Sore Throat vs Strep
A sore throat is a common complaint seen in toddlers, children and adolescents. Often, sore throat and strep throat are thought to be interchangeable, but in actuality, sore throats in pediatrics are often caused by viruses. Only 20% of sore throat visits to the pediatrician’s office are caused by a bacteria called group A strep. It is important to recognize the signs and symptoms of strep throat in order to determine when a visit to your child’s pediatrician is indicated.
What is strep and how does this differ from a sore throat?
Strep throat (or strep pharyngitis) is a medical illness caused by a bacteria called group A strep. Strep throat is most commonly seen in children and adolescents between the ages of 5 and 15 years old. Children younger than 2 years of age are not susceptible to strep throat and rarely need to be treated for strep throat if their test is positive. The reason for this is that most infants and toddlers are carriers of the bacteria and a positive test cannot differentiate between active infection and carrier status. Moreover, nearly 80% of sore throats in children younger than 2 years of age are caused by viruses. While untreated strep throat can lead to significant complications such as kidney/heart failure, these complications are only seen in children over the age 3. For these reasons, pediatricians rarely perform strep tests on children younger than 2 years old.
How are sore throats/strep contracted and how can it be prevented?
Most types of throat infections (both viral and bacterial) are contagious and are passed through the air in the form of droplets via a cough, a sneeze, or by sharing food/drink. When children/adults cough/sneeze on their hands, they now carry the infected droplets on their hands and may spread the infection in this manner. This is why excellent hand hygiene practices are necessary to prevent from acquiring a throat infection.
What are the symptoms?
Many times a cold virus can cause a sore throat as a result of nasal congestion/runny nose that causes irritation to the back of the throat. If your child has a cough, runny nose, or nasal congestion along with a sore throat, these are all symptoms of a virus and testing for strep throat is not indicated. Other viruses such as the Coxsackie virus may cause a sore throat as well as ulcers in the mouth/throat and a rash on the hands and feet (often referred to as hand, foot, mouth disease). Mononucleosis (mono) is also a common source of a sore throat and may present with fever, swollen lymph nodes, and swollen tonsils.
Symptoms for strep throat vary depending on the child’s age – younger children will often have a high fever (sometimes 102 F or higher), including decreased appetite, stomach pain, and vomiting, while older children will often complain of a sore throat, pain with swallowing, headache, abdominal pain, and nausea. Older children and adolescents may not have a fever. Strep throat is diagnosed in the clinic by obtaining a rapid strep test that provides results within minutes. If a strep test is negative, a culture will be sent to the lab to rule out the presence of group A strep. Culture results are typically back within 48 hrs.
What are the risk factors?
School aged children and children in daycare are most at risk for acquiring strep throat due to frequent exposure to the bacteria. Frequent hand washing, not sharing food/drink with others, and disinfecting surfaces at home that are often touched by others (such as phones, tablets, door handles, remote controls for TV/gaming systems), will help decrease the risk of acquiring or spreading infection.
How is it treated?
If a sore throat is due to a viral illness, no specific medicine is needed as the illness will self-resolve within 7-10 days. Of course, pushing fluids and using Tylenol/Motrin for pain and as fever reducers may be used to keep your child comfortable. If strep throat is diagnosed, the infection is treated with antibiotics. It is very important to take the full course of antibiotics to ensure clearance of the infection, even if your child is feeling better in a couple of days.
If your child has a sore throat along with cough, congestion or runny nose, these are symptoms of a viral illness and strep testing is not indicated. However, if your child has a sore throat that does not go away or is accompanied by fever, headache, stomachache, fatigue, please call your pediatrician or seek medical attention in person.