The question of whether a sore throat will run its course without medical intervention is common, especially when symptoms suggest a bacterial infection. Understanding the nature of this infection and the potential consequences of leaving it untreated is important. This article clarifies the expected course of this bacterial infection when treatment is not administered.
Understanding Group A Streptococcus
The infection known as strep throat is caused by the bacterium Streptococcus pyogenes, also called Group A Streptococcus (GAS). This bacterial infection differs significantly from a viral sore throat, which often includes symptoms such as a cough, runny nose, or hoarseness. GAS primarily causes inflammation and pain in the throat and tonsils.
The bacteria are highly contagious and live in the nose and throat of an infected person. Transmission occurs most frequently through respiratory droplets released when an infected person coughs or sneezes. Direct person-to-person contact and, less commonly, contact with contaminated surfaces can also spread the organism.
The Immediate Outcome of Untreated Strep
When an individual contracts Group A Streptococcus, the body’s immune system begins to fight the infection. Acute symptoms, such as severe sore throat and fever, often lessen after several days. This symptomatic improvement can give the false impression that the infection has been eradicated.
While the most painful part of the illness may pass, the bacteria may not be fully eliminated from the throat. The infection can persist at a low level, meaning the individual remains a carrier and can still transmit the bacteria to others. The lingering presence of the pathogen creates a hidden health risk that extends far beyond the discomfort of a sore throat.
Severe Long-Term Health Risks of Untreated Infection
The most significant danger of leaving Group A Streptococcus untreated lies in the potential for severe, immune-mediated complications. These serious health issues arise when the body’s sustained immune response to the remaining bacteria mistakenly begins to attack its own tissues. This autoimmune reaction can lead to long-term damage in various organ systems.
Acute Rheumatic Fever (ARF)
One concerning complication is Acute Rheumatic Fever (ARF), which typically develops two to four weeks after an untreated infection. ARF is an inflammatory condition that can affect the joints, skin, brain, and, most dangerously, the heart. The inflammation can permanently damage the heart valves, a condition known as Rheumatic Heart Disease, which can cause lifelong cardiac problems.
Post-Streptococcal Glomerulonephritis (PSGN)
Another serious sequela is Post-Streptococcal Glomerulonephritis (PSGN), a condition that affects the kidneys. PSGN involves inflammation of the glomeruli, the tiny filtering units within the kidneys. This inflammation can lead to symptoms like blood in the urine, high blood pressure, and swelling, particularly around the eyes and ankles.
Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS)
A third complication, primarily affecting children, is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). This disorder involves the sudden onset or worsening of neuropsychiatric symptoms, such as obsessive-compulsive behaviors or tic disorders, following a Group A Strep infection.
Diagnosis and Standard Treatment Protocols
Healthcare providers typically use a rapid antigen detection test (RADT) on a throat swab, which provides results in minutes. If the rapid test is negative but strep is still suspected, especially in children, a throat culture may be performed, with results available after a day or two.
Once the presence of the bacteria is confirmed, the standard treatment involves a course of antibiotics, typically penicillin or amoxicillin. These antibiotics are effective against Streptococcus pyogenes. Treatment shortens the duration of acute symptoms and reduces the risk of developing dangerous complications.
It is important to complete the full course of the prescribed medication, usually a 10-day regimen, even if symptoms disappear quickly. Stopping the medication prematurely may not fully eradicate the bacteria, allowing it to persist and potentially lead to complications. A patient is generally no longer contagious and can return to normal activities 24 hours after beginning the antibiotic treatment, provided their fever has resolved.