Strep throat, a common bacterial infection, affects many individuals, causing symptoms like a sore throat, fever, and difficulty swallowing. While typically manageable with antibiotics, some adults experience recurring episodes. Understanding the reasons behind these repeated infections is important for effective management.
Why Strep Throat Can Return
Recurring strep throat can arise from two main scenarios: a true recurrence, where the original infection was not fully cleared, or a reinfection, where an individual contracts the bacteria anew. Distinguishing between these possibilities is key to identifying the underlying causes. True recurrences suggest issues with bacterial elimination, while reinfections point to ongoing exposure to the bacteria from external sources.
Incomplete Bacterial Eradication
Incomplete eradication of Streptococcus pyogenes is a primary reason for recurring strep throat. This often occurs if the full course of prescribed antibiotics is not completed, as patients may stop medication once symptoms improve, leaving residual bacteria to multiply. For example, stopping a 10-day penicillin course prematurely can lead to relapse.
Incorrect antibiotic dosage or inconsistent use can also prevent full bacterial elimination. While Streptococcus pyogenes is usually susceptible to common antibiotics, rare resistance can occur. Such resistance, though infrequent, can make treatment more challenging and potentially lead to recurrence.
Ongoing Exposure to the Bacteria
Ongoing exposure to Streptococcus pyogenes from external sources frequently causes recurring strep throat. Asymptomatic carriers in households or social circles can unknowingly transmit the bacteria without showing symptoms. This makes identifying the source of repeated infections challenging, as healthy contacts can be silent reservoirs. Transmission occurs through respiratory droplets when an infected person coughs or sneezes.
Personal items can also become contaminated and serve as a source of reinfection. Shared toothbrushes, eating utensils, or drinking glasses can harbor the bacteria, facilitating its spread. Reinfection can also occur from contact with contaminated surfaces in shared environments, like doorknobs or toys. Thorough handwashing and avoiding shared items help reduce transmission risk.
Persistent Bacterial Presence
In some adults, recurring strep throat stems from internal factors that allow the bacteria to persist within the body. The tonsils, for example, can play a role, particularly in cases of chronic tonsillitis. Inflammation and structural changes in the tonsils can create an environment where Streptococcus pyogenes can thrive, leading to repeated infections.
Bacterial biofilms can form on the surface of the tonsils, providing a protective layer that shields bacteria from antibiotics and the body’s immune response. These slimy communities of bacteria are harder to eliminate than free-floating bacteria, contributing to persistent infections.
Small crevices or pockets within the tonsils, known as tonsil crypts, can also trap bacteria and debris. These crypts act as reservoirs for Streptococcus pyogenes, sheltering the bacteria and making it difficult for standard antibiotic treatments to reach and eradicate them completely.