Sore throat: how to diagnose strep throat?

A sore throat caused by streptococcus is diagnosed with a pharyngeal swab and treated with antibiotics. It can cause serious complications

  • In most cases a sore throat is viral and therefore does not need antibiotics.
  • Usually, a sore throat caused by a virus is accompanied by other symptoms such as a cold, conjunctivitis, hoarseness or diarrhoea.
  • If there are plaques in the throat, the child should not be given antibiotics without first having a strep throat swab.
  • Streptococcal pharyngotonsillitis is the only one that requires treatment with antibiotics.
  • The antibiotic is always Amoxicillin.

Causes of sore throat

Sore throat is one of the most common symptoms in children and adults when there is an upper respiratory tract infection.

In the majority of cases, sore throat has a viral origin and therefore does not require antibiotics.

In only 3 out of 10 children is a sore throat caused by group A streptococcus.


What are the symptoms of a sore throat

The typical pain of a sore throat is a sign of inflammation that may involve only the pharynx (pharyngitis) or also the tonsils (pharyngotonsillitis).

Usually, pharyngitis and pharyngotonsillitis caused by viruses are accompanied by other typical signs of viral diseases, such as a cold, conjunctivitis, hoarseness or diarrhoea.

In the case of a sore throat, the tonsils may be increased in volume, reddened and covered with a whitish material.

The technical term is exudate: these are so-called whitish plaques caused by the immune system’s reaction to the infection.

Plaques are not synonymous with streptococcus.

They can also appear in pharyngotonsillitis of viral origin (e.g. in mononucleosis, or in adenovirus infections).

Therefore, if there are plaques on the tonsils, one should never start antibiotics without first checking for strep with a swab.

When is streptococcus present: how do you distinguish between different sore throats?

Unfortunately, not even the most experienced paediatrician can tell with certainty from an examination whether or not pharyngotonsillitis is caused by streptococcus.

For diagnosis, the presence of streptococcus must be demonstrated by swabbing.

Group A beta haemolytic streptococcal pharyngotonsillitis (SBEGA) is the only one that requires antibiotic treatment.

Antibiotic treatment should never be started unless a swab is taken first.

Sore throat treatment

Treatment can shorten and alleviate a sore throat, but is mainly aimed at preventing complications, such as rheumatic disease, acute post-infectious glomerulonephritis or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections).

Rheumatic disease, which presents with fever, joint pain and swelling and often involves the heart, occurs after an infection with group A beta-hemolytic streptococcus.

It most frequently affects children between the ages of 5 and 15, while it is rare under the age of 4.

To ensure prevention of rheumatic disease, antibiotic therapy must be started within 9 days of the onset of a sore throat.

So we are in no hurry: to start the antibiotic, we can safely wait for the result of the swab.

The antibiotic of choice is always Amoxicillin.

Eighty percent of streptococci are resistant to antibiotics belonging to the macrolide class (such as Clarithromycin or Azithromycin), which should therefore be avoided.

Acute post-infectious glomerulonephritis is characterised by the appearance of dark-coloured urine, a sign of the presence of red blood cells, arterial hypertension, swelling (oedema) and a contraction of urine output (diuresis).

PANDAS are characterised by the appearance of an obsessive-compulsive disorder associated or not with tics.

Streptococcal carriers

There is a high frequency of streptococcal carriers.

In other words, the bacterium is present in the throat of between 5 and 20% of children without causing an actual infection.

In streptococcal carriers, treatment is completely ineffective.

Therefore, there is no point in treating a child with a positive swab but no symptoms (i.e. no sore throat and no fever).

For the same reason, it is also futile to perform a swab at the end of antibiotic therapy.

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Bambino Gesù

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