What to do about Strep Throat

While viruses are the most common cause of a sore throat, strep throat is a bacterial infection in the throat and tonsils caused by group A Streptococcus (group A strep). 

Diagnosing strep can be tricky; a diagnosis cannot be made simply by looking at the throat, even by a professional. Accurate diagnosis requires a laboratory test. The condition is far more common in children, specifically those aged 5-15, than adults. It's very rare to see strep in children younger than 3 years old. Infections are also most common during the winter and spring months. 

What Are The Symptoms Of Strep?

In most cases, strep throat is a mild but painful infection. The most common symptoms of strep throat include:

• a sore throat (which can begin very quickly)
• pain when swallowing
• fever
• red and white swollen tonsils (sometimes with white patches or streaks of pus)
• tiny red spots (petechiae) on the roof of the mouth
• swollen lymph nodes in the front of the neck

How does Strep Spread? 

Group A strep live in the nose and throat and can easily spread to other people. People who are infected spread the bacteria when they are talking, coughing, or sneezing. These actions create small respiratory droplets that contain strep bacteria. People can also spread the strep bacteria from infected sores on their skin. Most problematically, some infected people do not have any symptoms or even seem sick. People who have symptoms of strep throat are much more contagious than those who do not have symptoms. Once exposed, it usually takes two to five days to become sick with strep throat.

How Can I Prevent Strep? 

Close contact with another person with strep throat is the most common risk factor for illness, so it should be avoided if possible. Crowded settings can also increase the risk of getting a group A strep infection.

Good hand hygiene can prevent people from getting or spreading group A strep.  This is especially important after coughing or sneezing and before preparing foods or eating.  

How is strep treated? 

 Antibiotics

Antibiotic therapy may be appropriate in confirmed cases of strep throat. Penicillin, a first generation antibiotic, is the standard of care. Second generation antibiotics are not recommended. Treatment may last for 3, 6, or 10 days. 

Keep in mind, however, that antibiotics do not address the pain, inflammation, or other symptoms of strep throat. Those symptoms must be addressed through supportive measures. 

Supportive Care

Throat lozenges with menthol help to reduce pain in a sore throat. Honey has been found to reduce pain post-tonsillectomy and is a useful base for aromatic medicine during strep (Abdullah et.al., 2015). Anti-inflammatory botanicals such as turmeric reduce the inflammation that causes pain. Slippery elm bark makes swallowing more tolerable.

REFERENCES

Abdullah, B., Lazim, N. M., & Salim, R. (2015). The effectiveness of Tualang honey in reducing post-tonsillectomy pain. Kulak Burun Bogaz Ihtis Derg, 25(3), 137-43.

Choby, B. A. (2009). Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician, 79(5), 383-390.

Centers for Disease Control and Prevention. (2022). Strep Throat: All You Need to Know [Fact Sheet]. National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., ... & Van Beneden, C. (2012). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical infectious diseases, 55(10), e86-e102.

Tanz, R. R., & Shulman, S. T. (2007). Chronic pharyngeal carriage of group A streptococci. The Pediatric infectious disease journal, 26(2), 175-176.