soap and warm water, and covering the mouth and nose when coughing or sneezing.

In addition to seeing a healthcare provider, being diagnosed and taking the prescribed medication, people with strep throat can alleviate their symptoms with non-prescription remedies such as ibuprofen or acetaminophen, tea, honey, chicken soup, popsicles, ice chips or hard candy – whatever makes their throats feel better while the medicine does its work.