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*Strep Throat*
Sore throat is one of the most common of medical complaints. As many
as I out of every 10 Americans develops a "strep throat"
every year, and 40 million adults will see a doctor for it.
What Causes A Sore Throat?
Sore throat is one symptom of an array of different medical
disorders. Infections cause the majority of sore throats, and these
are the sore throats that are contagious (can be passed from one
person to another). Infections are caused by either viruses (such as
the "flu," the "common cold" or mononucleosis) or
bacteria (such as "strep," mycoplasma or hemophilus).
The most important difference between viruses and bacteria is that
bacteria respond well to antibiotic treatment, but viruses do not.
Viruses: Most viral sore throats accompany the "flu" or a
"cold." When a stuffy-runny nose, sneezing, and generalized
aches and pains accompany the sore throat, it is probably caused by
one of the hundreds of known viruses. These are highly contagious and
cause epidemics in a community, especially in the winter. The body
cures itself of a viral infection by building antibodies that destroy
the virus, a process that takes about a week.
Sore throats accompany other viral infections such as measles,
chicken pox, whooping cough, and croup. Canker sores and fever
blisters in the throat also can be very painful. One special viral
infection takes much longer than a week to be cured: infectious
mononucleosis or "mono." This virus lodges in the lymph
system, causing massive enlargement of the tonsils (with white
patches on their surface) and swollen glands in the neck, armpits and
groin. 1t creates a severely sore throat, sometimes causes serious
difficulties breathing, and can affect the liver, leading to jaundice
(yellow skin and eyes). It also causes extreme fatigue that can last
six weeks or more.
"Mono" is a severe illness in a teenager or young adult,
but it is less severe in a child. Since it can be transmitted by
saliva, it has been nicknamed the "kissing disease."
However, it can also be transmitted from mouth-to-hand to
hand-to-mouth or by sharing of towels and eating utensils.
Bacteria: "Strep throat" is an infection caused by a
particular strain of streptococcus bacteria. This infection can also
cause damage to the heart valves (rheumatic fever) and kidneys
(nephritis). Streptococcal infections can also cause scarlet fever,
tonsillitis, pneumonia, sinusitis and ear infections.
Because of these possible complications, a "strep throat"
should be treated with an antibiotic. "Strep" infections
usually cause a longer lasting sore throat than a "cold" or
the "flu." But "strep" is not always easy to
detect by examination, and a throat culture may be needed.
A newly developed "strep test" detects a streptococcal
infection in about 15 minutes, instead of the 24 hours or more
required for a culture to grow. These tests, when positive, influence
the physician to prescribe antibiotics. However, strep tests and
cultures might not detect a number of other bacteria that can also
cause severe sore throats that deserve antibiotic treatment. For
example, severe and chronic cases of tonsillitis or tonsillar abscess
may be culture negative; similarly, negative cultures are seen with
diphtheria, and infections from oral sexual contacts will escape
detection with "strep" culture tests.
Tonsillitis is an infection of the lumpy tissues on each side of the
throat toward the back of the tongue. In the first two to three years
of childhood, these tissues "catch" infections, sampling
the child's environment to help develop his immunities (antibodies).
Healthy tonsils do not remain infected, however, and frequent sore
throats from tonsillitis suggest the infection is not fully
eliminated between episodes. A recent study has shown that children
who suffer from frequently recurrent episodes of tonsillitis (such as
3 to 4 episodes each year for several years) were healthier after
their tonsils were surgically removed.
Infections in the nose and sinuses can also cause sore throats
because mucus from the nose drains down into the throat and carries
the infection with it. The most dangerous throat infection is
epiglottitis, caused by bacteria that infect a portion of the larynx
(voice box) and cause swelling that closes the airway. This infection
is an emergency condition that requires prompt medical attention.
Suspect it when swallowing is extremely painful (causing drooling),
when speech is muffled and when breathing becomes difficult. A
"strep" culture may miss this infection and be negative.
Allergy: Hayfever and allergy sufferers can get an irritated throat
during an allergy attack the same way they get a stuffy, itchy nose,
sneezing and post nasal drip. The same pollens and molds that
irritate the nose when they are inhaled also may irritate the throat.
People allergic to cat and dog danders can suffer an irritated throat
when they are around such animals. A very common allergy is house
dust, and it is a special problem in the winter when a heating system
blows dust throughout the house.
Irritation: During the cold winter months, dry heat may create a
recurring, mild sore throat with a parched feeling, especially in the
mornings. This often responds to humidification of bedroom air and
increased liquid intake. Patients with a chronic stuffy nose, causing
mouth breathing, also suffer with a dry throat. They need examination
and treatment of the nose.
An occasional cause of morning sore throat is regurgitation of
stomach acids up into the back of the throat where they are extremely
irritating. This can be avoided if you tilt your bedframe so that the
head is elevated four to six inches higher than the foot. You should
also avoid eating and drinking for one to two hours before retiring.
You might find antacids helpful. If these fail, see your doctor.
Industrial pollutants and chemicals in the air can irritate the nose
and throat, but by far the most common and pervasive air pollutant is
tobacco smoke. It cannot be tolerated by many persons who are either
allergic or over sensitive to its contents. Other irritants include
smokeless tobacco, alcoholic beverages, and spicy foods. A person who
strains his voice (yelling at a sports event, for example) gets a
sore throat not only from muscle strain, but also from the rough
treatment of his throat membranes. Well-trained, experienced public
speakers and singers learn not to abuse their throats and voices in
this way. They produce loud voices by taking deep breaths and using
their chest and abdominal muscles more than
their throat muscles.
Tumors: Tumors of the throat, tongue and larynx (voice box) are
usually (but not always) associated with long time use of tobacco and
alcohol. Sore throat and difficult swallowing-sometimes with pain
radiating to the ear - may be symptoms of such a tumor. More often
the sore throat is so mild or so chronic that it is hardly noticed.
Other important symptoms include hoarseness, a lump in the neck,
unexplained weight loss and/or spitting up blood in the saliva or phlegm.
The diagnosis will require examination by a physician with special
training in diseases of the ears, nose, throat, head and neck.
Special mirrors or telescopic instruments will be used to see the
suspicious areas of the throat.
How Can I Treat My Own Sore Throat?
A mild sore throat associated with "cold" or "flu"
symptoms can be made more comfortable with the following remedies:
Increase your liquid intake. (Warm tea with honey is a favorite home remedy).
Use a steamer or humidifier in your bedroom.
Gargle with warm salt water several times daily: 1/2 tsp salt to 1/2
cup water.
Take mild pain relievers such as acetaminophen (Tylenol, Datril,
Tempra), ibuprofen (Advil), etc.
Take non-prescription throat lozenges.
When Should I See a Doctor?
Whenever a sore throat is severe, persists longer than the usual five
to seven day duration of a "cold" or "flu," and
is not associated with an avoidable allergy or irritation, you should
seek medical attention. The following signs and symptoms should alert
you to see your physician:
Severe and prolonged sore throat
Difficulty breathing
Difficulty swallowing
Difficulty opening the mouth
Joint pains
Earache
Rash
Fever (Over 101 degrees)
Blood in saliva or phlegm
Frequently recurring sore throat
Lump in the neck
Hoarseness lasting over 2 weeks
Antibiotics are drugs that kill or impair bacteria. Penicillin or
erythromycin (well-known antibiotics)
are prescribed when the physician suspects streptococcal or other
bacterial infection that will respond to them. However, a number of
bacterial throat infections do not respond to penicillin, but require
other's categories of antibiotics instead. Antibiotics do not cure
viral infections, but viruses do lower the patient's resistance to
bacterial infections. When such a combined infection occurs,
antibiotics may become necessary.
When an antibiotic is prescribed, it should be taken - as the
physician directs - for the full course (usually l0 days). Otherwise
the infection will probably be suppressed rather than eliminated, and
it can return.
What If My Throat Culture Is Negative?
A "strep" culture tests only for the presence of
streptococcal infections. Many other infections, both bacterial and
viral, will yield negative cultures and sometimes so does a
streptococcal infection. Therefore, when your culture is negative,
your physician will base his decision for treatment on the severity
of your symptoms and the appearance of your throat on examination. Do
not discontinue your medications unless your physician instructs you
to do SO.
Should Other Family Members Be Treated? or Cultured?
When "strep" throat is proven by test or culture, many
experts recommend treatment of other family members, because
streptococcal infections are so highly contagious. Others recommend
treating only the family members with sore throats and culturing the
others. So be sure you tell your physician how other family members
are feeling. Practice good sanitary habits; avoid close physical
contact and sharing of napkins, towels and utensils with the infected
person. Handwashing makes good sense.
The advice in this pamphlet is for general information. But remember,
the best advice for your specific case is what you get from your
physician who hears your symptoms and examines your
throat.
©1992. American Academy of Otolaryngology-Head and Neck Surgery,
Inc. This leaflet is published as a public service. The material may
be freely used for noncommercial purposes so long as attributation is
given to the American Academy of Otolaryngology-Head and Neck
Surgery, Inc. One Prince Street, Alexandria, VA 22314-3357
