Health Tips

Once in a while you might get that sore and scratchy sensation in your throat. Chinese may dismiss a sore throat as ‘heaty’ and drinking plenty of fluids does seem to make it go away over time. 

It is true that most cases of sore throat, or acute pharyngitis, are not serious and tend to resolve on their own. They are usually caused by respiratory viruses and often associated with the common cold. 

However, sore throat can be caused by a bacterial infection called Streptococcus pyogenes. It is a more serious form of sore throat that is also known as ‘strep throat’, and it is especially common among children of school age and adolescents (5 to 15 years old).

This is a photomicrograph of Streptococcus pyogenes bacteria (orange color), 900x Mag.  Source: https://phil.cdc.gov/Details.aspx?pid=2110

Viral sore throat v.s. Strep throat

As mentioned, the overwhelming majority of cases will be mild, and the prevalence of the worrying strep throat is relatively lower. However, symptoms of strep throat broadly overlap with viral sore throat, which can be tricky to differentiate.

In general, strep throat is a mild infection and can be easily treated with antibiotics, but it can be very painful. The most common symptoms of strep throat include:

• Sore throat that can start very quickly

• Pain when swallowing

• Fever

• Red and swollen tonsils, sometimes with white patches or streaks of pus

• Tiny, red spots (petechiae — pronounced pi-TEE-kee-eye) on the roof of the mouth (the soft or hard palate)

• Swollen lymph nodes in the front of the neck

A set of large tonsils in the back of the throat covered in white exudate. Image source: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons

Mouth wide open showing the throat. Note the petechiae, or small red spots, on the soft palate. This is an uncommon but highly specific finding in strep throat. Image source: CDC/Dr. Heinz F. Eichenwald, Public domain, via Wikimedia Commons

Other symptoms may include a headache, stomach pain, nausea, or vomiting — especially in children. Someone with strep throat may also have a rash known as scarlet fever (also called scarlatina).

On the other hand, if the person has:

• Cough

• Runny nose

• Hoarseness (changes in voice that makes it sound breathy, raspy, or strained)

• Conjunctivitis (also called pink eye)

Then it is likely that the person suffers from a viral infection instead of a strep throat.

Nonetheless, if you have any doubts when it comes to the cause of sore throat, we encourage you to see a doctor for further examination. 

Is there a test for strep throat?

Yes. In fact, only a rapid strep test or throat culture can determine if Streptococcus pyogenes is the cause of the sore throat. A doctor cannot tell if someone has strep throat just by looking at his or her throat.

This is an example of a strep test kit. Image source: myself, CC BY-SA 4.0, via Wikimedia Commons

A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if Streptococcus pyogenes is causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects strep throat, then the doctor can take a throat culture swab. 

A throat culture takes time to see if Streptococcus pyogenes grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use in children and teens since they can get rheumatic fever from an untreated strep throat infection. 

For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following a strep throat infection.

Wait… rheumatic fever? What’s that?

An untreated strep throat in children and adolescents can lead to some serious complications, and one of them is rheumatic fever. Rheumatic fever is a disease that can affect the heart, joints, brain, and skin. It is not contagious, but can result in fever and painful, swollen joints. Other complications that can occur if strep throat is not properly treated include:

• Abscesses (pockets of pus) around the tonsils

• Swollen lymph nodes in the neck

• Sinus infections

• Ear infections

• Post-streptococcal glomerulonephritis (a kidney disease)

My child has strep throat, what can I do to help my child feel better?

Make sure that your child takes his or her antibiotics as directed by the doctor. Do not purchase antibiotics without a doctor’s prescription for your child’s sore throat, as it might not be the right cure to the problem.

There are also other ways to help relieve symptoms:

• Soothing foods and drinks – Give your child things that are easy to swallow, like tea or soup, or popsicles to suck on. Your child might not feel like eating or drinking, but it's important that he or she gets enough liquids. Offer different warm and cold drinks for your child to try.

• Medicines – Paracetamol (sample brand name: Panadol) or ibuprofen (sample brand names: Nurofen) can help with throat pain. The right dose depends on your child's weight, so ask your child's doctor how much to give.

• Do not give aspirin or medicines that contain aspirin to children younger than 18 years. In children, aspirin can cause a serious problem called Reye syndrome. 

• Other treatments – For children who are older than 4 to 5 years, sucking on hard candies or a lollipop might help. For children older than 6 to 8 years, gargling with salt water might help.

Remember to finish the entire antibiotic course to prevent antibiotic resistance. Consult your healthcare professional if you have doubts on how to deal with your child’s strep throat.

Could my sore throat be Covid-19?

According to the World Health Organization, sore throat is indeed one of the possible symptoms of Covid-19. Since all age groups are susceptible to catching Covid-19, if you are worried that your sore throat/ your children’s sore throat may be a symptom of Covid-19, you can see a doctor first for further diagnosis or a Covid-19 test. We cannot tell if a person has Covid-19 solely based on symptoms alone, a Covid-19 test is required to confirm the diagnosis. 

For more information related to testing facilities for Covid-19, visit here.

If you have any enquiries related to Covid-19, you can consult our Covid-19 Task Force, which consists of professional doctors and healthcare professionals, for FREE! 

You can access to free Covid-19 virtual health advisory by downloading the Doc2Us app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat https://web.doc2us.com/

Disclaimer: Covid-19 is a novel disease. The information and scientific evidence of its development and vaccines are changing as we speak. Some content of this article may be outdated in the future. We encourage you to always speak with a healthcare professional you trust for the latest updates on Covid-19 and its vaccines.

Protect yourself and others from strep throat

Strep throat, after all, is a bacterial infection. Hence, the prevention strategies for other infectious disease are true for the prevention of strep throat as well:

• Cover your mouth and nose with a tissue when you cough or sneeze.

• Put your used tissue in the rubbish bin.

• Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue.

• Wash your hands often with soap and water for at least 20 seconds.

• Use an alcohol-based hand rub if soap and water are not available.

• You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

• People with strep throat should stay home from work, school, or daycare until they no longer have a fever AND have taken antibiotics for at least 12 hours.

People can get strep throat more than once. Having a strep throat does not protect someone from getting it again in the future. While there is no vaccine to prevent strep throat, practising these strategies are important to protect yourself and the community from strep throat.

A word from Doc2Us

If you have any questions related to strep throat, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download Doc2Us app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

Till then, stay at home and take care!

Note: Doc2Us is not for medical emergencies. In the event of urgent medical conditions, please call 999.

Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. CDC - Strep Throat: All You Need to Know

2. UpToDate - Patient education: Strep throat in children (The Basics)

3. UpToDate - Evaluation of acute pharyngitis in adults

Written by

Ms Joyce Toh