strep throat Archives - Jeffrey Sterling, MD

Straight, No Chaser: Here's When Your Sore Throat Needs Antibiotics – The Centor Criteria

I enjoy giving you tips that provide insight into what your physician is thinking. Some of these considerations are so simple that you can use them at home. In many examples, these can help you understand what to expect or even if a physician’s visit is even necessary.

For example, in revisiting sore throats, the big concern is whether you have strep throat. Not all sore throat are strep throat – in fact most aren’t. There’s scratchy throats from trauma, cigarette smoking and viruses, just to name a few non-strep throat causes of sore throats. As such, not all sore throats require antibiotics – in fact most don’t. However, all cases of strep throat require antibiotics. To not receive antibiotics for an actual strep infection can have devastating consequences, as discussed in this post.
Physicians use a set of criteria (the Centor criteria), based on clinical signs and symptoms, to identify the probability that your sore throat is strep throat. In case you’re wondering “Why not just do a test?”, the answer is those rapid tests done in the ER are very inconsistent and often inaccurate. Think about it this way: how still are you when someone’s sticking that swab in the back of your throat? Really, how persistent is your doctor or nurse in getting that swab all the way to the back of your throat? Many rapid strep tests are negative in the presence of real infection because the swab never got to the right area.

The criteria only involve four considerations. One point is assigned for each positive consideration.

History of fever above 101.4
Tonsillar exudates (those white patches you can see in the back of your throat)
Tender anterior cervical adenopathy (the swollen, tender “knots” in your neck found just about under the angle of your jaws)
Absence of cough (because the presence of a cough implies something else is occurring)

It’s worth noting that physicians may assign additional consideration to their decision to treat or not. If you’re less than 15, strep throat is more likely, and if you’re older than 44, it’s less likely.
The purpose of all this is it directs the need for testing and treatment.

0 or 1 points – No antibiotic or throat culture necessary, as the risk of strep infection is less than 10%.
2 or 3 points – You should receive a throat culture. You will be treated with an antibiotic if the culture is positive. The risk of strep infection here is 32% in the presence of three positive criteria and 15% in the presence of two.
4 or 5 points – You should receive antibiotics. The risk of strep. infection is approximately 56%.

Whether you use this information for a better understanding of what your physician is doing on to empower you in utilizing the healthcare system, it’s good to know. Now get back to avoiding strep throat in the first place!

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Straight, No Chaser: Simple Questions About Sore Throats

Sore throats. So common. So simple. So sore. Here are a group of frequently asked questions to help you sort out the whys and what next considerations for you and your family.
How do I catch a sore throat?
You only “catch” them when the cause is an infection. Routine measures such as regular hand washing, covering your mouth when sneezing or coughing and keeping your hands out of your mouth go a long way to protecting you from infectious causes of sore throats.

Is a sore throat the same thing as tonsillitis?
Tonsillitis is one of many causes of sore throats. Causes can include infections, smoking, allergies and trauma to the back of your throat. Yes, bad singing can hurt more than someone else’s ears.
So what do I need to know about tonsillitis?
First you should know what and where the tonsils are. Besides being preferred landing spots for ice cream, the tonsils are the tissue located on both sides of the back of your mouth, as highlighted in the picture above. Tonsils are a common site for infection.
How is tonsillitis treated?
The treatment of sore throats in general is based on the cause. Tonsillitis can be caused by either bacterial or viral infections. Viruses do not respond to antibiotics, whereas bacteria do. Tonsillectomies are not needed in most people with tonsillitis. If you get severe tonsillitis often enough, or if you’re having breathing problems, you doctor may consider it.

Is strep throat the same as tonsillitis?
No. Strep throat is a sore throat caused by a specific type of bacteria (Streptococcus).

What is mono?
Mononucleosis (aka mono, the kissing disease) is a viral infection that causes sore throat. One clue that is very suggestive of the presence of mono is gland swelling in the back of your neck, as noted in the above picture.
Are sore throats dangerous?
It depends on the cause. If untreated, strep throat can result in dangerous disease of the kidney (called glomerulonephritis) or the joints and heart (called rheumatic fever). The complications of mononucleosis can be more serious that the disease, including splenic enlargement and rupture, as well as hepatitis (inflammation to the liver).
How does my doctor determine the cause of my sore throat?
Some physicians rely on clinical signs and symptoms. Others will obtain a throat culture or a rapid strep test. These tests are especially important if the decision is being made not to treat, because of the complications mentioned for untreated strep throat. Regarding mono, diagnosis may be confirmed with a blood test.
How are sore throats treated?
If your sore throat is caused by bacteria, you will receive an antibiotic. If it’s caused by a virus, you won’t. Antibiotics are ineffective against viruses. Just as occurs with other viruses such as the common cold, sore throats caused by viruses will go away on their own in 7-10 days.
Regarding specific treatment considerations:

If you have strep throat, your doctor will need to know if you’re allergic to penicillin.
No one under age 18 should take aspirin. Acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin, Advil) or naproxen (e.g., Aleve) can be given for relief of pain and/or fever.
If allergies are the cause of the sore throat, avoiding the causes is the most important consideration. Additional medicine for symptom relief is available.
Yes, gargling with warm salt water is effective. Place one teaspoon of salt in eight ounces of water.
Sucking on hard candy, throat lozenges, ice cream or frozen foods (e.g., popsicles) can help.
Drink plenty of fluids, warm or cool.
A humidifier is helpful for easing scratchy throats.

Another Straight, No Chaser post will address a simple way to figure out if your physician is likely to give you antibiotics for your sore throat.