By David Weiss, MD

Torrance Memorial Physician Network, Internal Medicine Specialist

Although strep throat can occur any time of year, it tends to circulate in winter and early spring. Strep Throat is caused by a bacteria and that bacteria can potentially reach us in June as easily as it can in November. Strep bacteria flourish wherever groups of people are in close contact. Torrance Memorial Physician Network primary care physician David Weiss, MD, answers your questions below.

1. What is strep throat and what causes it?

Strep throat is an infection in the pharynx /tonsils caused by a specific bacteria, Group A Streptococcus (GAS) pyogenes that causes a sore throat. There are other Streptococcus strains in the oral mucosa but strep throat refers specifically to symptomatic infection caused by GAS.

2. How contagious is strep throat (when and for how long is a person contagious) and how is it passed from one person to another?

Strep throat can be spread among close contacts within a household but the rate varies wildly from 5-50%. It is spread through respiratory droplets which are released when coughing, sneezing, laughing, talking, etc. As with most upper airway infections, patients are most contagious in the early stages when experiencing symptoms. Untreated, half of the patients can harbor the bacteria for 3-4 weeks.

3. How is strep throat diagnosed?

As with most potential infections, diagnosis starts with a careful history and physical exam. Often a clinician can exclude the possibility of strep throat at the bedside. When strep throat is suspected, there are several tests that can help confirm the diagnosis. These include rapid tests that can be done in the office or with throat culture.

4. How common is it in adults versus children?

Strep throat is the most common cause of pharyngitis in children, accounting for 15-30% of acute pharyngitis infections. The rate is lower in adults about 5-15%.

5. How is it treated? And is there any difference in the way it’s treated in adults versus children?

Penicillin is the treatment of choice in both adults and children; Amoxicillin is an acceptable option. When a severe Penicillin allergy is suspected, alternative antibiotics include Azithromycin and Clindamycin. It is important to note the treatment course is for 10 days and the entire course should be completed. Treatment can help improve symptoms, prevent complications of strep throat such as rheumatic fever, arthritis, and kidney inflammation.

6. Should I seek emergency or urgent care for a suspected case of strep throat, or should I wait to see my PCP?

Immediate evaluation should not be delayed if the sore throat is accompanied by fever that is greater than 100.5, muffled (“hot potato”) voice, drooling, stridor, and breathing difficulties. This can be due to potential complications when the infection causes significant swelling in the airway. Other concerning symptoms include severe pain that is present in only one side of the throat or neck, bulging appearance in the throat, neck swelling, or stiff neck. The danger with strep throat is that the infection can spread to local soft tissues potentially causing an abscess as well as spreading to the sinuses and middle ear. Rarely it can lead to meningitis and bacteremia when it spreads to the blood. Most patients will present with milder symptoms that can wait to be evaluated by their personal physician. Prompt access to their physician is an entirely separate discussion.

7. What else do you want readers to know about symptoms of strep?

Most cases of pharyngitis are due to respiratory viruses which do not respond to antibiotics. For this reason, physicians should refrain from prescribing antibiotics for this condition, as unnecessary use can diminish their effectiveness against bacterial infections.

David Weiss, MD, practices at Torrance Memorial Physician Network in Torrance, 3400 Lomita Blvd., Ste. 500. He can be reached at 310-784-4939.