Strep throat, a common bacterial infection, is caused by Streptococcus pyogenes, also known as Group A Streptococcus (GAS). It presents with symptoms like a sore throat, fever, and swollen tonsils. While often a one-time occurrence, repeat infections are possible, even three times in a row, though uncommon.
Understanding Recurrent Strep
Recurrent strep throat can stem from several factors, including re-infection, an asymptomatic carrier state, or incomplete treatment. One common reason for recurrence is re-exposure to new strep bacteria from external sources, such as family members, school, or work environments. Immunity from one GAS strain does not protect against all others, allowing infection by a different strain after recovery.
An asymptomatic carrier state is another possibility, where an individual harbors the Streptococcus pyogenes bacteria in their throat without displaying any symptoms of illness. Carriers can unknowingly spread the bacteria, leading to recurrent infections within a household or close-contact settings. Up to 20% of school-aged children may be strep carriers. While less likely to transmit than symptomatic individuals, carriers can still act as a reservoir for re-infection.
Incomplete treatment of a previous strep infection also contributes to recurrence. If the full course of antibiotics is not completed, even if symptoms improve, some bacteria may survive and cause a new infection. This allows Streptococcus pyogenes to persist, leading to relapse or a carrier state. Some research also suggests individuals with recurrent infections may have a less robust immune response due to fewer antibacterial antibodies.
Managing Persistent Infections
Accurate diagnosis is important for recurrent strep throat, as many sore throats are viral and do not respond to antibiotics. Healthcare providers use rapid strep tests or throat cultures to confirm Streptococcus pyogenes. A rapid antigen detection test (RADT) provides results in minutes. If negative but strep is suspected, a throat culture, which takes up to two days, may be performed for confirmation.
For confirmed recurrent cases, antibiotic strategies may involve extended courses or different types of antibiotics. Penicillin and amoxicillin are common first-line antibiotics, usually prescribed for 10 days. If these are ineffective, alternative antibiotics like clindamycin, azithromycin, or amoxicillin-clavulanate may be considered. For patients with penicillin allergies, cephalosporins or macrolides are alternative options.
If a strep carrier state is suspected, especially within a household with recurrent infections, a doctor might test other family members. While asymptomatic carriers do not typically require antibiotics, in specific situations like recurrent pharyngitis without cough or congestion, eradication treatment might be considered. Such eradication therapies might include a 10-day course of clindamycin or a combination of intramuscular penicillin with rifampin for a shorter duration.
Tonsillectomy, the surgical removal of tonsils, may be considered for chronic, recurrent strep infections when other treatments fail. Criteria often include a documented history of frequent infections: seven or more episodes in the past year, five or more per year for two consecutive years, or three or more per year for three consecutive years. While tonsillectomy can reduce strep throat frequency and severity, it does not eliminate future infections, as the bacteria can still infect other parts of the throat.
Minimizing Risk and Recognizing Serious Outcomes
General hygiene practices can minimize strep throat transmission. Frequent handwashing with soap and water, especially after coughing or sneezing and before eating or preparing food, is recommended. Avoiding sharing personal items like cups, utensils, and toothbrushes can also prevent the spread of bacteria. Staying home when sick and covering coughs and sneezes with a tissue or the bend of an arm further reduces transmission.
Recurrent strep throat, if untreated or inadequately treated, carries a risk of serious complications. The bacteria can spread, leading to conditions like ear or sinus infections, or abscesses around the tonsils. More concerning are immune-mediated complications, which occur when the body’s immune response to the strep infection attacks healthy tissues.
These complications include acute rheumatic fever, a severe inflammatory condition that may affect the heart, joints, brain, and skin, potentially causing permanent heart damage. Another complication is post-streptococcal glomerulonephritis, a kidney condition that can develop after a strep infection. Prompt diagnosis and completion of the full antibiotic course are important to reduce the risk of these serious outcomes. Consulting a healthcare professional for any suspected strep infection, especially if it recurs, is advisable to ensure proper diagnosis and treatment.