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Strep Throat

Every winter, there’s a strep season. Symptoms include fever (either high or low), a sore throat and difficulty swallowing, red swollen tonsils, headache, a general feeling of fatigue, and belly pain. There may also be a red, sandpapery rash on the face and torso, in which case the condition is called scarlet fever (not to be confused with rheumatic fever, a complication of strep). This occurs when the strain of streptococcal bacteria also produces a toxin that causes a rash [See: Scarlet Fever].

Strep primarily affects children over five years of age, but younger tots are not immune. In infants, symptoms are mostly limited to fever, and as a result, strep is commonly confused with the flu. Strep infections can be confirmed in minutes with a quick, reliable test. This is particularly useful, because not everything that looks like strep is strep. Several viruses can produce similar symptoms, including the common mononucleosis virus, which does not require antibiotic treatment [See: Mononucleosis].

Strep throat frequently goes unnoticed, which means that a lot of people walk around with a scratchy throat and never know they have strep. They may not be symptomatic, but they are contagious, which is one of the reasons strep is so common. In these uncomplicated cases, strep almost always resolves on its own.

Your doctor will treat a confirmed case of strep throat with oral antibiotics, not only to alleviate the primary symptoms, but also to prevent potential complications such as rheumatic fever, which occurs when the strep bacteria take up residence in the heart and produce a toxin that damages its valves. Extremely rare in the United States but more common in developing nations, rheumatic fever primarily affects children between the ages of five and ten. Infants never get this rare complication, and toddlers almost never do; for this reason, treatment before five years of age to avoid complications is not so crucial. From five years on, the standard of practice is to treat all confirmed cases. Strep throat can also lead to kidney problems.

The treatment for strep is simple penicillin. There’s no need for the newer, more complex antibiotics, since it’s one of the only bacteria that has yet to develop antibiotic resistance. There’s also no rush to treat strep if the child is not in too much discomfort; early treatment may prevent the body from mounting a natural defense, which could lead to early reinfection.

Real questions from real parents
When can my child resume school?
The day after the antibiotics begin, if Jimmy feels better. Half the class probably has strep by that point anyway; that’s how contagious it is.

Why does my child keep getting strep? It seems like it happens every month during the winter.
Some kids are predisposed to strep, especially those with enlarged tonsils. If it occurs more than five times a year, you and your doctor should consider tonsil removal.

My child just finished an episode of strep, and now he’s getting sick again. Why?
This is a common occurrence that has nothing to do with your child’s immune system or incorrect antibiotic treatment. Rebound strep happens because children are continually exposed to other infected children during an outbreak, so the second they stop treatment, they’re vulnerable again. Sometimes children require one or more courses of antibiotics a few times in a row before the infection clears up.

Why is my child testing positive even though he’s not sick?
If your child has had strep a few times and still tests positive without any other symptoms, he could very well be a “strep carrier,” which means that he’s harboring the strep bacteria in his tonsils, even though he’s not manifesting symptoms. The good news is that strep carriers are not contagious, are not at an increased risk for rheumatic fever, and are no more prone to the illness than other children are. Once he’s recognized as a strep carrier, he needs no further treatment unless new symptoms appear. Eventually, his body’s natural defenses will clear his throat of the bacteria.


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