Answering common questions about Strep throat

Strep throat is one the most prevalent infections in the U.S. It's estimated that millions of cases are diagnosed with Strep throat each year. Strep throat is a bacterial infection caused by a bacterium belonging to Group A beta hemolytic Streptococcus (GAS). Generally speaking, Strep throat affects children more frequently than adults. Approximately three out of every ten cases of sore throat is classified as a Strep throat infection. In this article we will try to answer some questions that commonly pop up when we are talking about Strep throat. 


Who has a higher risk of catching Strep throat? 

As we mentioned, children get Strep throat more frequently than adults. School-aged children are the most vulnerable to Strep throat among children of all ages. Compared to younger children (less than 5 years), kids between 5-15 years old have a higher risk of Strep throat infection (24% risk for younger children vs 37% risk for school-aged children). 


Adults are the least affected age group with a risk of getting Strep throat ranging between 5-15%. However, adults who have frequent contact with school-aged children are at a higher risk of acquiring Strep throat infection. Strep throat infections are generally more common in late winter and early spring. 


How can we differentiate between Strep throat and other causes of sore throat? 

Despite the fact that Strep throat is the most common bacterial cause of sore throat, the most common cause of a sore throat is generally viruses. That's why Strep throat can get missed and sometimes misdiagnosed as a viral infection, like infectious mononucleosis or hand-foot-and-mouth disease. 


The seasonality and the symptoms can help distinguish these infections from Strep throat. Strep throat is characterized by having a rapid onset, high fever, and intensely red inflamed tonsils. On the other hand, infectious mononucleosis is most common among people 20-30 years old, and causes more fatigue and enlarged lymph nodes in the neck (cervical lymphadenopathy). Hand-foot-and-mouth disease is characterized by painful oral lesions and rash in the hands and feet. This one is far more common in babies, especially those in daycare settings. 


How to diagnose Strep throat? 

Strep throat is diagnosed using a combination of both clinical decision and rapid antigen detection testing (RADT). The clinical decision on its own whether to treat should be made based on consideration of age, symptoms of the patient, and signs on examination. Based on the clinical assessment, patients who have low risk of strep throat should be treated symptomatically, which usually means antibiotics, but medications to help alleviate the symptoms.


On the other hand, for patients who have intermediate risk for Strep throat, a RADT test should be ordered to confirm the diagnosis before starting antibiotic therapy. Moreover, patients who have a high risk for Strep throat can be treated with antibiotics immediately without ordering a RADT. 



Is a tonsillectomy recommended if you have recurrent Strep throat infections? 

A tonsillectomy (surgically removing the tonsils) should be considered only for a specific group of patients who have recurrent Strep throat infections, and who also have an allergy to the antibiotics used to treat Strep throat. It can also be considered for patients with a peritonsillar abscess. A tonsillectomy is an invasive procedure and should be considered only after careful assessment.


As always, if you think you could have Strep throat, contact your physician for further guidance.