STREP THROAT

DEFINITION

Strep throat is an infection of the pharynx (pronounced FAAR-ingks). The pharynx is the part of the throat that connects the mouth and the larynx (pronounced LAAR-ingks), or voice box. Strep throat is caused by a group of bacteria known as the streptococcal (pronounced strep-tuh-KOK-uhl) bacteria. If untreated, a strep throat can lead to serious complications, such as rheumatic fever (see rheumatic fever entry).

DESCRIPTION

Strep throat accounts for 5 to 10 percent of all sore throats. Anyone can get the disease but it is most common among school age children and certain groups of adults. Adults at higher risk include smokers, people who are unusually tired, and those who live in damp, crowded conditions.

Strep throat occurs most often between November and April. The disease passes directly from person to person and coughing, sneezing, or close contact can transfer it from one person to another. If someone in a household has strep throat there is a one in four chance that another person in the household will get the infection, too.

CAUSES

Strep throat is caused by various types of bacteria called Group A streptococcal bacteria. These bacteria cause other common infections also, such as tonsillitis and scarlet fever.

SYMPTOMS

The first symptoms of strep throat appear one to five days after a person is infected. The symptoms are no different from any other kind of sore throat (see sore throat entry). They include fever, chills, headache, muscle aches, nausea, a feeling of tiredness, and swollen lymph glands. (Lymph nodes are small round or oval bodies that are part of the body's immune system.) The patient's tonsils will be swollen and have bright red with white or yellow patches on them. A person with strep throat often has bad breath. Strep throat can often spread and cause an infection to the tonsils (see tonsillitis entry).

Some people with the disease may have few or no symptoms of strep throat. Many young children may get a headache or stomachache, but show no signs of having a sore throat. Other patients develop a high fever along with a sunburn-like rash on the face and upper body, and their tongues may become right red. This form of the infection is known as scarlet fever (see scarlet fever entry). Scarlet fever is no more dangerous than strep throat and both illnesses are treated the same way.

A serious complication of strep throat is rheumatic fever. Rheumatic fever (pronounced roo-MAT-ick FEE-vur) occurs most often in children between the ages of five and fifteen. However, rheumatic fever is relatively rare and is seldom a problem if strep throat is treated properly and quickly.

DIAGNOSIS

The first steps in diagnosing strep throat are a patient history and physical examination. The doctor will ask if the patient has been around other people with the infection. He or she will also examine the patient's throat and chest. The doctor will also try to eliminate other potential causes of the symptoms, such as bronchitis (see bronchitis entry) or sinus infection.

Two kinds of tests are available for strep throat. Both involve taking a throat culture, which is done by using a cotton swab to remove a sample of tissue from the sore area in the throat. The sample can then be used for a rapid strep test or a culture.

The rapid test shows whether streptococcal bacteria are present in the throat. The results are available in about twenty minutes. The advantage of the test is the speed with which a diagnosis can be made. Its disadvantage is its high rate of error. The results are wrong in about 20 percent of all cases.

For this reason, the throat culture is often used for a second test. In this test, the sample obtained from the throat is allowed to grow in a warm, moist place for a period of twenty-four to forty-eight hours. During this period, the bacteria reproduce and grow. They reach a size where they can be studied under a microscope to see what types of bacteria are present. This test produces a much higher rate of accuracy in determining whether a patient has strep throat.

TREATMENT

Strep throat is treated with antibiotics. Antibiotics are substances derived from bacteria or other organisms that fight the growth of other bacteria or organisms. Penicillin is the most common antibiotic used. The penicillin is usually given orally (by mouth). The usual treatment lasts for ten days. Patients are advised to be sure that they take all of the medication given. If they stop too soon, the infection may return. Penicillin is sometimes be given by injection. A long-lasting form of the drug (Bicillin) may have the same effect as a 10-day treatment with pills.

About 10 percent of the time, penicillin is not effective against the strep bacteria. In that case, another antibiotic is prescribed. People who are allergic to penicillin may also require an alternative. Other antibiotics used in such cases include amoxicillin, clindamycin, erythromycin, or cephalosporin.

Though strep throat usually gets better on its own after four or five days, antibiotics are usually prescribed anyway, to prevent complications such as rheumatic fever from developing.

Home Care for Strep Throat

Some simple home care treatments can be used to make a patient with strep throat more comfortable. These treatments are used in addition to, not in place of, antibiotics. These home treatments include:

• Pain killers, such as acetaminophen or ibuprofen. Aspirin should not be given to children because of the risk of Reye's syndrome (see Reye's syndrome entry).
• Gargling with double strength tea or warm salt water
• Drinking plenty of fluids, excepting for acidic fluids such as orange or grapefruit juice
• Eating soft, nutritious foods, such as noodle soup
• Avoiding smoking and second hand smoke
• Resting until the fever is gone and then resuming normal activities gradually
• Using a room humidifier

Most throat lozenges and sprays available in drug stores should be avoided. They are likely to make a strep throat worse.

Alternative Treatment

Most alternative treatments are designed to ease the symptoms of strep throat. They do not help to cure the infection. One recommended treatment is the use of the bacterium that occurs in yogurt, Lactobacillus acidophilus, (pronounced LACK-toe-buh-SILL-us as-ih-DOFE-uh-luhss) to counteract the effects of antibiotics on bacteria that occur naturally in the intestines.

Other suggested treatments include:

• Inhaling the fragrances of certain herbs, such as lavender, thyme, eucalyptus, sage, and sandalwood
• Gargling with a mixture of water, salt, and tumeric, alum, sumac, sage, or bayberry
• Taking a tea made from osha root, sage, Echinacea, or cleavers

PROGNOSIS

Patients with strep throat usually begin feeling better about twenty-four hours after first taking antibiotics. Symptoms rarely last longer than five days.

People remain contagious until they have been taking antibiotics for twenty-four hours. Children should not return to school until they are no longer contagious. Food handlers should not work during the same time period. People who are not treated with antibiotics may continue to spread strep bacteria for several months.

PREVENTION

The risk of passing strep throat from one person to another can be reduced by some simple actions, such as:

• Washing hands frequently and well, especially after nose blowing or sneezing and before handling foods
• Disposing of used tissues properly

Group A Streptococcus bacterium. (© 1998

J.L. Carson

. Reproduced by permission of

Custom Medical Stock Photo

.)

• Avoiding close contact with someone who has strep throat
• Not sharing food and eating utensils with other people
• Not smoking

FOR MORE INFORMATION

Web sites

"Ask NOAH About: Respiratory Disorders." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/respiratory/resp.html#STREP (accessed on October 31, 1999).

National Institute of Allergy and Infectious Diseases. "A Group of Streptococcal Infection." NIAID Fact Sheet. [Online] http://www.niaid.nih.govfactsheets/strep.htm (accessed on February 1, 1999).