The Call-On-Doc Guide to Strep Throat

Being one of many common conditions in the cold and flu season, strep throat is primarily spread through respiratory droplets or the tiny particles of moisture that are expelled from our mouths when we breathe, talk, or sneeze. (2) It can additionally spread by way of: 

• Direct Contact: The bacteria can spread through direct contact with an infected person's respiratory secretions, such as saliva or nasal discharge. This can occur through activities like kissing or sharing utensils, food, or drinks.
• Contaminated Surfaces: The bacteria can survive for a short period on surfaces like doorknobs, countertops, and toys. If someone touches a contaminated surface and then touches their mouth, nose, or eyes, they may become infected.
• Airborne Transmission: In some cases, the bacteria can remain suspended in the air as droplet nuclei, which are tiny particles. These droplet nuclei can be inhaled by others, leading to infection.

The symptoms caused by strep throat are due to the inflammatory response triggered by the invasion of Streptococcus pyogenes bacteria in the throat and tonsils. When the bacteria enter the throat, they interact with the immune system, leading to an immune response to fight the infection. The body's immune cells release various inflammatory substances and chemicals, which cause the blood vessels in the throat to dilate. This increased blood flow and leakage of fluid into the surrounding tissues resulting in redness, swelling, and soreness in the throat and tonsils. The swollen tonsils can obstruct the throat and make swallowing painful. The immune response also leads to the release of cytokines, which induce fever, chills, and body aches. In some cases, certain strains of strep throat may produce toxins that cause the characteristic rash of scarlet fever. (3) As a result, those infected with strep throat may experience: 

• Severe Sore Throat: Strep throat is characterized by a very sore and painful throat. The pain is often described as sharp, scratchy, or raw, making it uncomfortable to swallow, talk, or even breathe through the mouth. The soreness may extend to the back of the throat and can be aggravated by eating or drinking.
• Fever: Strep throat can cause a fever, which is a higher-than-normal body temperature. The fever may range from mild to high-grade, and it can be accompanied by chills and body aches. The fever is the body's natural response to fighting the infection.
• Swollen Tonsils: The tonsils, which are located at the back of the throat on each side, may become red, swollen, and inflamed due to the infection. They can be visibly enlarged and may have a white or yellow coating or patches, indicating the presence of pus or debris.
• Swollen Lymph Nodes: The lymph nodes in the neck are small, bean-shaped glands that play a crucial role in the body's immune response. In strep throat, these nodes may become tender and swollen as they work to combat the infection. You might notice them feeling tender to the touch or experience discomfort when moving the neck.
• Difficulty Swallowing: The severe sore throat and swollen tonsils can make swallowing painful and challenging. You may feel as if there is a lump or obstruction in your throat, and the act of swallowing can intensify the pain.
• Headache: Some individuals with strep throat may experience headaches. These headaches are usually secondary to the overall systemic response to the infection, including a fever and body aches.
• Rash (in some cases): In a subset of strep throat cases, particularly those caused by certain strains of Streptococcus pyogenes that produce toxins, a characteristic rash known as scarlet fever may develop. The rash typically appears as tiny red spots that merge and give the skin a rough, sandpaper-like texture. It often starts on the chest and abdomen and can spread to other parts of the body.
• Stomachache (in children): Children with strep throat may complain of abdominal pain and nausea. This is thought to be related to the body's immune response and is more commonly observed in pediatric cases.

Strep throat starts hurting in the throat area, specifically in the back of the throat near the tonsils. The onset of pain is usually sudden and intense, making the throat feel raw and scratchy. As the Streptococcus pyogenes bacteria begin to multiply and cause infection, the throat tissues become inflamed and swollen, leading to soreness. The pain may worsen when swallowing, talking, or breathing through the mouth. Along with the sore throat, other symptoms like fever, swollen lymph nodes, and headache may also develop as the body's immune system responds to the infection.

Strep throat is typically not associated with a constant cough or congestion, being an infection that is generally isolated to the tonsils and throat. While some individuals with strep throat may experience mild cold-like symptoms such as a runny nose, these symptoms are not typical to strep. More commonly, there are many diseases that can be confused with strep theat feature drainage and a cough (3). These can include: 

• Allergies
• Chlamydia
• Gonorrhea
• Influenza
• Upper respiratory infection 

The contagious period for strep throat can vary, but generally, an infected person remains contagious until they have been on antibiotics for at least 24 hours. This means that during the first day or two of treatment, the person can still spread the Streptococcus pyogenes bacteria to others through respiratory droplets or by direct contact with infected respiratory secretions.

Distinguishing between strep throat and a regular sore throat can be challenging based on symptoms alone because they can overlap. However, there are some key differences that can help you differentiate between the two:

Sore Throat:

• A sore throat caused by a viral infection (common cold, flu) is more common than strep throat.
• Other cold or flu symptoms, such as runny nose, cough, and congestion are often present.
• A viral sore throat usually improves on its own within a few days with rest and home remedies like warm liquids and throat lozenges.
• The absence of other significant symptoms like fever and swollen lymph nodes may indicate a viral sore throat.

Strep Throat:

• Strep throat is caused by the bacterium Streptococcus pyogenes (group A Streptococcus).
• The throat pain in strep throat is typically more severe and sudden, accompanied by difficulty swallowing and a raw or scratchy feeling.
• Fever is a common symptom of strep throat, often with temperatures above 100.4°F (38°C).
• Swollen and tender lymph nodes in the neck may be noticeable.
• The absence of significant cold-like symptoms (runny nose, cough, sneezing) distinguishes strep throat from viral infections.

If testing is needed, doctors will typically provide a patient with a normal consultation to deduce if they have strep throat or a similar condition. This process will often include: 

• Medical History and Symptoms: The doctor will begin by asking about your medical history and the symptoms you are experiencing. They will inquire about the duration and severity of your sore throat, the presence of fever, swollen lymph nodes, and any other accompanying symptoms.
• Physical Examination: The doctor will perform a physical examination, focusing on your throat, tonsils, and neck. They will look for signs of inflammation, redness, swelling, and the presence of white spots or patches on the tonsils. The doctor may also palpate your neck to check for swollen and tender lymph nodes.
• Throat Swab Test: To confirm the diagnosis of strep throat, the doctor will perform a throat swab test. They will use a cotton swab to gently take a sample from the back of your throat, specifically from the area near the tonsils. The swab is then tested for the presence of group A Streptococcus bacteria.

Due to the infection featuring noticeable and a specific group of symptoms, a doctor can diagnose and treat strep throat without lab testing in certain cases. In many situations, the diagnosis of strep throat can be made based on the typical symptoms. If a patient presents with classic symptoms of strep throat, such as severe sore throat, fever, swollen tonsils with white spots, and swollen lymph nodes, a doctor may confidently diagnose and treat strep throat without additional testing.

The most effective medicine for strep throat is antibiotics. Antibiotics are medications that can kill or inhibit the growth of bacteria, and they are the primary treatment for strep throat caused by Streptococcus pyogenes. Provided by a medical provider in a set amount specific to your needs, the best options for strep throat currently goes as follows: 

• Amoxicillin: Amoxicillin is effective in treating strep throat because it is a type of antibiotic known as penicillin. Streptococcus pyogenes, the bacterium causing strep throat, is susceptible to penicillins. When amoxicillin is administered, it interferes with the bacterial cell wall synthesis, leading to the weakening and eventual destruction of the bacteria. This action helps to eliminate the infection and alleviate symptoms such as sore throat, fever, and swollen lymph nodes. 
• Augmentin: Augmentin is effective in treating strep throat because it is a combination antibiotic containing amoxicillin and clavulanate potassium. The amoxicillin component targets and kills the Streptococcus pyogenes bacteria responsible for strep throat, just like regular amoxicillin. However, the addition of clavulanate potassium in Augmentin helps overcome bacterial resistance by inhibiting certain enzymes that bacteria may use to inactivate the amoxicillin. This makes Augmentin more effective against certain strains of bacteria that may have developed resistance to regular amoxicillin. By eradicating the bacteria causing strep throat, Augmentin helps alleviate symptoms, reduce the duration of the illness, and prevent potential complications, promoting a faster recovery and minimizing the risk of antibiotic-resistant strains. 
• Azithromycin: Azithromycin is effective in treating strep throat because it belongs to a class of antibiotics called macrolides. When administered, azithromycin works by inhibiting bacterial protein synthesis, which is essential for the growth and reproduction of Streptococcus pyogenes, the bacterium causing strep throat. By interfering with this process, azithromycin effectively kills the bacteria and stops the infection from spreading further. It helps alleviate the symptoms of strep throat, such as sore throat, fever, and swollen lymph nodes, and promotes a quicker recovery.
• Cefuroxime: Cefuroxime is effective in treating strep throat because it is a cephalosporin antibiotic that targets and kills the Streptococcus pyogenes bacteria causing the infection. As a bactericidal antibiotic, cefuroxime works by disrupting the formation of the bacterial cell wall, which is vital for the bacteria's survival and reproduction. By interfering with this process, cefuroxime effectively weakens and destroys the bacteria, stopping the infection from spreading and helping to alleviate symptoms like sore throat, fever, and swollen lymph nodes.
• Cefdinir: Cefdinir is effective in treating strep throat because it is a cephalosporin antibiotic that targets and kills the Streptococcus pyogenes bacteria responsible for the infection. Cefdinir works by inhibiting the synthesis of the bacterial cell wall, which is essential for the bacteria's survival and growth. Without a properly formed cell wall, the Streptococcus pyogenes bacteria become vulnerable inside of the human body and are unable to maintain their structure, leading to their destruction. As a result, cefdinir helps to eliminate the infection, alleviate symptoms such as sore throat, fever, and swollen lymph nodes, and promote a faster recovery.

In some cases, strep throat can go away without antibiotics. Strep throat is caused by the bacterium Streptococcus pyogenes, and it is a self-limiting infection, which means that the body's immune system can often clear the infection on its own over time. However, in the time that it affects the body, it leaves you vulnerable to other diseases. The benefits of taking antibiotics for strep throat include: 

• Faster Recovery: Antibiotics help speed up the recovery process, alleviating symptoms and reducing the duration of the illness. This can help you feel better sooner and return to your normal activities.
• Preventing Complications: While strep throat is generally a mild infection, if left untreated, it can lead to potential complications such as tonsillitis, sinus infections, and, in rare cases, more severe conditions like rheumatic fever or post-streptococcal glomerulonephritis.
• Reducing Transmission: Strep throat is highly contagious, especially in the early stages of the illness. Taking antibiotics helps reduce the risk of spreading the infection to others, particularly family members, friends, or coworkers.
• Preventing Antibiotic Resistance: Completing a full course of prescribed antibiotics ensures that all the bacteria causing the infection are eradicated. This helps prevent the development of antibiotic-resistant strains of bacteria.

What happens if strep throat goes untreated?

• Tonsillitis: Strep throat can lead to tonsillitis, which is the inflammation and infection of the tonsils. This can cause additional symptoms such as severe throat pain, difficulty swallowing, and enlarged tonsils with white spots or pus.
• Sinus Infections: The bacteria that cause strep throat can spread to the sinuses, leading to sinus infections. Symptoms of sinus infections include facial pain, nasal congestion, and thick nasal discharge.
• Scarlet Fever: In some cases, certain strains of Streptococcus pyogenes can produce toxins that lead to a characteristic rash known as scarlet fever. The rash typically appears as tiny red spots that merge and give the skin a rough, sandpaper-like texture. Scarlet fever is usually accompanied by a sore throat, fever, and other symptoms.
• Rheumatic Fever: Rheumatic fever is a serious autoimmune complication that can develop after a strep throat infection. It can affect the heart, joints, skin, and other organs. Rheumatic fever is rare but can cause long-term damage to the heart valves if left untreated.
• Post-Streptococcal Glomerulonephritis: This is a kidney condition that can occur following a strep throat infection. It leads to inflammation of the kidney's filtering units (glomeruli) and can result in blood in the urine, swelling, and decreased urine output.

While complications are not common, they can especially occur if the patient goes without treatment and antibiotics. It is essential to seek medical attention if you suspect you have strep throat or if you have severe symptoms such as high fever, difficulty swallowing, and persistent sore throat. 

• Rest: Getting plenty of rest allows your body to focus on fighting the infection and helps speed up the healing process.
• Stay Hydrated: Drink plenty of fluids, such as water, warm tea, or soothing broth, to prevent dehydration and soothe the throat.
• Gargle with Saltwater: Gargling with warm salt water several times a day can help reduce throat inflammation and provide temporary relief from soreness.
• Use Throat Lozenges or Sprays: Over-the-counter throat lozenges or throat sprays containing numbing agents like benzocaine can help alleviate throat pain temporarily.
• Warm Compress: Applying a warm compress to your neck can help reduce pain and discomfort caused by swollen lymph nodes.
• Humidify the Air: Using a humidifier or spending time in a steamy bathroom can help moisten the air and soothe your throat.
• Avoid Irritants: Avoid smoking, exposure to secondhand smoke, and other irritants that can worsen throat inflammation.
• Soft, Cool Foods: Consuming soft, cool foods like ice cream, yogurt, or smoothies can be soothing to the throat.
• Pain Relievers: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help reduce pain and fever. However, consult your doctor before giving any medications to children.

To prevent oncoming strep throat, it's essential to practice good hygiene and take precautionary measures. Wash your hands frequently with soap and water, especially after being in public places or touching surfaces. Avoid close contact with individuals who have strep throat or other contagious illnesses, and avoid sharing personal items to reduce the risk of transmission. Cover your mouth and nose when coughing or sneezing, preferably with a tissue or your elbow. Maintain a clean environment by regularly disinfecting frequently touched surfaces. Strengthen your immune system through a balanced diet, regular exercise, adequate sleep, and stress management. 

If you suspect you have been exposed to strep throat or experience symptoms like sore throat, fever, and difficulty swallowing, consider consulting with CallonDoc for a medical evaluation. Our platform provides access to specialized doctors through convenient asynchronous communication, available every day of the week. Moreover, we offer the option to have your prescribed medication delivered to your preferred pharmacy, if not straight to your door, ensuring a quick and affordable strep throat treatment process with CallonDoc.

1. “Strep Throat: All You Need to Know.” CDC, https://www.cdc.gov/group-a-strep/about/strep-throat.html.
2. “Strep throat - Symptoms & causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338.
3. “Strep Throat: Symptoms, Causes, Diagnosis & Treatment.” Cleveland Clinic, 20 December 2022, https://my.clevelandclinic.org/health/diseases/4602-strep-throat.
4. “Strep throat - Diagnosis & treatment.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344.