Still in the sick season and I’m counting the weeks that are left. Probably at least 6-8 more weeks before it will really slow down. The good news is that flu does seem to be waning, but there are still plenty of coughs, colds, and sore throats.
So many children have sore throats at this time of year and I find myself explaining to parents what we pediatricians are looking for during the physical exam to determine if a child might have strep throat. Although parents often “want a throat culture” regardless of their child’s age or symptoms, their pediatrician is using clinical judgement before performing a “rapid strep test”, which is the most common method for detecting streptococcal pharyngitis (strep throat).
Strep throat is a bacterial infection and is treated with antibiotics, while most other causes of a sore throat (pharyngitis) are due to viral infections and are therefore self limited and do not require antibiotics. In fact in a recent study of a general pediatric office practice about 20-30% of sore throats seen throughout the year were due to strep. The other 70-80% were viral.
The “typical” child with strep throat will have some notable symptoms and physical findings. Strep is most commonly seen in children between the ages of 2-13 years. Most children will NOT have concomitant upper respiratory symptoms (cough, runny nose) but will complain of a sore throat, difficulty swallowing and may also have a stomach ache or even vomiting. On physical exam they will have fever, a “beefy” red throat and enlarged tonsils and tender lymph nodes in their neck. These are the symptoms and physical findings your doctor is using when deciding to swab your child’s throat.
So, why not culture everyone with a sore throat? There are several reasons, one of which is the cost of the test, but also there are false positives for those children (and adults) who might be strep carriers. The medical literature suggests that somewhere between 5-25% of asymptomatic school aged children harbored group A strep. While hard for a parent to initially comprehend, the strep carrier does not need antibiotics. No one wants their child to be on antibiotics unnecessarily.
So.....don’t run off to have all sore throats swabbed at first mention of pain, wait 12-24 hours to see if there are other symptoms as well. I also see entire families come in for a “strep test” because one of the children is ill or their child rode in carpool with a child with strep. There is No need to swab contacts unless they are symptomatic. Hopefully this will save you an unnecessary trip to your pediatrician too.