Help, I have a sore throat! Is it Strep? Understanding pharyngitis

shutterstock_120865177Sore throat is one of the most common problems that people have in the winter when they come to the medical clinic. There are many different causes of a sore throat, including bacterial or viral infections.  Although a sore throat usually resolves without any complications, there are times that antibiotic treatment is required.  There are very rare causes of sore throat pain that can be serious or life threatening.

When to call the doctor:  Since it’s tough to know your sore throat is caused by a virus or bacteria, I encourage you to call your doctor if one or more of the following are present:  temperature > 101 degrees F or 38 degrees C, season is late fall, winter or early spring, you don’t have a cough, the age of the patient is between 5-15 years old, recent exposure to someone with strep throat, difficulty breathing/swallowing, your voice sounds muffled, they have a stiff neck or difficulty opening their mouth.

Causes of sore throat:  Viruses are the most common cause of sore throat, but bacteria are another common cause.  The causes of sore throat depend on the age of the patient as well as the season and geographic location.  Many different viruses can cause swelling and throat pain.  Most common viruses that cause sore throat also cause the common cold, but others include influenza, adenovirus, and Epstein-Barr virus (the cause of mononucleosis).

Symptoms of viral pharyngitis:  Usually with a viral infection, the patient will have runny nose, nasal congestion and can even have irritation and/or redness of the eyes, cough, hoarseness, skin rash and even diarrhea.  Viral infections can also cause fever that makes you feel miserable.  A high fever does not mean that your you have a bacterial infection.

Group A streptococcus – (GAS):   The bacteria that causes strep throat.  Other bacteria can also cause sore throat, but group a strep is the most common.  Up to 30% of children with sore throat will have strep throat.  Winter and early spring are the most common times of the year when it occurs.  It is the most common in school-age children and their young siblings.

Symptoms of  Strep Throat:  Sudden development of fever (temperature > 100.4 degrees F), headache, abdominal pain, nausea and vomiting, swollen glands in the neck, white patches of pus in the back or sides of throat, small red spots on the roof of the mouth.  A cough and cold are not usually seen with strep throat.

Diagnosis:  Most of the time the cause of the sore throat is a virus and does not require treatment with antibiotics.  It is, however important to recognize and treat kids with strep throat to prevent complications of strep throat which can cause rheumatic fever.  There are two types of tests that can help diagnose strep throat.  One is a rapid strep test and the other is a throat culture.  Both of these tests require a swab of the back of the throat to look for the strep bacteria.   The throat culture is more accurate, but it takes 24-48 hours to get the results back.  The rapid test isn’t quite as accurate but the benefit is that you know the results before going home from the clinic.

Treatment:  The treatment of sore throat depends on the cause; strep throat is treated with antibiotic while viral pharyngitis is treated with rest, pain relievers and measure to make the patient more comfortable while the body heals. It is important to monitor for dehydration because some children with sore throat are reluctant to drink or eat due to pain.

Strep throat is usually treated with an antibiotic such as penicillin or similar antibiotic.  After 24 hours of treatment, children can return to school most of the time.  If they are having trouble swallowing or eating, they should not go to school and should be re-evaluated.  The antibiotic is usually continued for a full 10 day course.

Anti-inflammatory medications such as naproxen, ibuprofen, dexamethasone or prednisone can be helpful to reduce the pain of sore throat.  Oral rinses such as salt-water gargles, sprays, lozenges, and sipping warm liquids can also be helpful for sore throat pain.

Complications of strep throat:  Most of the time strep throat itself isn’t dangerous.  It can, however lead to serious complications such as the spread of the bacteria to the sinuses, skin, blood and middle ear.  Strep throat can also lead to Scarlet fever (illness with rash), inflammation of the kidney (post-streptococcal glomerulonephritis), and even Rheumatic fever, which is a serious condition that can affect the heart, joints, nervous system and skin.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO



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