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Strep Throat

Strep throat is a bacterial sore throat. It is due to the group A strep bacteria and although it can affect people of all ages, it is especially common in grammar school children. Many people are exposed to strep and never get sick because of factors in saliva that prevent the bacteria from adhering to surface of their throats. Other people have acquired a high level of immunity and even though they are exposed, antibodies quickly inactivate the bacteria. During the 1930s, the New York City Board of Health did throat cultures on large groups of school children. They found that in some classrooms, up to 30% of the children who were well enough to be in school had group A strep in their throat. Many of them were asymptomatic carriers. Others were in the recovery phase, or a few would be incubating it and on the verge of being symptomatic.

Prior to the development of antibiotics, if a child came down with a strep throat, he/she could be out of school for a couple of days, or a couple of weeks. When a child had serious strep throat – they would be burning with fever for days. The parents would give them soups, juices, and various gargles such as salt water, peroxide, vinegar, to help fight the germ. Doctors would sometimes paint the child’s tonsils with medicines like gentian violet.

Parents used to dread scarlet fever. This is a more virulent form of strep in which the bacteria contains microscopic packets of toxins that cause fever, and/or a rash. There are several different serotypes of strep and some are more pathogenic and contagious than others. When one of these strains gets introduced into a classroom, or birthday party, the kids tend to be sicker and have a high fever. Fortunately, antibiotics are available and the infection can be stopped before overwhelming infection occurs. Strep used to be a significant killer . One of Abraham Lincoln’s sons died of strep during the Civil War. Jim Henson, the creator of the Muppets, died of septic shock strep which had extended into a pneumonia. However, even when exposed to more virulent strains of strep, many children won’t get sick.

Besides its ability to cause severe infection, strep can also cause the auto-immune disease Rheumatic Fever. This is a form of arthritis and fever due to antibodies against strep that cross-react with collagen. The antibodies can damage the heart, especially the valves. Many children who had recovered from strep would go on to have weakened hearts, like the character Beth in Little Women. In the days before antibiotics, some young adults who had rheumatic fever were unable to climb stairs and would die at an early age of complications of heart failure.

Sometimes it’s difficult to distinguish between strep and viral sore throats. Some characteristics of strep are:

  • Fever that rises to 102 or persists
  • Worsening of the sore throat (viral sore throats often are worse at the beginning and then lessen)
  • Pain that’s worse with swallowing (viral sore throats can hurt more with coughing)
  • Bad breath
  • Some children will have a headache or vague abdominal pain whenever they have strep

People who have had strep will often recognize the feeling.

Co-existing viral infections and strep

While a child has a cold, if they are co-exposed to a child with strep, they can have both a viral and bacterial infection. During viral infection, the tonsils become slightly puffed up. If strep is able to attach and grow along the mucous membranes, a secondary bacterial tonsillitis, otitis, or sinusitis can arise. That’s why doctors become concerned if a child had a cough/cold and low grade fever that starts spiking after several days.

Ways to Prevent Strep:

Because a certain number of strep bacteria have to adhere to and grow along the throat, saliva is the first defense against strep. They don’t know why young grammar school children have a particularly high incidence of strep, but saliva factors must play a role. Salt is a deterrent for strep, as is garlic. Sugar can be a facilitator. Cavities are promoted by a less virulent strain of strep, group C. Foods that are protective against tooth decay, such as apples and cheese, can perhaps have a protective effect against strep.

Have your child rinse his/her mouth with water after having something sweet. Put water instead of a juice box in the lunch box. (Sharing food in the lunch room is a possible vector for strep, and the child shouldn’t go back to the classroom with ‘sweet’ saliva..)

Put an piece of apple, cheddar cheese or a few pretzels in his/her lunch box.

There is a mouth wash and toothpaste, Biotene, that has ingredients that protect against strep. It is usually used for adults with impaired saliva production, but is also good for children with recurrent strep.