ASK THE DOCTOR: Have son tested as strep throat carrier
By JIM MITTERANDO
The Patriot LedgerQ. My son recently had his third episode of strep throat. What should I do? Is it going around the family? No one else has a sore throat. Can our dog be spreading it? Is there a problem with resistance and should we be using a different antibiotic. My doctor has given him penicillin each time and mentioned he might be a strep carrier. What is a strep carrier? Is this dangerous? Should my whole family be taking penicillin.
A. Streptococcal pharyngitis commonly known as “strep throat” is a bacterial infection of the throat that causes 20% of sore throats in children and 5% in adults.
Strep throat earned its bad reputation years ago when it used to cause epidemics of rheumatic fever that resulted in arthritis, and heart disease. Fortunately, those nasty strains of strep are now rare in the U.S. affecting one in a million. We continue to treat strep throat because it may cut down on its spread in schools, prevent rare complications and shorten the illness by one day.
The word “strep” is used to describe many different kinds of bacteria. Strep throat is caused by a bacteria called Group A streptococcus which is different than Group B streptococcus that can affect newborns. Strep pneumonia(the most common bacterial pneumonia) is a different strep strain, as well.
Children are more likely than adults to get strep throat. It has an incubation period of two to seven days and tends not to infect children under 18 months old. An accompanying rash known as scarlet fever caused panic years ago when strep was more virulent and antibiotics had not yet been discovered. Today, the rash is not considered dangerous and is just a sign of strep infection.
The triumph of penicillin over strep throat 60 years ago resulted in most children getting penicillin shots for any cold symptom. This practice stopped in the 1970s when we learned most people with sore throats or cold symptoms have viral illnesses that are unaffected by antibiotics. Additionally, overuse of antibiotics led to increasing problems of bacteria resistant to treatment. Strep throat is one of the few infections that has not developed resistance to penicillin. Strep bacteria can sometimes be resistant to a class of antibiotics called macrolides that include erythromycin, Zithromax and Biaxin.
After one day of penicillin treatment, children are no longer contagious and can return to school. Antibiotics are generally prescribed for 7 to 10 days. Relapses after completing antibiotic treatment occur in 5 to 10% of people. Relapses can simply be retreated with penicillin. If someone continues to have recurrent strep throat, their doctor may try a different antibiotic.
Strep throat can be confirmed by a rapid test done in 10 minutes. The rapid test detects 90% of strep infections. If negative, the rapid test is followed by a backup throat culture that takes 1 to 2 days to grow.
Not everyone should be tested for strep. Your healthcare provider can best determine who needs testing. 10-20% of school age children carry strep bacteria in their throats for several months without any infection. Testing everyone with a sore throat would lead to many “false positives” and many receiving unnecessary treatment.
People are often alarmed to learn that they may unknowingly carry disease-related bacteria in their nose and throats. This is not uncommon and not unique to strep. About 5-10% of adults are asymptomatic carriers of the meningococcus bacteria which can cause rare, deadly meningitis.
If your child has repeated strep throats, it is possible that they may be a strep carrier. This can be confirmed by a positive strep test when they are feeling well without any sore throat. If he/she is a carrier, then the strep test is not useful to guide treatment for a sore throat since strep may simply be an “innocent bystander” during a viral cold illness. In that case, your health care provider would determine treatment by examination and symptoms rather than by the test. Strep carriers tend not to spread disease. Furthermore, they are not at risk of developing rheumatic fever. Treatment with antibiotics often does not eliminate strep in carriers. Carriers are only treated with antibiotics in the rare instance that a family member has repeated strep infections and it is suspected that the infection seems to be cycling through the family.
In your case, have your son tested to see if he is a carrier. If he is not, then consider checking the family to see if someone may be a carrier. It is not recommended to simply treat all family members. There is no credible evidence that family pets contribute to spread in the household. Consider rinsing toothbrushes and orthodontic appliances more thoroughly since strep bacteria can survive up to 15 days on a toothbrush that is not rinsed well. If rinsed well, strep survives 3 days on a toothbrush which is not problematic since antibiotics are taken for 7 to 10 days. Another option would be to use a new toothbrush after being on antibiotics for several days.
Parents commonly ask when should they suspect strep and visit the doctor and when can they just wait it out. Most sore throats are viral and do not require treatment or medical evaluation. You can wait several days to see if the sore throat improves.
If your child develops a sore throat associated with a cough, hoarseness and runny nose, it is most likely part of a viral “cold” illness. Generally, strep throat does not cause hoarseness or a cough. If a sorethroat develops along with fever, headache, stomachache, rash, difficulty opening the mouth or recent close strep exposure, then you should follow up with your health care provider.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, December 09, 2003