Sunday, September 21, 2014
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When strep isn't strep

Sore throat season's coming and with it one of the big guessing games of parenthood: "Is it strep -- or not"? About 30 percent of kids who get trundled off to the doctor with a sore throat are actually playing host to streptococcus bacteria.

When strep isn’t strep

Though doctors prescribe antibiotics for 70 percent of sore throats, infection experts announced this week that plenty are actually look-alike viral infections - and don’t need drugs or even a trip to the doctor’s office. (AP Photo)
Though doctors prescribe antibiotics for 70 percent of sore throats, infection experts announced this week that plenty are actually look-alike viral infections - and don’t need drugs or even a trip to the doctor’s office. (AP Photo) AP Photo

Sore throat season’s coming and with it one of the big guessing games of parenthood: “Is it strep - or not?" About 30 percent of kids who get trundled off to the doctor with a sore throat are actually playing host to streptococcus bacteria. This super-contagious bug hits infectious heights from October to April, especially among 5 to 15-year-olds, who often pick it up when classmates cough, sneeze or leave it behind on desks and doorknobs.

But though doctors prescribe antibiotics for 70 percent of sore throats, infection experts announced this week that plenty are actually look-alike viral infections - and don’t need drugs or even a trip to the doctor’s office. And that’s not the whole strep story. For the past few years, doctors have been noticing that about one in 10 sore throats in teenagers aren’t strep either - but are caused by nasty bacterium called Fusobacterium necrophorum that can lead to a sometimes-deadly condition called Lemierre syndrome.

Like strep infections, these sore throats need antibiotics, too. Since there’s no test for a Fusobacterium necrophorum infection, groups like the American Academy of Family Physicians suggest doctors look for potential signs of trouble and prescribe bacteria-fighting drugs, usually penicillin.

How can you tell these three sore throat types apart - and know when to get your kid to the doctor? Check for these signs:

  • A sore throat is probably caused by a virus if: Your child also has a cough, runny nose, hoarseness and mouth sores, say sore throat experts from the Infectious Diseases Society of America (IDSA).  A viral sore throat should clear up in a few days.
  • It may be strep if: Throat pain came on fast, your child has trouble swallowing and/or has a fever. Other signs are swollen tonsils and lymph nodes, white or yellow spots on the back of a bright red throat, a headache, stomach pain, a red skin rash, vomiting, body aches and just not feeling hungry. Your doctor can test for strep and prescribe antibiotics if needed.
  • Your teen may have a Fusobacterium necrophorum infection if: Tests show it’s not strep, but she or he has a fever, white patches on their tonsils, swollen and tender areas on the sides of the neck where lymph nodes are, and no cough.
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 Does all this really change anything for parents? Maybe not. It’s always worth calling the doctor if you’re worried about your kid’s sore throat, experts say. It’s just as important to check back if it doesn’t get better in a few days or if seems to improve, then gets worse again.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, M.D., Ph.D Jefferson Medical College
Mario Cruz, M.D. St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, M.D., Ph.D Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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