Sore throat is a common complaint in the pediatrician’s office. The most common cause is viral infection resulting in a sore throat, low grade temperature and usually accompanied by a runny nose or cough. Strep throat usually presents with a triad of symptoms: fever between 101 and 104 degrees Fahrenheit, sore red throat and swollen lymph nodes in the neck. Children with strep throat are often more ill appearing than those with viral infection. It is important to differentiate between viral throat infection and Strep throat because antibiotics are needed to treat Strep.
Group A Streptococcus is the name of the bacteria causing the infection. Strep throat infections occur most commonly in school age children. Winter and spring seasons tend to be when we see the most Strep infections, though we do see it throughout the year.
Common viral causes of sore throat are Coxsackie virus which causes Hand Foot and Mouth illness and adenovirus which can cause conjunctivitis or “pink eye” along with the sore throat. A variety of other viruses and cause sore throat as well.
Strep throat and viral throat infections are spread through contact with the infected person’s saliva or other secretions that are expelled when coughing or sneezing. This transmission is aided by kids being close together while at school or day care centers. The rate that the infection is passed is about 35% of the time when close contact occurs between infected and non-infected people. We all know how frequently kids come into close contact with each other, so it does make it easy for the infection to spread. Signs of infection occur 2-4 days after contact with the infected person.
The symptoms of Strep throat are most commonly sore throat, fever, headache, and difficulty swallowing. Kids often complain of stomach pain, nausea, and vomiting as well. When we check the throat it is often a “beefy” red with or without pus on the tonsils. The lymph nodes in the neck are also swollen and sometimes a rash may be present. When the rash is present it often feels like running your hand over sandpaper and is called the “scarlet fever rash”. Symptoms of runny nose, cough and diarrhea are less likely to be related to a strep infection and more often a result of a virus.
Diagnosing Strep can be done quickly and easily with a swab of the throat and a rapid strep test. This can be done in the office in about 10 minutes. Sometimes it may be necessary to send a throat culture to the lab to verify strep infection. Throat culture takes about 48 hours to be resulted.
Treatment of strep throat with antibiotics is necessary to both shorten the course of illness and to prevent complications. We use either a Penicillin type antibiotic, such as Amoxil, or a Cephalosporin, such as Keflex, as first line treatment. In spite of using these antibiotics for many years, they are still effective in killing Strep germs the majority of the time. These antibiotics should be taken for a full 10-day course. An injection of long acting penicillin can be given as an alternative to oral medication. One penicillin shot equals 10 days of oral antibiotics. Penicillin allergic patients can be given Azithromycin or clindamycin instead.
If a viral infection is suspected as the cause of the sore throat, symptom care is all that needs to be done. Antibiotics are not helpful in the treatment of viral infections.
Finally, here are some tips to help avoid infections this fall and winter: wash your hands frequently and especially before meals, cover mouth and nose when coughing or sneezing, get plenty of rest and eat a healthy diet. Also make sure to get a flu vaccine! We wish you the very best health this fall.