Strep throat is a prevalent infection. It is estimated that millions of cases of strep throat are diagnosed in the United States every year. Strep throat is a bacterial infection caused by a bacterium belonging to Group A Beta Hemolytic Streptococcus (GAS). Approximately 3 out of every 10 cases of sore throat is classified as a strep throat infection. 

What Are the Risk Factors of Catching Strep?

Children tend to get strep throat more frequently than adults. However, school-aged children are the most vulnerable to strep throat. Compared to children under the age of five, children who are between 5-15 years old have a higher risk of strep throat infection (24% risk for younger children vs 37% risk for school-aged children). Adults are the least affected age group with a risk of getting strep throat, with a chance ranging between 5-15%. However, adults who have frequent contact with infected school-aged children are at a higher risk of acquiring strep throat infection. Regarding the seasonal variation, strep throat infections are generally more common in late winter and early spring.

How to Differentiate Between Strep Throat and Other Causes of Sore Throat

Despite the fact that strep throat is the most common bacterial cause of sore throat, the most common causes of sore throat, in general, are not strep. That's why strep is often misdiagnosed as a viral infection like infectious mononucleosis (mono) and hand-foot-and-mouth disease. The seasonality and the symptoms of the diseases can help in distinguishing these infections from others. Strep throat is characterized by a rapid and acute onset of high fever and intensely red and inflamed tonsils.

On the other hand, infectious mononucleosis (mono) is most common among 20-30-year-olds and causes more fatigue and cervical lymphadenopathy (lymph nodes enlargement in the neck.) Hand-foot-and-mouth disease is characterized by painful oral lesions and rash on the hands and feet.

How is Strep Throat Diagnosed?

Strep throat is diagnosed using a combination of both clinical decision and rapid antigen detection testing (RADT). Clinical decisions should be made based on the consideration of symptoms upon clinical examination. Based on the clinical assessment, patients who have a low risk of strep throat should be treated symptomatically. For patients who have an intermediate risk for strep throat, RADTs test should be ordered to confirm the diagnosis before starting antibiotic therapy. Patients who have a high risk for strep throat can be treated with antibiotics immediately without ordering RADT. The best part about rapid strep tests is that they can be done at home.

Is a Tonsillectomy Recommended For Recurrent Strep Throat?

A tonsillectomy should be considered for a subgroup of patients who have recurrent strep throat infections and, at the same time, have allergic reactions to the antibiotics that are used to treat strep throat. Additionally, it should be considered for patients who have peritonsillar abscesses. Keep in mind that this is an invasive procedure and should be considered only after careful assessment.

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