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Strep throat or virus?

Reviewed By: Isaac Thomsen, M.D., a fellow in Pediatric Infectious Diseases at Vanderbilt (Last Updated: February 17, 2011)

Cold and flu season usually means viruses are making the rounds, but bacterial illnesses, like strep throat, can also circulate, especially among children. Experts at Monroe Carell Jr. Children's Hospital at Vanderbilt say it is important to determine if a child has a virus or strep throat for two reasons: to prevent over-use of antibiotics, and to avoid the potentially serious side effects of true strep throat.

Strep throat is caused by the bacteria Streptococcus pyogenes, or "Group A Strep." Its symptoms are a little different than sore throats caused by viruses, so an examination by a doctor or primary care practitioner to determine the presence of strep throat is important.

Isaac Thomsen, M.D., a fellow in Pediatric Infectious Diseases at Vanderbilt, answers some common questions about strep throat.

Question: Is it true that if you don't get treated for strep you'll get heart disease?

Answer: In fact, one of the reasons that we treat strep throat with antibiotics is to prevent the development of rheumatic fever. Before antibiotics, rheumatic fever was the leading cause of heart disease in people under age 40.

Fortunately, this is rare in the United States today, as children with strep throat are appropriately treated with penicillin or other antibiotics.

Other strep-related illnesses, such as a certain type of kidney disease, can follow a streptococcal infection. These are illnesses that are caused by the body's immune system after it interacts with the Strep germ rather than by the bacteria itself. 

Question: Are some kids more susceptible to repeat bouts of strep?

Answer: This appears to be true, but it can be difficult to sort out. One source of confusion can occur when children only have what is called "colonization" with the strep bacteria. As much as 10 to 15 percent of children carry strep bacteria in their throats without any symptoms. This does not require treatment unless others are catching the germ and getting ill.

In these children, a rapid strep test will be positive because the germ is present, but it is not necessarily causing their symptoms. Instead, the symptoms might be caused by a virus, such as one of the common cold viruses. Children who do not have hallmark signs and symptoms of strep-illness (see list below) do not require antibiotics if their symptoms are viral. Unnecessarily prescribing antibiotics for these children can contribute to the overuse of antibiotics.

A true diagnosis of strep throat illness requires fulfillment of certain symptom criteria, as assessed by a qualified health care provider.

Question: Can family pets harbor the germ and re-infect family members?

Answer: Household objects and pets do not transmit the bacteria to people. Strep throat is primarily spread by contact with respiratory secretions from a person with the infection. Excellent hand washing is always recommended if a household contact has strep throat. Patients are considered contagious until 24 hours after they start antibiotics for their infection.

If multiple family members are repeatedly developing streptococcal infections, it might be necessary to get throat cultures from all household contacts, and give antibiotics to anyone who is carrying the strep germ.

Warning signs of strep:

  • Pain: your child may say it hurts to swallow
  • When you look at the back of their throat they may have white spots on a red throat
  • Fever may last longer than 24 hours
  • They may have swollen glands in the neck.

Parents should call their child's doctor if their child has a sore throat and fever lasting more than 24 hours so that the doctor can determine if the child has strep throat.

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