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Not All Sore Throats are Strep

By Dr. Michael Boettcher

Sore throats are one of the most common complaints in children and adults. There are many causes of sore throats ranging from infectious to environmental to side effects of various medications. Infections of the throat are primarily viral in origin. However, a significant portion of infections is bacterial. The most common and most important bacterial throat infection to treat is Strep Throat which is caused by the bacteria Group A beta-hemolytic streptoccocus. It is important to treat to prevent rheumatic fever (not to be mistaken with scarlet fever), which can occur if untreated for a while.

Viral Throat Infections:

Many viral upper respiratory illness such as the common cold or influenza cause sore throats from the infection itself, irritation from post-nasal drainage, increase mouth breathing, coughing, etc. Herpes stomatitis, hand-foot-mouth disease, and others can cause canker sores or ulcers, which are very painful. Symptomatic treatment is the treatment of choice while encouraging plenty of fluid intake.

Infectious mononucleosis is often mistaken for strep pharyngitis secondary to it similar symptoms of fever, sore throat, large glands, and white patches on tonsils. The treatment of mono is plenty of rest and observation of the spleen size and an exclusion of activities that increase the risk of abdominal trauma for a period of time recommended by your physician.

Symptomatic treatment of viral illnesses is proper pain control with humidity, plenty of fluids, and acetaminophen or ibuprofen. If at any time your child is unable to open the mouth, speak clearly, swallow, has difficulty breathing, or has prolonged fever >4 days, your physician needs to be notified.

Allergic Irritation:

Many allergens can affect the throat secondary to the post-nasal drainage, cough, and mouth breathing they cause. This can be a seasonal or a year round phenomenon. These sore throats are not accompanied by fever. However, you can have a febrile viral illness and allergies at the same time, which can make the symptoms worse.

Medication Side Effects:

Occasionally, the side effects of medications can make the throat sore. Inhaled steroids can irritate the back of the throat, so it is important to follow the instructions of rinsing the mouth after using them. Medications can also cause some increase in post-nasal drip which can make the throat sore. Please contact your physician if you feel that your medication is causing too much discomfort for you or your child.

Bacterial Throat Infections:

Many different bacteria can cause a throat infection. Group A beta-hemolytic streptococcus is the most common bacterial cause, but only accounts for 15 to 30 percent of cases of sore throats in children and 5 to 20 percent in adults. The infection is transmitted by respiratory secretions, and the incubation period is 24 to 72 hours. The typical symptoms of Strep throat are acute (1-2 days) onset of fever (>100.4F), swollen lymph nodes in neck, very sore throat, headache, stomachache, sandpaper-like rash on body, and occasionally vomiting. In order for the most accurate rapid test results and treatment success, symptoms should be present for at least 24 hours. However, if at any time you are concerned that your child is significantly ill with persistent vomiting, difficulty breathing, inability to speak or swallow your physician should be notified immediately. Occasionally, strep throat can lead to tonsillitis, pneumonia, and other infections. At anytime you feel the treatment is not working or your child is getting worse, please notify your physician.

Most of the other bacteria that can cause sore throats generally will clear by themselves, however some require antibiotics and your physician can determine that. The treatment of choice for Strep throat is still amoxicillin for 10 days, however, your doctor may choose an alternative antibiotic treatment plan based on recent antibiotic use or history. Please notify your physician of any allergies to medications. Strep throat is a contagious illness spread by close contact and sharing of drinks, towels, toys, etc. Common sense regarding proper sanitary hygiene, i.e. hand-washing, avoiding sharing foods/drinks, and avoiding kissing, prevents the spread of most illnesses and therefore should be practiced. Also, replacing the toothbrush after 24 hours may be a beneficial practice, though this is not been formally recommended. Toothbrushes should be changed every 3 months anyway, so it may very well be time. Return to school, work, daycare is based on how the patient feels and time. After 24 hours of antibiotic treatment, the patient is considered at low risk for spreading disease and can return to daycare/school if feeling better. However, good hygiene practices need to be continued. Repeat or follow-up testing in asymptomatic patients is not generally recommended.

Topics and Subtopics: Children's Health

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