Strep throat accounts for between five and ten percent of all sore throats. Although anyone can get strep throat, it is most common in school age children. People who smoke, who are fatigued, run down, or who live in damp, crowded conditions are also more likely to become infected with strep throat. Children under age two and adults who are not around children are less likely to get strep throat.

Causes of Strep Throat

The bacteria that cause strep throat are highly contagious and spread through saliva or mucous droplets. Being around anyone who is infected and who is coughing or sneezing makes you susceptible. Strep bacteria can live on surfaces, anything from a doorknob to utensils, a bathroom towel or a remote control or cell phone. It’s important to regularly disinfect these things if someone is contagious.

Viral Sore Throat

Approximately 90% of sore throats are caused by viral infections. There is no simple way to distinguish a viral sore throat from a bacterial sore throat. Viral sore throats are quite contagious. They can be spread by personal contact and by coughing or sneezing. Cold and flu viruses are the main culprits. When a stuffy-runny nose, sneezing, and generalized aches and pains accompany the sore throat, it is probably caused by virus. For a viral infection, no antibiotic is usually needed and the infection can be expected to run a four to six day course.

Treatment

Visit your physician as soon as you notice any of the symptoms of strep throat. The physician will conduct a physical examination of your throat and if strep throat is suspected, a rapid strep test will be performed. This is usually sufficient for the physician to be sure of the bacterial presence, but if the test is not conclusive a throat culture could be done. Throat culture results take time, so if your physician suspects strep throat based on physical examination and the symptoms, medication could be started immediately.

Even though the sore throat usually gets better on its own, people who have strep throat SHOULD take antibiotics to prevent more serious complications of this infection, including rheumatic fever. Penicillin has been traditionally recommended and is still very effective. There has been resistance reported to azithromycin and related antibiotics.

Antibiotic treatment will reduce symptoms, minimize transmission, and reduce the likelihood of complications. Treatment consists of penicillin (oral drug for 10 days; or single intramuscular injection of penicillin G). Erythromycin is recommended for penicillin-allergic patients. Second-line antibiotics include amoxicillin, clindamycin, and oral cephalosporins. Although symptoms subside within 4 days even without treatment, it is very important to complete the full course of antibiotics to prevent complications.

Be aware that most sore throats are caused by viruses, not strep. The Centers for Disease Control and Prevention (CDC) recommends AGAINST treating sore throats with antibiotics unless the strep test is positive. Strep cannot be diagnosed by symptoms or a physical exam alone. Gargling with warm salt water (one half teaspoon of salt in a glass of warm water) several times a day may also help.
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