Sunday, March 15, 2009

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.


Anonymous said...

Oh dear, where do I begin?? My daughter had a very severe sore throat right before Christmas, that night her throat closed off..her pediatrician would not do a strep test b/c he said strep does not cause the throat to close off. Instead he gave her an inhaled steroid and a rx for orapred (oral steroid)...3 days later her throat closed off again and the ER gave her decadron (oral steroid) NEVER did they do strep. 10 days later she started having post-strep complications...migrating pains throughout her body, complete lethargy, muscle weakness, this lasted for 8 weeks, at that point she tested positive for strep and it took 4 antibiotics to have any effect....10 days after that she has strep again (don't know if it ever left or if her body is so ravaged by the bacteria that it's chronic now) we've now had it for an additional 4 weeks (sign of rheumatic fever is recurrent strep and she had rashes, but not what scarlet typically presents)...they want to take her tonsils out, she continues to have debilitating pains in her legs/knees/feet/hands/chest...last Monday they sent a culture for the rapid test and it came back positive, when they cultured it nothing grew, I can find nothing that tells me why this is the case, how could rapid test be positive and it not grow the strain? Have all the antibiotics prevented the growth?? But why does the strep test show positive? She has had one case of strep prior to this and tested negative many times, but the past 2 months each time they've done the test she's been positive..tonsils come out but ENT says it's HIGHLY likely she'll never get strep again, and ER Doc says not..I'm so confused. My daughter needs healing, please pray for Eliza.

Lisa of Longbourn said...

I'm sorry! That sounds like a nightmare!

I'll definitely pray for her.

To God be all glory,
Lisa of Longbourn

Carmen Virginia said...

Lady in waiting? Waiting for what? Please...

Lisa of Longbourn said...

Carmen Virginia,
I was so confused how I could have gotten "lady in waiting" into a post about Strep Throat a couple months ago, but I figured it out now. And it is arguable that "lady in waiting" is just as confusing a reference. I suppose ladies in waiting most accurately refers to servants of a queen or princess. But when it is used to describe myself, the phrase means a lady who is waiting. In this case, I am waiting on a husband, not in the servant sense, but in the will-you-please-show-up sense.

To god be all glory,
Lisa of Longbourn

youg kiid 17 said...

yeahh i just recently went to the doctor cause i noticed white spots on my tonsils and they did a rapid test and it came back negative which i thought was odd. so they said i may have mono , which i doubt i caught cause my symptoms werent all that serious and it felt like it was slowly going away. i wanted to tell them to do another test but i juss let it go. its only been 24 hours and the white spots are already dissappearing i can swallow without pain and my tonsils are back to normal size. so im going to have another visit tomorow and im going to tell them to do another test so i can know for a fact if it was strep or something else , but thank you , your post helped me understand more about that rapid test they perform. i thought that was juss the initial result and if its negative you dont have it.