Strep Throat Diagnosis, Carriers, and Special Cases

About as long ago as I can remember, my brothers would come down with strep throat. They are four and six years younger than me, so we weren’t constant playmates, but we were homeschooled, so whatever germs one got, we usually shared. I don’t particularly like being sick, so as soon as I learned about hygiene and contagious symptoms, I began avoiding them. Still, even if they got strep, when I had a strep throat too, the doctor would have us all in for a strep test, and mine was always negative. What’s up with that?

A mom at our church reports that she thinks strep tests are unreliable, because both of her boys will be sick with the same symptoms – and she knows her kids. She knows what they’re like when they have a sore throat because of drainage. But she will take them to the doctor, and one will test positive for strep but the other tests negative.

Why this talk of strep? There’s a virtual epidemic among my acquaintance lately, including my sister (9 years younger). She went to the doctor – she also has a cough and cold symptoms. My brother went with her because he was starting to have symptoms, and thought he had the beginning of the symptomatic red spots on his throat. (He is always looking in his own throat with a flashlight and a mirror.) So the quick strep test came back positive for my sister, and she was given antibiotics accordingly. But the brother, the expert on strep from experience, claims that the nurse didn’t get a good culture, so he is doubting the negative result.

(Speaking of negatives and positives, why is a positive strep test such a negative thing? Can’t they be a little less confusing?)

Some doctors say you need antibiotics to get over strep, that little bodies have a hard time fighting back. A few people have told me you can have strep without the white spots near your tonsils. But others say they’ve had the spots, gotten a negative test, and been told that they’re just fine; go home. (Doctors.) Never mind actually figuring out what is wrong.

So here’s the scoop. Strep throat is a bacterial infection spread through the air (mostly when people cough or breathe). It can also be spread through communal use of cups, drinking fountains, toothbrushes, etc. (That’s just gross anyway; don’t do it.) Infants don’t usually get strep, and it is most common in children 5-15. But a lot of people carry the bacteria without getting sick. These people, however, are not likely to spread the bacteria to others. (Here’s one of my theories, though: if you carry the bacteria and then get a cold or cough, that sort of weaponizes the bacteria and spreads it to the world, so that you get blamed for contaminating others who have less resistance to the bacteria.) One of the reasons people don’t get sick from strep is saliva. One doctor’s website I found recommended drinking lots of water, and eating salt, garlic, apples, cheese, and less sugar. Like most illnesses, if your immune system is weakened by something else (lack of sleep, stress, other viruses, malnutrition), you are more vulnerable to strep throat.

It is possible to recover from strep without treatment. Going without antibiotics was discouraged in the 20th century because there were several strains in existence that were more dangerous, leading to rheumatic fever (can cause arthritis and heart disease). These strains are mostly eliminated from the US at this time. However, you are potentially contagious much longer if you do not take an antibiotic.

Scarlet fever is associated with strep, but it is feared mostly because it accompanied those dangerous strains that brought on rheumatic fever. The rash can come with strep without having any serious side effects. If my friend who didn’t take her antibiotics the whole 7-10 days is a typical case, though, the rash can take a long time to go away.

A few people commented on a forum that they believe they can taste strep when they have it or are about to have it.

Most doctors and medical websites consider the strep tests to be reliable, especially the longer culture. I found very little conversation about the possibility of false negatives. Of course the rapid test often gives a false negative, but the culture is considered to be the final authority. A doctor is not liable to do the culture, but it may be a good idea to find one who would automatically do the second test if the rapid one is negative.

Am I convinced? I just may be a chronic skeptic. But in this case it doesn’t seem too important. If you do have strep and the test is negative, most likely you’ll kick the bug in a few days just like you would a cold. And the doctors will say I told you so, but you can think what you like about whether you had strep or not. The final bit of advice from a non-professional that I’m offering here is that if your test does come back negative and you don’t get better in a few days – or get worse! – go back to the doctor, complain a little that they should have figure out what was wrong with you in the first place, and don’t leave until you have more of a diagnosis.

Do you have any stories to contribute to my questions?

To God be all glory.