How We Diagnose and Treat Strep Throat

Strep Throat is one of the most common illnesses kids face on a regular basis. As a parent, you probably receive a dozen notes from school stating that another child has the illness, and at North Suburban Pediatrics (NSP), we see dozens of kids every month with suspected cases. But what is strep throat and what should we consider when treating it?

Strep throat is an infection caused by a bacteria called Streptococcus pyogenes or “Group A Strep.”  It often affects children and adolescents ages 3 to 15 years old but infections in younger and older children (and adults) are possible.  

The hallmark symptoms of strep throat are fever, sore throat, and swollen lymph nodes in the front of the neck; other symptoms can be mild abdominal pain, nausea or vomiting, and in some cases, a pinprick, sandpapery red rash on the trunk.  Strep can cluster in families, childcare settings, and classrooms although sometimes an ill child won’t have any known contact with someone with strep. Physical exam findings of strep include pus on the tonsils, red spots on the roof of the mouth and tenderness of the lymph nodes in the front of the neck.

The reasons for treating strep from a parental experience are satisfying – an antibiotic can reduce symptom duration and get your child back on track (and back to school) more quickly.  From a pediatric medical perspective, however, the reasons for using antibiotics are more nuanced. The importance of treating strep is twofold – we want to help kids feel better quickly AND we want to prevent future complications from this infection.  If left untreated, almost all cases of strep throat will eventually resolve on their own.  However, when this occurs, there is a risk developing a more serious condition, rheumatic fever, which can involve heart disease and lifelong reliance on antibiotics.  

Strep is diagnosed with a throat swab. Deciding to perform a throat swab for your child is something we take seriously. However, a positive result does not always indicate that Group A strep is causing your child’s illness!  Many studies have found that a percentage of healthy school children will have positive strep swabs without having an infection; this “false positive” phenomenon is known as “colonization” and is not associated with disease.  When a doctor advises against performing a strep swab in your child, they are trying to guard against discovering a false positive that nonetheless obligates treatment. This leads to unnecessary antibiotic exposure to your child and will not get them better any more quickly.

The most common situation where a child ought not to need a throat swab include when a child has classic symptoms of a cold – runny nose and watery eyes – or cough.  Cold viruses can cause sore throat but testing for strep in these contexts is usually not advised unless your doctor identifies findings on physical exam that could suggest co-infection with two different things.

We value the trust our patients put in us as their pediatricians.  While there are many situations where children have a sore throat illness that requires a throat swab for diagnosis, in reality, many children who come in to the office for a “rule out” strep have already done so by their illness history and exam.  Avoiding unnecessary testing is a great way to reduce antibiotic exposure in your child and one that we endorse as an evidence-based medical home.

Our team of doctors and nurses are always available to help you make the decision about whether to bring your child in for a sick visit.  We are also happy to talk through our decision-making process with you.  We always want to help our patient families understand how to make the best and most well-informed medical decisions for their children.

Written by: Dr. Ben Kornfeld

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