Starting in childhood, we're taught to wonder the same thing about every sore throat: Is it strep?

More than 90 percent of the time, the answer is no. Most sore throats have nothing to do with strep, which is short for streptococcus, a common type of bacteria. But it's still a reasonable question. When strep throat does strike, it shouldn't be ignored. Unlike viral infections -- the most common cause of sore throats -- a case of strep can be quickly and easily treated. And if the infection is not treated promptly, the illness could spread to others or cause serious complications.

No matter what you do, there will always be a variety of germs in your throat. It's warm and moist down there, which is the ideal environment for bacteria to thrive. Most of these germs are completely harmless, but there is one type of bacteria that can be especially unwelcome: Group A strep. (This is also the same type of bacteria that can cause impetigo, a common skin infection.)

Anyone can get strep throat, but it's most common in children between the ages of 5 and 15. According to the Centers for Disease Control and Prevention, several million people develop strep throat each year.

Some people with strep bacteria in their throats don't have any symptoms. But if the germs get a chance to multiply, they usually make their presence known by causing a nasty sore throat. Most people also have a fever higher than 101 degrees Fahrenheit, along with swollen neck glands. Children may also have stomach pain and a rash with small spots predominantly under the arms and between folds of skin (like in elbow creases or behind knees).

After swabbing the back of the throat, doctors can run a rapid strep test in less than 15 minutes. But this procedure often fails to detect the germs, especially when performed by someone without enough experience. So although you can buy home strep test kits at the drugstore, you're much better off having the test done in a doctor's office.

If the rapid test indicates that you do have strep, your doctor can start treatment right away. If the test is negative, your doctor will probably order a throat culture just to make sure. A culture involves taking another sample from your throat, and then waiting 24 hours for any germs to grow. This test is a highly accurate way to detect strep. But if strep isn't your problem, you'll need other tests to diagnose the true cause of your sore throat.

The most effective treatment for strep throat is an antibiotic that kills the germs. Penicillin is often the first choice, but amoxicillin, erythromycin, and other drugs can also do the job. The infection should start to clear within 24 to 72 hours after starting the antibiotics. If a child has been taking antibiotics for at least 24 hours and the fever is gone, he or she can go back to school without the danger of spreading the strep germ to anyone else. But even if your child goes back to school -- or starts to feel better -- it's important to finish the entire course of antibiotics that the doctor prescribed.

Remember, however, that antibiotics only work against bacteria, and most sore throats are caused by something else. Overuse of antibiotics can encourage the growth of drug-resistant germs, so some doctors may be reluctant to prescribe antibiotics unless they're certain that strep is the culprit.

Despite these concerns, antibiotics are still overprescribed. A 2005 study published in the Journal of the American Medical Association found that over half of children who went to a doctor because of a sore throat received a prescription for antibiotics. Researchers estimated that -- at most -- only 36 percent of these children actually had strep.

While the antibiotics kill the germs, you can take a few steps to feel better. Ibuprofen or acetaminophen can help ease throat pain. (Never give aspirin to a child under the age of 18 who has a sore throat. There's a small but real risk that aspirin could trigger a serious illness called Reyes syndrome.) Older children or adults can suck on a throat lozenge or a piece of ice, or gargle with warm salt water (made by dissolving 1/4 teaspoon salt in one cup of warm water). Eating only soft foods, drinking cool or warm liquids, or sucking on popsicles may bring relief, too.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, Prevention, and other journals. He writes The Healthy Skeptic, a biweekly column in the Los Angeles Times. He is also the co-author of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

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First published February 28, 2008
Copyright © 2008 Consumer Health Interactive

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