Strep throat occurs at all times of the year and is one of the most common reasons kids
go to the doctor. Strep throat is caused by Group A streptococcus, and accounts for
15% of all sore throats. That means that 85% of all sore throats are caused by something
The symptoms of strep are sore throat, difficulty swallowing and fever. Kids can also
get fatigue, headache and belly pain. If your child has a runny nose, a cough or is
hoarse, or has evidence of an eye infection at the same time, the cause of the disease is
unlikely to be strep. It would fall into the category of something else.
I know that "scarlet fever" always sounds really scary, but it's just strep
throat with a rash. I think that before strep was found to be the cause of scarlet fever,
the diseases (scarlet fever and strep throat) were considered separate. They aren't. Just
some kids are lucky enough to get the whole package ( that was sarcasm). And just as you
can get strep throat more than once, you can get scarlet fever more than once.
Even the best doctors in the world can only predict strep based on physical exam alone
about half the time ( we can all guess right half the time!). We only prove the
presence of strep in the throat by testing for it. We do a "rapid strep" when
you come to the office to test for the Group A strep antigen. It's right about 90% if done
well. And a positive test is very helpful. A negative one isn't. That's why we run a back
up culture on all rapid strep tests that are negative. We are testing, with that backup
culture, not only for the presence of Group A strep, but for other members of the strep
family and for other sore-throat-causing bacteria. Neither the rapid strep nor the culture
will detect viral infections.
We only need to treat certain bacteria. Group A strep is a problem because it makes us
feel awful, but moreso because it causes harmful consequences if it isn't treated
Your child needs to be on antibiotics 24 hours prior to returning to school or work or
whatever. If the strep test is negative, returning to activities when your child feels
better, even the next day, is fine.
I hear this all the time: "amoxicillin isn't strong enough." Now's the time
for a crash course in microbiology. Each antibiotic has a certain range of bacteria that
it takes care of. When we treat ear infections, pneumonia, sinusitis or other bacterial
infections, we are basing the treatment on which bacteria, if any, we think are most
likely to be causing the disease, and then tailoring the treatment based on what we know
about antibiotic resistance patterns of those particular bacteria.
Many kids get the infection, get treated right away and then, as soon as they get off medication, get it again. This usually happens during the school year when strep is all over. Since strep is really sensitive to penicillin, if we treat it early enough (within a day or two of symptoms, then the immune system may not have even known it was there. So, when you are around people with strep again, you get it again, since your body never made antibodies against your last infection. Some researchers suggest waiting for symptoms to progress for 2 days prior to treatment. I haven't done that, but the risk we run is that you get re-infected as soon as you're off medication.
I'm going to talk about a few of the other sore throat things that aren't bacterial.
It's the season for hand-foot and mouth disease, a summer viral infection. As you can
guess, it involves the hands (including the palms), the feet (including the soles) and the
This is a disease caused by another summer virus (enterovirus) and again causes mouth ulcers, especially on the
tonsils. This one can also cause fever, as high as 105 can be expected. Kids may have
vomiting, headache, and gum swelling. In fact, the gums will often bleed. This disease is
common in kids ages 3-10 and lasts about a week.
This one's caused by a member of the herpes virus family (not the herpes
virus, but another family member). It's usually seen in kids 6 months to 3 years of age.
call us if your child