Chris Van Beneden, MD, MPH
Chris Van Beneden, MD, MPH, senior epidemiologist, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta.
Bottom Line: Here’s how to tell whether you’ve got this nasty bug…
My 28-year-old daughter was just diagnosed with strep throat, but she didn’t have a sore throat. Is it possible that the symptoms are different in adults?
To be diagnosed with strep throat (known medically as group A strep pharyngitis), there are two requirements—a sore throat (pharyngitis) and laboratory confirmation of an infection caused by bacteria known as group A Streptococcus. It sounds like your daughter was a carrier for the bacteria that causes strep throat but did not actually have strep pharyngitis. Here’s what can happen: People can have the group A strep bacteria in the back of their throats without being sick. We call this being a carrier. In general, group A strep carriers do not need antibiotics, since they are unlikely to spread the bacteria to other people or become ill themselves. Even though strep throat most often affects children from ages 5 to 15, the illness can occur at any age. Symptoms include a sudden onset of sore throat that causes pain when swallowing…fever (typically 101 degrees Fahrenheit or higher)…red, swollen tonsils (with or without white patches)…and tender lymph nodes in the front part of the neck. However, children are more likely than adults to also have a headache, stomach pain, nausea and/or vomiting. In adults, throat symptoms caused by strep are often mild. A person with a sore throat due to strep may also have a bright red rash—when accompanied by a high fever, this illness is called “scarlet fever.” The rash looks like a sunburn and feels like sandpaper. A doctor cannot diagnose strep throat just by looking at a person’s throat. Testing for group A strep includes a rapid test (a throat swab is performed in a doctor’s office, and results are available in 10 to 20 minutes) or culture (a throat swab specimen is sent to a lab for analysis, and results come 24 to 48 hours later). Even though strep throat is more common in children, adults should ask their healthcare provider about getting tested if they have the symptoms described above. An important distinction: When a person has a cough, runny nose (rhinorrhea), hoarseness and oral ulcers (small, painful lesions that can develop in your mouth or at the base of your gums) along with a sore throat, it’s more likely that a virus is to blame rather than a strep infection. In fact, most cases of a sore throat are due to a viral infection, which does not require antibiotics. A viral infection will typically improve on its own within a few days. Giving a test for strep to people who have these symptoms is not recommended. If an adult or child has a sore throat, you can… Soothe the sore throat with ice chips, sore throat spray, popsicles or lozenges (do not give lozenges to young children). Gargle with salt water. Drink warm beverages. Use a clean humidifier or cool-mist vaporizer. Take acetaminophen, ibuprofen or naproxen to relieve pain or fever. For more information on what’s safe to give a child, read here.
