To test or not to test. Strep is the question.

By Pediatrician Sarah Lallaman, DO

Lallaman_small_RGBIf you are one of the many who feel that you or your family have been trounced with a strep infection or four, you are not alone. For an illness that is well known and so common, it seems that testing and treatment protocols would be more straightforward. However, when all details are considered, it’s not so simple. We receive many questions about strep testing, and I hope to clear up some confusion.

Strep throat is most common in school-aged children (5 years -15 years) during the colder months from fall to spring. The presence of specific symptoms helps us rule out strep from other possible causes. Along with a sore throat, a fever of over 101 degrees is usually present along with a lack of other cold-like symptoms, such as cough or congestion. Other common symptoms associated with strep throat include headache, stomachaches, vomiting and rash. A young child may have some respiratory symptoms, but these are generally mild and do not necessarily mandate treatment.

Strep throat can occur in other age groups, but the younger the patient, the more careful we all should be. Medical research has shown that children under age 2 years can be natural carriers and harbor strep over 25 percent of the time without it being a problem. Additionally, while toddlers are more likely to carry strep (and test positive), they are also less likely to have the strep be the cause of their illness. Young children are less frequently affected because they have fewer receptor cells in their throat to allow strep to be an active problem. For the same reason, toddlers and infants have a near negligible risk for some of the more severe complications of strep.

When strep is truly the culprit causing the problems, it is important that it be identified. Treatment is indicated to help decrease the severity and duration of symptoms, prevent the spread to others and to prevent serious complications, such as acute rheumatic fever and rare heart disease. Acute rheumatic fever resulting in heart disease has life-long complications.

It is quite reasonable to check a school-aged child or even adult, if the symptoms do seem to fit for strep throat. A common misconception is that if a child has tested positive for strep, household members should also be tested. Medically, only patients who have symptoms should be tested unless other circumstances arise. Testing and treatment is not recommended for family members or close contacts unless they are ill.

Occasionally, a situation will arise of a patient getting recurrent strep throat infections. While we try to convey the importance of hygiene to prevent repeat infections, it can be tricky for sure. Changing to a new toothbrush while on antibiotic therapy and cleaning or discarding anything else that routinely goes in the mouth is recommended. Household contacts can sometimes be a reason for a person to have multiple episodes of strep. There is debate whether testing and treating everyone in the house is worthwhile and effective – especially knowing that it is harder to rid a person who is a carrier of strep than one who has an acute infection from strep.

In some cases, Winona Health allows for walk-in strep testing, but only under the right circumstances. Given the low frequency of an active strep infection and low risk for strep complications, we don’t routinely do walk-in strep tests for children under age 2 years. We’ll ask a series of questions to determine whether a visit with a healthcare provider is necessary. If an appointment is needed, we do our best to accommodate people as soon as possible.

Pediatric & Adolescent Medicine