Tuesday, February 16, 2010

Do I have strep throat?

Patients come in all the time with a sore throat and think it's strep throat. In Arizona, it's more commonly postnasal drip from allergies or viral causes top the list but if it is strep what would you look for?

One of the more reliable tools that physicians can use to determine pre-test probability is the Centor criteria:
Fever +1 point
Exudate +1
Absence of cough +1
anterior cervical lymphadenopathy +1
Age <15 +1
Age >45 -1

Let me explain.
Fever- A fever is defined as a temperature of 100.4 F or higher. Also, some data has suggested that the patients report of feeling feverish is also significant regardless of an actual value.
Exudate- Exudates are physical exam findings that show white stuff on your throat. Remember, there are many things that can cause white stuff in the throat, but white stuff on your tonsil with the other findings at the same time is more concerning for strep.
Absence of cough-This history is important because typically a cough is viral and less likely strep.
Ant. cervical lymphadenopathy-This is when you can feel lymph nodes in your neck and they are tender and painful to the touch.
Age <15- More likely strep
Age >15- Less likely strep

Why is all this important?
There is a rare complication to strep throat which left untreated could lead to rheumatic heart disease and can cause complications later in life.

Depending on the number of points, physicians can decide whether or not to treat with antibiotics.
If all the points are present the physician will usually treat. If there is 2 or 3 points some physicians will use a rapid strep in office to get results in minutes. If 1-2 points present, watch and wait is a more prudent approach. Some physicians, especially pediatricians will send a throat culture. This is different than the above rapid strep. This culture is collected in the office and sent to the lab and results can take 3 days. Based on the culture results, physicians will then call mom and call in a prescription for antibiotics.

If you have the above symptoms concurrently, you should call your doctor and be seen. Strep or not, there are many remedies to help patients with sore throats.

Read more from this patient information sheet from the AAFP.org:

Bryan Glick, DO, MBS