Strep throat and viral pharyngitis lead to inflammation of the throat. Even though they lead to the same outcome of the throat at times, they are both treated differently. Strep throat is caused by bacteria whereas viral pharyngitis is caused by viruses. Read more below as Dr. Bornstein discusses the symptoms, causes, treatment and his opinion regarding strep throat and viral pharyngitis.
SYMPTOMS:
- Fever
- Malaise
- Throat pain
- Swollen glands in the neck
CAUSES:
Viruses and Group A beta-hemolytic streptococcus (strep throat)
DIAGNOSIS:
A rapid strep test or throat culture will be performed if a child presents with a sore throat or red, inflamed, or white-covered throat. If the rapid strep test or throat culture is negative (i.e., no strep throat), a diagnosis of viral pharyngitis will be made. If the throat culture or rapid strep test is positive (i.e., strep throat), then a diagnosis of strep throat can be made. Without performing the lab test, there is no way to be sure if it is strep.
TREATMENT:
For viral pharyngitis: acetaminophen (Tylenol, Tempra), ibuprofen (Motrin, Advil), lozenges (cough drops), fluids, rest, and time.
For strep throat: antibiotics
CONTAGION:
Strep throat is contagious until you have been taking antibiotics for 24 hours. Viral pharyngitis is contagious as long as symptoms are present. Both are transmitted by coughing or sneezing out respiratory secretions. The incubation period is 2 to 3 days.
OUTCOME:
For viral pharyngitis, the outcome is excellent. Sometimes the virus causing the pharyngitis can lead to an ear infection or sinus infection, but this is rare. The outcome for strep throat is also excellent if the strep is treated. If untreated, strep throat can lead to rheumatic fever, scarlet fever, and post-streptococcal glomerulonephritis (kidney disease).
DISCUSSION:
Sore throats are very common in children. A sore throat is usually the first symptom of a cold, but it can also be a symptom of strep throat. If it is viral pharyngitis, the best treatments are acetaminophen (Tylenol, Tempra), ibuprofen (Motrin, Advil), cough drops (if the child is old enough to take them), fluids, rest, and time. If it is strep throat, penicillin is the drug of choice, although most physicians use amoxicillin, also known as the “pink medicine” because of its better taste and once or twice a day dosing for strep. Other antibiotics can be used, but penicillin or amoxicillin will cause the least amount of side effects and resistance.
The only way to diagnose strep throat is by rapid strep test or throat culture. You cannot tell if it is strep throat by looking in the throat. Fortunately, the diagnosis will be viral over 85% of the time. If it is strep throat, it is vital to get treatment within ten days of symptoms to prevent the complications of strep (rheumatic fever, scarlet fever, and kidney disease). Once an antibiotic is started, the child will still be contagious until they have been on the antibiotic for 24 hours. After that, they can return to school or daycare.
Some children are strep carriers, meaning they are always positive on a rapid strep test or throat culture, even when they have no symptoms. These children are not at risk for the complications of strep; however, they can pass the strep to others and cause illness. It is difficult to diagnose these children with strep because one doesn’t know if a sore throat is a new onset of strep throat or a harmless carrier state.
Either way, the lab test will show the strep. Some physicians like to have the tonsils removed if a child gets multiple strep throats or they are a strep carrier. Others will try different antibiotics to clear the strep.
Some studies have shown that tonsillectomy helps, and others have shown this to be of no benefit. Physicians and patients should weigh the pros of tonsillectomy, which can decrease throat infections and lead to fewer school absences and easier breathing if the tonsils are enlarged and obstructive. But, they also need to weigh the cons of a surgical procedure with pain and bleeding involved, the possibility of no benefit, and make an individual decision for each case. Things that have shown no benefit to strep throat or viral pharyngitis include Vitamin C, zinc lozenges, multivitamins, and antihistamines.
ONE DOCTOR’S OPINION:
I have a pet peeve regarding a specific scenario in my treatment of sore throats. When a child has been to my office with a painful red or white covered throat that looks infected, I have run a rapid strep test and/or throat culture, which showed no strep (no bacteria), and sent the patient home with instructions to use acetaminophen and cough drops. Sometime later, I discover that the child’s parents took their sick child (who should have been taken straight to bed) to another physician or Emergency Room where another doctor only looked in the throat, “diagnosed” strep, and then prescribed an antibiotic, which only works on bacteria. Unless the Emergency Room doctor has microscopic vision, it is impossible to diagnose strep by looking in the throat. Some of the nastiest-looking throats result from viral pharyngitis, and sometimes a patient will complain of a sore throat that looks normal but is, in fact, strep. One just cannot tell by looking. I have read studies where people try to grade symptoms: they give positive points for strep for sore throat, fever, red spots on the tonsils (petechiae), and negative points for congestion, cough, and runny nose, which are most likely due to viruses. None of these grading systems ever work out well. In the back of your mind, think mononucleosis “mono” if it is a throat covered with white material and a negative strep. Mono is viral, and you can do nothing about it, but at least you know what is causing the problem.
As an educated parent or patient, insist on a rapid strep test or throat culture, which will prove or disprove strep before you’re given an antibiotic prescription. Remember, if you are given an antibiotic without really needing it, it can lead to antibiotic resistance.
Written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
FOLLOW US