Family Medicine
Incidence of strep throat probably unchanged today Question: Can you give me an update on strep throat? Is it getting worse? Will my kids outgrow strep throat so I eventually won’t have to worry about it anymore? Finally, I heard recently that strep throat can cause behavioral changes in children — is this true? Answer: Based on incidence rates and reported symptoms, Streptococcal pharyngitis, known as strep throat, is probably unchanged from when you were a child.
This infection is most common in children between the ages of five and 15, but it can occur at any age. In other words, children do not outgrow strep throat, but they do seem to grow more resistant to this infection as older teenagers and adults.
Many people think that having tonsils removed can prevent strep throat, but people can get strep throat with or without tonsils. The best preventive strategy is good hygiene, particularly hand-washing, and avoiding direct contact with people infected with strep throat. The hearty bacteria that cause strep throat are spread through direct person-to-person contact. Coughing, sneezing and talking can all spread droplets of saliva, where the bacteria live.
Cases of strep throat usually begin showing up in the late fall, and they peak in the winter. Although most sore throats result from viruses, strep throat is the most common bacterial infection of the throat. Because its incubation period is only a few days after exposure, strep throat can spread rapidly.
The onset of the infection is usually sudden, involving fever, sore throat, trouble swallowing and swollen glands in the front of the neck. This is the “classic” presentation, but symptoms can also be mild. It is important for a child to get tested for strep if a sore throat persists for a couple of days. A throat culture is the only way to definitively diagnose strep throat.
Once diagnosed, the infection is easily treated with antibiotics. Typically, either penicillin or amoxicillin is prescribed. Warm tea with honey and lemon can help relieve the pain, as can gargling with warm salt water.
As for behavioral changes, there has been a recent finding that, following a strep infection, some children develop behaviors similar to those seen in children with obsessive-compulsive disorder (OCD). This syndrome, called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS), develops very abruptly, even though it comes on weeks – sometimes even months – after the strep throat infection. In OCD not associated with strep, the behaviors come on more gradually over months or years.
A child’s abrupt change in behavior should always be investigated by a pediatrician or family physician. Even if you do not recall your child having been ill, you should ask for a strep throat culture as part of the evaluation following an abrupt behavioral change.
Fortunately, PANDAS seems to be a relatively new disorder, and it is not very common. Treatment of the strep infection with antibiotics can sometimes result in a dramatic improvement in the child’s behavioral symptoms.
Family Medicine is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, Communication Office, Athens, Ohio 45701, or via e-mail to familymedicine@-oucom.ohiou.edu. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.