Interview: Strep throat. What is it? What are the symptoms and what do you do about it? That's next on The Scope.
Announcer: This is "From the Front Lines" with emergency room physician, Dr. Troy Madsen, on The Scope.
Interview: All right. Today on the Scope, we're talking about strep throat: the symptoms and what you can do about it. Troy Madsen is an emergency room physician at University of Utah Health. Tell me, strep throat, and I think we should also talk about what people might confuse it with, but what is strep throat?
What Is Strep Throat?
Dr. Madsen: So strep throat is a bacterial infection of the tonsils. It's by strep, streptococcus, it's the full name of the bacteria. It's something you can get just by being exposed to someone with strep, usually from droplets like if they're coughing or they touched something that's been in their mouth and then you'd touch that and put it in your mouth. That's primarily how you're going to catch strep.
Interview: And what are the symptoms, normally?
Symptoms of Strep
Dr. Madsen: It's interesting with strep, it's one of these things where it's probably been so over-treated and confused over the years that there have really been some good studies done to try and figure out exactly what symptoms would suggest strep throat. There are four things that suggest strep throat. Those things are:
- first of all, not having a cough, so if your throat hurts and you don't have a cough, you're more likely to have strep;
- if you push on the front part of your neck and you feel your glands or your lymph nodes, sometimes we'll call them glands, you feel that area and it's swollen and it hurts, that also means you're more likely to have strep;
- if you have a fever, you're more likely to have strep; and
- the fourth thing, if you can somehow look in a mirror or if someone can look in your mouth with a flashlight, kind of pushing your tongue down a little bit, and you can see your tonsils and there's white stuff on the tonsils, that also suggests strep.
So those four things. There have actually been several studies done that looked at those and each one of those increases the likelihood of strep from about if you have one of those four maybe it's 10-15 percent chance, all four it's closer to 60-70 percent. So those are the classic symptoms of strep: sore throat without a cough, with tender, swollen lymph nodes in your neck, with a fever, and with white stuff on your tonsils.
Can You Get Strep Throat Without Tonsils?
Interview: And if I don't have tonsils, then I can't get strep throat?
Dr. Madsen: Technically, you could still get an infection back there. That's a great question. It's going to significantly decrease the likelihood that you would have strep throat. I think you can still get a bacterial infection back there. If someone came in and told me they have their tonsils removed and they're having pain there, I'm still going to do a throat culture on them to make sure there's nothing there.
Interview: All right. So that's the next step, right?
Dr. Madsen: Yes.
Interview: So if you have all those symptoms, then you should go to see your doctor and they're going to do a throat culture.
Rapid Strep
Dr. Madsen: Usually. But it's funny if you look at throat cultures, so we have what's called the rapid strep. It's that test that comes back, you do the swab, it comes back within an hour, sometimes faster, yes or no on strep, that's only going to pick up strep 70-80 percent of the time. And, like I mentioned, if you meet four of those four criteria for those symptoms, odds are 60-70 percent.
So it's really not wrong for a physician even to just examine you and say, "Hey, you meet all four of these criteria. You've got strep. Let's skip the rapid strep. We know what the answer is." It's not wrong to just do that and then treat with antibiotics. But your doctor very well may opt to just do a throat culture to confirm what they already think.
Strep Treatment
Interview: All right. And antibiotics, is that the only form of treatment?
Dr. Madsen: It is. Yeah. I mean typically, yup, you're going to be on antibiotics for that and usually about a week of antibiotics.
Interview: Got you. Is there anything other than the discomfort that could come up strep throat that if I didn't take care of quickly enough?
Dr. Madsen: There are things. I mean they're rare, but the concern with strep is if it's untreated it can lead to things. You may have heard of scarlet fever. That can be something that happens after strep. It can cause kidney issues, heart issues, and those are rare things, but they do happen in people who do not have strep treated.
Interview: And what would be the difference between recovery time not treated and antibiotics?
Dr. Madsen: That's a great question and it's probably subject to a little bit of controversy. There's more out there suggesting that antibiotics may shorten the duration of strep by maybe a day.
Interview: That's it?
Dr. Madsen: I know. It's so surprising. And a lot of times, the antibiotics, it's even more maybe in kids to prevent some of these complications I talked about, but more stuff that's come out is suggesting maybe even in adults, it may shorten the symptoms by a bit, maybe get you back to work in four days instead of five, but it may not be that magic pill we've talked about. There are even some people who have argued maybe in adults, you don't treat it with antibiotics.
Again, there's a little bit of a controversial area, something that's been subject to more research that I've seen more kind of come out on and more people trying to sort out what exactly do we do with this. But I think in kids, it's probably a bigger deal because of those complications I mentioned. In adults, I'm not suggesting necessarily you tough it out, but also don't expect that you're going to take antibiotics and within 12 hours you're going to feel great. You're going to continue to feel sore and continue to have a sore throat for probably at least a few days after starting antibiotics.
Interview: Alright. So you can choose to treat it or not, it sounds like. If somebody's asking you for advice, "Should I take the antibiotics?" what would you say? I mean this is where it gets into that thing about your kind of own experience versus what does the data say? What does the research say?
Dr. Madsen: Yeah, if someone comes to the ER and I diagnosed them with strep, I recommend they take antibiotics. And I'm doing that in part because they've come in seeking help, it's going to shorten the duration of their symptoms at least a little bit. It probably helps, also, to decrease the transmission of the bacteria. I think it's going to assist with that. My recommendation is to be treated, to take the antibiotics, and, at this point, I can't say that I would feel comfortable just absolutely saying, "Don't treat it; don't worry about antibiotics; tough it out; you'll be fine."
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updated: July 6, 2018
originally published: December 5, 2016
