Recurring Strep Throat: What to Do When It Comes Back

Illustration by Joshua Seong. © Verywell, 2017.

Recurring strep throat can result in pain and discomfort, lost days at school or at work, and ultimately surgery. This article will explore ways to discover why you may be experiencing recurring strep throat and what you can do about it.

What Is Recurring Strep Throat?

This actually can be a broad name for several scenarios:

  • A case of strep throat that is not cured after the first course of antibiotic treatment.
  • A person who is infected by strep throat frequently, perhaps a few times a year.
  • Lastly, a person who gets strep throat frequently.

If you have had strep throat 7 or more times in one year, your doctor will usually consider performing a tonsillectomy. This makes it less likely for you to get strep, but some individuals still get strep throat even after their tonsils have been removed.

Experts can narrow recurring strep throat down to a few factors. One is that you have simply contracted a resistant form of the bacteria or your antibiotic has failed for some other reason. Another possibility is that you may have a weakened immune system. There may also be a strep carrier in your family.

Follow These Steps to Prevent Recurring Strep Throat

  1. Finish all of your antibiotics when you have a strep infection, even if you feel better. If the bacteria is not completely destroyed, it will come back stronger than ever.
  1. During the first 24 hours after you start an antibiotic, you are still able to spread strep throat to others. Stay at home, cover your mouth, wash your hands, and do not share drinks, utensils, or lip balm.
  2. Throw your toothbrush away 24 hours after you start a course of antibiotics. If you keep the same toothbrush you can reinfect yourself with strep after your antibiotics are finished.
  1. Keep toothbrushes separate. Do not use toothbrush holders that allow your family's toothbrushes to touch.
  2. Do not share a bed with someone in your family until you have been taking antibiotics for at least 24 hours.
  3. Identify strep carriers.

Who Are Strep Throat Carriers?

If you are a strep throat carrier, you are infected with group A strep in the back of the throat, but will not exhibit symptoms of strep throat. Your blood tests will also show that there is no immune response to group A strep.

It is possible for these people to have strep for months or even years without knowing it, all the while inadvertently infecting other people. If your family has had a lot of recurring strep throat, all family members should be tested for strep throat. Once carriers have been treated with antibiotics they will no longer be contagious. However, physicians are not encouraged to treat strep carriers unless the carrier is having complications of strep throat or are frequently infecting other individuals.

A "group A strep carrier" will test positive for strep throat, (when tested with a rapid strep test or throat culture), even if they are not really having a current episode of strep throat. If you are routinely having positive strep tests, you may need to consider the fact that you are a strep carrier and have actually been infected with a cold virus which is causing sore throat rather than as a result of strep throat.

When Your Antibiotic Doesn't Work

The first antibiotic choice for treating strep throat is penicillin or amoxicillin. If you have a penicillin allergy, penicillin or any other antibiotic in the -cillin family will not be used. Individuals with penicillin allergies are often prescribed Keflex (cephalexin), clindamycin, or erythromycin. There has been reported resistance with the use of Zithromax (azithromycin). This is often disappointing, because the z-pak (azithromycin) is convenient because of how quickly you can get through the treatment.

Whether or not the first antibiotic works for you is related to timing.

There is clinical evidence that individuals who receive their prescription too early (within the first 48 hours) in the course of their illness are at a higher risk for recurring strep throat. However, it is not recommended that doctors delay treatment of strep throat unless they are treating an individual with recurring strep throat.

There are many different kinds of bacteria that live in the back of the throat without making us sick and that actually fight off the bacteria that is harmful to our bodies. This bacteria is called "normal flora." Some studies have shown that the normal flora in some individuals is capable of disabling the bactericidal mechanism of penicillin and related antibiotics. In this case, another antibiotic not in the penicillin family should successfully treat your strep throat.

It is also true that most antibiotics will destroy the normal flora in the back of your throat that normally fight off harmful bacteria—including the bacteria responsible for strep throat. This makes it very easy to contract another case of strep throat within the first month or so after your initial treatment, even if the first antibiotic was successful.

Resistant strains of the bacteria responsible for strep throat are not common. In most cases, if the first course of antibiotics does not work, a new antibiotic will. If this is not the case for you, you may want to explore other explanations for your recurring strep throat.

Can Surgery Help?

Many physicians will recommend having a tonsillectomy if you have had strep throat 7 or more times within one year. However, the risks of surgery must be carefully considered before deciding to have surgery. In most cases, a tonsillectomy will solve the problem of recurring strep throat, but not always. It is best to discuss possible reasons for your recurring strep throat and the benefits versus risks of surgery before having a tonsillectomy.

Recurring Strep Throat Related to a Weakened Immune System

There are many diseases that can cause decreased immunity. You will have a weakened immune system if you have HIV/AIDS, are receiving chemotherapy, are an organ transplants recipient, or are taking corticosteroid medications. However, some individuals simply inherit a weak immune system.

You will need to explore possibilities of a weakened immune system with your physician and then be extra diligent in practicing the following hygienic measures, (and any others recommended by your doctor). These suggestions are good practice not only for those with decreased immunity but for anyone who has had problems with recurring strep throat:

  • Wash you hands frequently. Wash for at least 15 seconds. Use antibacterial soap if you can. Use an alcohol-based hand sanitizer if soap and water are not available. Wash before and after you eat, after you use the restroom, and after entering and exiting a public place.
  • Do not share drinks or utensils with others.
  • Avoid individuals you know are ill.
  • Strep throat is most common in children ages 5 to 15 years old. As much as possible, avoid places where large numbers of kids in this age group will be. If you need to be in an area where there are a lot of children this age, wash your hands more frequently. Depending on how severe your weakened immune system, you may consider wearing a face mask.
  • Be aware of your personal space. Crowded living conditions have been proven as culprits for the spread of strep throat.
  • Always cover your mouth when you cough or sneeze and ask others around you to do the same.
  • Inform your friends and family that you have a weakened immune system and ask them to follow good hygiene as well.

A Word From Verywell

Strep throat that just won't go away can feel discouraging. It may have you questioning whether your doctor is good, or if you have something else wrong with you. Unfortunately there are many factors that can set you up to have recurrent strep throat. Following the steps outlined in this article and taking medications exactly as prescribed by your physician will help you prevent recurrent strep throat.


Medline Plus. Tonsillectomy.

Pichichero, Michael E. Antibiotic Failure in the Treatment of Streptococcal Tonsillorpharyngitis.