People often get sore throats this time of year. Many sore throats are caused by viruses, but it is wise to determine if a sore throat is caused by bacteria.
The most common bacteria that can cause a sore throat is Group A strep. Strep throat can lead to inflamed kidneys, neurologic symptoms, scarlet fever, or rheumatic heart disease if left untreated (i.e. painful, inflamed joints, a rash, bloody urine, abnormal involuntary movements, and possible damage to the heart valves).
Health care providers should consider the following clinical questions:
- Is there a fever (typically greater than 102)?
- Does the patient have tender anterior cervical adenopathy?
- Does the patient have no cough or a dry cough and/or mild upper respiratory symptoms?
- Does the patient have a red, painful throat, with enlarged tonsils with or without white exudates or red spots on the roof of the mouth?
- Has the patient been exposed to anyone known to be positive for strep throat?
Physical exam and history alone are not enough to determine if a sore throat is caused by a bacteria or a virus. While a rapid strep test administered at the point of care can detect Group A strep in 5 minutes, rapid tests do not detect every case of Group A strep or other strains of strep throat. A negative rapid strep test does not guarantee strep throat is not present.
A throat culture should be the next step, which will take approximately 48 hours for a result. In the meantime, health care providers may choose to treat empirically with antibiotics for those who have more than 3 out of 5 risk factors or to monitor until the culture returns for those who have 2 or fewer risk factors. If the culture returns negative, then antibiotics can be stopped.
