Strep throat, or streptococcal pharyngitis, is a bacterial infection of the throat and tonsils caused by Streptococcus pyogenes (Group A Streptococcus or GAS). This common infection typically presents with a sudden sore throat, fever, and sometimes a rash. While widely prevalent, especially among children and adolescents, prompt treatment is important to prevent complications.
The Role of Antibiotics
Antibiotics are prescribed for strep throat primarily to eliminate Streptococcus pyogenes bacteria. This treatment helps shorten the illness, reduces transmission, and prevents serious complications. Penicillin and amoxicillin are commonly used and effective. Antibiotics target the bacterial cause, unlike viral infections. Completing the full course is important, even if symptoms improve, to eliminate all bacteria and prevent recurrences and complications.
Immediate Consequences of Untreated Strep
If strep throat is not treated with antibiotics, the acute symptoms can persist and potentially worsen. Common symptoms like a severe sore throat, difficulty swallowing, fever, headache, and stomach pain may continue. A sandpaper-like rash, known as scarlet fever, can also develop when the bacteria release toxins, often accompanied by a high fever and a characteristic “strawberry tongue.” Without treatment, the infection can spread locally to other areas of the head and neck. This can lead to a peritonsillar abscess, a collection of pus behind the tonsils, causing severe pain and difficulty opening the mouth. The infection can also extend to the middle ear, resulting in ear infections (otitis media), or to the sinuses, causing sinus infections (sinusitis).
Serious Long-Term Complications
Untreated strep throat can lead to severe, non-suppurative complications that stem from the body’s immune response to the bacteria. One of the most serious long-term complications is Acute Rheumatic Fever (ARF), an inflammatory disease that can affect various organ systems. ARF can damage the heart, leading to rheumatic heart disease, which can cause permanent heart damage.
ARF typically manifests 2 to 3 weeks after an untreated strep throat infection. It can also affect the joints, causing arthritis-like pain, and in some cases, the brain, leading to involuntary movements known as Sydenham’s chorea. Skin manifestations like erythema marginatum or subcutaneous nodules may also occur. While ARF is less common in developed countries due to antibiotic use, it remains a serious concern.
Another complication is Post-Streptococcal Glomerulonephritis (PSGN), a kidney disorder that can develop 1 to 2 weeks after a strep throat infection. PSGN occurs when the body’s immune system, fighting off the strep infection, mistakenly attacks the filtering units of the kidneys, called glomeruli. Symptoms of PSGN can include dark, reddish-brown urine, swelling (edema) in the face and extremities, and high blood pressure. While PSGN often resolves without specific treatment, some cases may require management of symptoms.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition where a strep infection may trigger or worsen obsessive-compulsive disorder (OCD) and tic disorders in children. The hypothesis suggests that antibodies produced to fight the strep bacteria may mistakenly attack healthy brain cells, particularly in the basal ganglia, due to molecular mimicry. Symptoms often appear abruptly and dramatically, with a relapsing and remitting course.
When to Seek Medical Care
It is important to seek medical attention if strep throat symptoms are suspected. These symptoms include a sore throat that starts suddenly, difficulty swallowing, fever, or tender, swollen lymph nodes in the neck. Red and swollen tonsils, sometimes with white patches or streaks of pus, can also indicate strep throat. A proper diagnosis, typically involving a rapid strep test or throat culture, is necessary to confirm the bacterial infection. Early diagnosis and treatment are crucial to alleviate symptoms, reduce contagiousness, and prevent the development of the serious long-term complications discussed.