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When a child complains of a sore throat, most parents worry that it could be strep throat, initiating a visit to my office.  Parents know their children need to be seen, but don’t necessarily understand why.  “What is strep throat? Why is it treated? Is it contagious? Could it be scarlet fever, and do I have to worry?” are all very common questions that parents ask.

 First, let’s consider some symptoms that make you think of strep: a sudden onset of a very painful throat, a fever typically between 101-104 degrees, swollen glands in the neck, headache, and an ill-appearing child.  In addition, there may be abdominal pain, nausea, vomiting, and even a rash.  It’s important to realize though that infants and toddlers with strep present with different and less specific symptoms.  Usually, they have a fever, poor appetite, thickened nasal discharge, and are quite cranky.

Although there are different types of strep bacteria, strep throat is caused by group A streptococcus.  Interestingly, there are over 120 distinct serotypes of group A strep, all causing strep throat.  Different from a virus and other forms of strep, group A strep requires treatment with antibiotics.

 Why is group A strep treated?  For a few different reasons.  First, it makes your child feel better pretty quickly, usually within 24 hours.  Next, it stops them from being contagious and spreading the infection to others.  And third, it helps prevent very real complications, including glomerulonephritis (a type of kidney disease) and rheumatic fever.  For these reasons, it is very important to make sure that your child takes the antibiotic as prescribed and finishes all of it.

 Is it contagious?  Yes.  Strep throat spreads following contact with respiratory secretions from another child or adult with strep.  Although strep throat occurs in all ages, it is most common among school-aged children and adolescents (most likely because of close contact).  If diagnosed, keep your child home until they are both fever free and have been on antibiotics for 24 hours.  If you’re worried your child has been exposed to strep, the incubation period is 2-5 days.

 Now for the diagnosis that causes the most concern: scarlet fever, which is truly just a fancy way to say strep throat with a rash.  I always explain scarlet fever this way because parents get very nervous with this diagnosis.  They know they’ve heard stories about how deadly this disease was, but not sure why.  That’s because a long time ago, before penicillin, there wasn’t a treatment for this illness, and, in fact, it was often severe and a leading cause of death in children.  During epidemics, those with the disease were quarantined to their homes to help stop the spread.  Thankfully we live in an era where we have many antibiotic choices to treat strep throat (and scarlet fever since it’s the same treatment).  For those who are interested in the reason for the rash, it is an exotoxin produced by the strep bacteria.  The rash is best described as a diffuse, erythematous, blanching (meaning the color goes away when you push on the skin), rough rash that feels like sandpaper.

 Although viruses can also cause a sore throat, they commonly occur with other upper respiratory symptoms (sneezing, congestion, cough, etc.).  The next time your child has a fever and sore throat, pay close attention to any associated symptoms and remember that it could be strep.

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