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Should asymptomatic carriers of Strep throat receive antibiotics?

Strep throat is a common bacterial infection caused by bacteria known as Group A Streptococcus or in short, GAS. Although Strep throat is easily treated with simple antibiotics, left untreated it can lead to dangerous complications like Rheumatic heart fever. These complications are especially prevalent in developing countries. Although certain groups of people even in developed countries can experience complications from Strep throat.

Diagnosing and treating Strep throat is critical to preventing these complications. Some individuals carry Strep throat bacteria in their throats and have no symptoms at all. These people are known as carriers. Although Strep throat carriers are asymptomatic, they are still contagious, and Strep throat can spread quickly, especially in crowded places like dorms and camps.

Who should get antibiotics for Strep throat?

Recommendations for treating Strep throat carriers with antibiotics vary widely between countries. For example in France, Finland, and the United States, treating everyone who tests positive for Strep throat is mandatory, regardless of being symptomatic or not. 

On the other hand, in New Zealand for example, a Strep throat-positive patient should be symptomatic first to receive treatment for Strep throat. 

For physicians and policy makers it's really a matter of weighing the risks and benefits of antibiotic therapy. Walking the line between preventing serious Strep throat complications and minimizing unnecessary antibiotic prescription.

Reports on the rates of Strep throat infection and carriage (asymptomatic carriers) vary considerably from one setting to another, and between age groups. For example, approximately 10% of  school-aged children are carriers of Strep throat. This figure drops to 7% when looking at the general population.

The benefits of rapid testing

Due to the damaging effects of unnecessary antibiotic use on both the environment and human health, proper Strep throat management and testing is critical. Rapid testing is the most efficient and effective way to quickly diagnose Strep throat. Once Strep throat is diagnosed, it can be easily treated with a course of antibiotics, like penicillin.

Recent developments in testing capabilities have led to rapid testing methods that can detect a Strep throat infection in a matter of minutes. There are two testing methods widely used to diagnose a Strep throat infection: throat bacterial cultures and antigen-detection methods. Both tests can quickly and accurately detect a Strep throat infection whether the patient is symptomatic or not. 

Strep throat carriers

A study was performed to measure asymptomatic strep throat carriage across different countries and age groups. The study found that children between the ages of five and 19 years old had the highest rate of carriage with nearly a quarter of children studied determined to be Strep throat carriers. 

As we mentioned earlier, the rate of complications from Strep throat is higher in developing countries than in higher-income countries. Although when studying the rate of Strep-throat carriage among various populations, the researchers found that the percentage of Strep-throat carriers is slightly more among higher-income countries than lower-income countries (6% in lower-income countries compared to 7% in higher-income countries). This difference can be attributed to fewer resources available to detect Strep throat in developing countries.

Carriers of Strep throat can be a real issue when it comes to preventing Strep throat infection within a population. Detecting infections using any and all available testing resources is important not only for the prevention of Strep throat spread, but to also limit the unnecessary use of antibiotics, which is a current global health problem. 

Antibiotic overuse and superbugs

Overusing antibiotics is contributing to the growing number of drug-resistant “superbugs.” Strep throat is easily managed because the bacteria is easily killed by common antibiotics. But when antibiotics are used when they aren’t needed, certain viruses and bacteria can learn to resist the drugs. Creating illnesses that are more difficult to treat, or require stronger medication with a greater risk of side effects.

Strep throat complications are serious and a real concern, which is why testing and diagnosing all Strep throat infections, whether they’re symptomatic or not, is critical.