Sore Throat/Strep Throat

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Sore throat is among the most common symptoms which disrupt our otherwise ‘normal life’. Usually it comes due to infection in the throat. The good news is most infections of the throat are viral in nature and does not need antibiotics. I advise you first try salt water gargling, tylenol and ibuprofen. Also note down whether you have any other symptoms such as

Fever

Sinus drainage

Headache

Ear pain

Shortness of breath

Cough

Abdominal pain

Vomitings

The most common causes of acute pharyngitis are respiratory viruses and group A Streptococcus (GAS). Less common causes include other bacteria, herpes viruses such as Epstein-Barr virus, HIV, and some sexually transmitted infections.

Most patients with pharyngitis present with nonspecific symptoms such as a sore throat that worsens with swallowing and cervical lymphadenopathy. Although the etiology of pharyngitis can rarely be determined based on clinical features alone, certain characteristics can help focus the evaluation.

When evaluating the patient with acute pharyngitis, I use a systematic approach  that helps identify patients who can be clinically diagnosed with a respiratory viral syndrome, those who require testing for GAS or other treatable pathogens such as HIV, and those who have severe or life-threatening conditions.

For patients with symptoms that strongly suggest a viral upper respiratory tract infection, the diagnosis of viral pharyngitis can be made clinically. Testing for GAS or other pathogens is not needed, unless risk factors for a specific treatable cause are present (eg, risk factors for sexually transmitted infections).

Testing for GAS is indicated for patients who have a clinical syndrome compatible with GAS pharyngitis (eg, fever, tonsillar exudates, and cervical lymphadenopathy) and lack features of a viral upper respiratory tract infection. When the need for testing is unclear based on clinical features alone, I use the Centor criteria to help guide my decision. I generally test for streptococcal pharyngitis in patients with ≥3 Centor criteria.

Using a sensitive rapid antigen test (RADT) alone is usually sufficient for diagnosis of GAS pharyngitis. Follow-up throat culture is reserved for selected patients who are at high risk for complications, those who are in close contact with persons at high risk for complications, or for persons who live in areas where the prevalence of GAS and/or acute rheumatic fever is high.

Evaluation should also include a sexual history and assessment of risk factors for HIV. While HIV and sexually transmitted infections are uncommon causes of acute pharyngitis, these are treatable conditions with important public health implications.

Although rare, recognizing signs and symptoms of severe or invasive infections and upper airway obstruction is a critical part of evaluation. Patients with these signs and symptoms may require urgent stabilization and/or referral to an emergency or inpatient setting for additional care.

The majority of patients presenting to clinical care with acute pharyngitis can be clinically diagnosed with respiratory viral syndrome and/or test negative for GAS. These patients typically recover within five to seven days without specific treatment. Patients with GAS pharyngitis usually recover soon, often within 24 to 72 hours of starting antibiotics. Failure to improve within these time periods should raise suspicion for alternative diagnoses or complications.

When We Meet

Please tell me about all your symptoms when you come to see me. That will help me to get a full picture of your sickness and provide the best treatment for you.

Based on your history, sometimes I order one or more of the following tests:

Rapid Strep Test: this is a simple in-house test and the results are available within 5 minutes. I need to take a throat swab to perform this test. Please open your mouth widely so that I can take a better look at your pharynx and choose the correct spot to take the throat sample.

Rapid Flu Test: this is also a simple in-house test. I will take a swab from your nose. The results will be available in 15 minutes. Please don’t get impatient and walk out.

Rapid Mono Test: for this test I need to prick your finger tip to get a blood sample. This test needs a blood sample. Sorry, you might hate needles and I wish this would not need a blood sample. Let us hope technology will improve so that in the near future, we don’t need a blood sample to perform this test. But at this time I have no choice. So, please cooperate.

Throat Culture: We take a throat swab and send it to the lab. They grow the microorganisms in the swab under controlled conditions and identify the exact bacteria, viruses and fungi. Based on the results of this test, I can advise you what exactly you need. If there is streptococcus in the throat culture, I will prescribe an antibiotic. If there are only viruses, I usually suggest simple analgesics, fluids, and salt water gargling. The results come only after 2-3 days.

Thank you for your cooperation.

Paul Kattupalli MD

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