A sore throat can be a sudden, painful nuisance, but determining its cause is an important first step toward treatment. Strep throat is a specific infection caused by a bacterium known as Group A Streptococcus (GAS), or Streptococcus pyogenes. The answer to whether you need antibiotics is straightforward: only if this particular bacterial infection is confirmed. Since the symptoms of strep throat often look exactly like those of a common cold or other viral infections, relying on how you feel is not enough to decide on treatment.
Confirming the Need for Antibiotics
Antibiotics are only effective against bacteria, making a diagnostic test mandatory before starting treatment for strep throat. Using antibiotics unnecessarily for a viral infection contributes to antibiotic resistance. The diagnostic process typically begins with a Rapid Strep Test (RST), which involves swabbing the back of the throat to check for the presence of GAS antigens. This test is valued for its speed, providing a positive result within minutes and allowing treatment to begin almost immediately.
While the RST is excellent at identifying positive cases, it may miss up to 10% to 20% of true infections, leading to a false negative result. For this reason, a follow-up throat culture is often used to confirm a negative RST, particularly in children and adolescents. The throat culture is considered the gold standard because it is more accurate, though it requires the sample to be incubated for 24 to 48 hours to allow the bacteria to grow. Once a positive result is confirmed by either method, a healthcare provider will prescribe an antibiotic.
Why Untreated Strep is Dangerous
The necessity of confirming and treating a strep infection stems from the risk of severe complications if the Group A Streptococcus bacteria is allowed to persist in the body. The bacteria can trigger a misdirected immune response that targets the body’s own tissues, leading to serious systemic health issues. Acute Rheumatic Fever (ARF) is one of the most concerning complications, as it is an inflammatory condition that can permanently affect the heart valves, joints, brain, and skin.
This inflammatory disease typically appears two to three weeks after an untreated strep infection and can cause long-term heart damage. Another severe complication is Post-Streptococcal Glomerulonephritis (PSGN), which is inflammation of the kidneys. PSGN can develop after a strep infection of the throat or skin, and while it often resolves on its own, it can sometimes lead to serious kidney problems.
The primary goal of antibiotic treatment is to eradicate the GAS bacteria quickly enough to prevent serious, non-throat-related complications, not just to reduce symptoms. Treatment with common antibiotics like penicillin or amoxicillin is typically prescribed for a full 10-day course. It is important to complete the entire duration of the medication, even if symptoms improve within a day or two. Stopping treatment early risks not fully clearing the bacteria, which allows complications like rheumatic fever to develop.
Treating Viral Sore Throats
The majority of sore throats are not caused by Group A Streptococcus, but rather by viruses like those responsible for the common cold or influenza. When a strep test comes back negative, the infection is highly likely to be viral, and antibiotics will have no effect on the course of the illness. In these cases, the focus shifts entirely to supportive care, which helps manage the symptoms until the body’s immune system clears the virus.
Symptom management includes using over-the-counter pain relievers and fever reducers, such as acetaminophen or ibuprofen. Staying well-hydrated is also recommended; drinking warm liquids like broth or caffeine-free tea can be soothing. Simple home remedies, such as gargling with warm salt water, can help relieve throat pain, though this is not recommended for young children who may swallow the solution.
Rest is another component of recovery, as the body needs time and energy to fight off the viral infection. Lozenges and hard candies can help stimulate saliva production, which keeps the throat moist and temporarily relieves dryness and irritation. These supportive measures are the safest and most effective approach when a bacterial cause has been ruled out, preventing the misuse of antibiotics.