How Can I Tell If I Have Strep Throat?

Doctor looking at young girl's throat.
Doctor checking girl's throat. Blend Images - REB Images/Brand X Pictures/Getty Images

Most people know that strep throat causes a very sore throat. But so do many other illnesses. So how do you know if it's strep or not? Can you tell just by looking at the throat? Or by how it feels? Unfortunately it's not that easy. 

My Throat Is Really Sore

Strep throat usually causes a very sore throat. Swallowing is often painful and many kids with strep also have a fever. Other common symptoms include headache and stomach pain.

However, just because your throat hurts a lot doesn't mean it is strep. Pain is subjective, meaning really bad pain to one person may not be so bad to someone else. There are other things that can cause sore throats as well. So just basing your "diagnosis" on severity of throat pain isn't good enough.

White Spots in the Throat

Some people who have strep may see white spots or patches in the back of the throat. Although this can be caused by strep, it can be caused by other things as well and is not enough to determine what is making you sick.  

Fever and Sore Throat

Although these are the two most common symptoms of strep throat, only 20-30% of children who see a doctor for a sore throat actually have strep. Many illnesses - including the flu - can cause fever and sore throat. Strep cannot be diagnosed by symptoms alone. 

Positive Rapid Strep Test

You would think the rapid strep test in the doctor's office would be definitive but it isn't always.

The gold standard for testing for strep throat is a throat culture. But those take several days to get results from so rapid antigen testing (this is the test that your doctor can do in the office) was developed to give faster results and allow health care providers start treatment sooner if necessary.

 

Unfortunately some providers test nearly everyone - no matter their symptoms. If you have a cough and runny nose with a sore throat, you almost certainly don't have strep throat. These are symptoms of a viral illness, not strep. To make matters more complicated, Group A streptococcus, the bacteria that causes strep throat, is present in almost everyone's body. It shouldn't be in the back of your throat but if the person performing the test doesn't get a good sample (which is very common, especially in young children), the results may not be accurate. There are also people that do carry Group A strep in their throats all the time but do not have active infections. These are known as "strep carriers". If your health care provider performs a rapid strep test every time you get sick, the results are likely to be positive if you are a strep carrier but that doesn't mean you have strep throat. 

If you have symptoms of strep throat without viral symptoms like congestion, runny nose or cough and your rapid strep test is positive, then the diagnosis and treatment of strep throat is accurate and appropriate.

But if you have a bunch of cold symptoms - including a sore throat - your health care provider shouldn't be performing a strep test at all and giving you antibiotics won't help. In fact, taking antibiotics when they aren't necessary can be dangerous and may lead to serious health risks in the future. Antibiotic resistance is a very serious global health concern that is made worse by the overuse of antibiotics when they aren't necessary. 

Sources:

Karen E. Gieseker, Martha H. Roe, Todd MacKenzie, James K. Todd. "Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing." Pediatrics Jun 2003, 111 (6) e666-e670. 30 Mar 16. 

"Group A Streptococcal (GAS) Disease". For Clinicians, Group A Strep. 1 May 14. US Centers for Disease Control and Prevention. Department of Health and Human Services. 30 Mar 16. 

"Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. (2012)doi: 10.1093/cid/cis629. 30 Mar 16. 

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