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5 Things You Might Not Know About Strep

When someone in my kid’s class is diagnosed with strep throat, a note goes home notifying the rest of the class that STREP IS IN THE CLASSROOM. I get it; it’s an infection control message and provides me the opportunity to:

  1. Check my child for symptoms, and
  2. review with my own kids that they shouldn’t be sharing drinks or lip balms with their classmates, to be good about handwashing, and all that prevention stuff.

Maybe I’m reading into it a bit, but the ‘tone’ of the letter sort of makes it seem like someone in the class has leprosy.  Or the plague. I won’t share the note here in order to protect what I’m sure aren’t any nefarious motives, but the school note made me think that it’s time to publish some less commonly known trivia that I think you oughta know about strep. Beside the fact that your child isn’t a threat to public health if she has it.

We all know that a strep infection is nearly always pretty easily solved with a course of penicillin or amoxicillin: effective and inexpensive antibiotics.

We used to give these medicines 3 and 4 times a day: a total pain, right? I’ve seen parents carrying around a cooler with the medicine in it (because it has to be refrigerated) just so they can keep their kids on schedule. Awesome parents, towing the line and doing right by their kids. Good thing most kids like the taste of amoxicillin. What’s not to like about that artificial bubble gum flavor? Well, I want to make sure you know now that the medicine can be given only ONCE per day and still treat the infection effectively. Many physicians even have a hard time changing their ways and can’t quite let go of the every 8-12 hour medicine dosing, but the once daily dosing works. It’s been studied; ask for it. 


Scarlet fever is just the skin manifestation of a strep infection.

It’s a red, sandpaper-like rash that usually starts on the trunk and may spread to the extremities. It’s dramatic looking AND sounding, and I wish we could all agree to change the name to “strep rash” or something incredibly dull so that there wouldn’t be as much of a hype about it. People simply love to report that they or their child “had scarlet fever” and describe it with a gravitas usually reserved for diagnoses known for very poor outcomes. When I rain on the parade with my reaction that is the opposite of shock, I know I disappoint just a little bit but I won’t be able to live with myself if I contribute in any way to the mystique about scarlet fever. Scarlet fever is easily treatable and not life-threatening.rashes on arm

Strep will go away on its own.

Without medicine. Weird. But it’s true. Your body’s immune system can and will eventually clear the strep bacteria. We mostly give antibiotics to get rid of the infection quicker and avoid the complications of strep, known (cue appropriate dramatic music…) as acute rheumatic fever. Rheumatic fever is uncommon in developed countries like the US, with the CDC reporting 0.04-0.06 annual cases per 1000 children, but remains a problem for underdeveloped nations. Unlike scarlet fever, acute rheumatic fever can cause serious medical problems in the joints and kidneys, among other places, so we treat strep in kids who are most susceptible to these complications, those older than age 3.


A negative predictor for strep infection is COUGH.

What that means is that if you have a cough, you are LESS LIKELY to have strep. This has been studied too. Additionally, many children who DO have strep have symptoms OTHER THAN a sore throat: namely headache and stomachache. Any school age child who comes to visit me with a fever, headache and abdominal pain always gets a strep test. Even if their throat looks ok.girl coughing into arm

What’s all the talk about some kids being a strep “carrier?”

What this means is that some kids always seem to have strep living in peace and harmony in the back of their throat so that even when they are not sick, they will still test positive when a throat swab is obtained. It’s not very common, but I do consider carrier status when a child gets back to back infections that test positive and that look clinically different from the very common back to back viruses that all kids get. The general thought is that children who are carriers are not in a state of constant infection or transmission of strep to others, and so there’s no good reason to be sending fancy immunologic tests to try to figure this out. What it may mean however, is that a stronger antibiotic may be prescribed to try to knock the infection out.

Well, did you learn something new? Does your child’s school notify you when strep is present in the classroom? One thing is for sure: we’re always learning something new in medicine, even about diseases that have been around for ages. I want to make sure that you are as up to date as possible about changes that might affect you and/or or your children, even as it relates to routine, run of the mill infections that we encounter often enough that we all might be considered experts in our own right, no matter what our background and training may be. Sometimes “parent” is the only qualifying title we need.

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