When a child frequently experiences strep throat, parents often feel frustrated and concerned. While common, its repeated recurrence can be puzzling and disruptive. This persistent issue prompts questions about why some children are more prone to these infections and what can be done to break the cycle.
Reasons for Recurrent Strep
Children can get recurrent strep throat for several reasons, often involving continued exposure or incomplete bacterial eradication. One common cause is re-infection, where a child is exposed to new strains of Group A Streptococcus (GAS) from their environment, such as school or daycare. Since many different GAS strains exist, one infection does not provide immunity against others, making re-infection possible.
Another factor is the presence of asymptomatic carriers within the household or close contacts. These individuals harbor strep bacteria without symptoms, yet they can still transmit the infection. An asymptomatic family member can repeatedly expose the child to bacteria, even after the child has been treated.
Incomplete treatment of a strep infection is also a common reason for recurrence. Stopping antibiotics too soon, even if symptoms improve, can leave some bacteria alive. These surviving bacteria can then multiply, leading to a relapse or allowing the child to remain contagious. Additionally, some sore throats are caused by viruses, not bacteria, and can be mistaken for strep, leading to ineffective antibiotic treatment.
Factors Influencing Susceptibility
Individual characteristics can make some children more susceptible to recurrent strep throat infections. Strep throat is most common in school-aged children (5-15 years old). This age group experiences increased exposure in group settings like schools and daycares, alongside developing immune systems, which contributes to their higher susceptibility.
The physical structure of a child’s tonsils can also influence how often they get strep. Tonsils have small pockets or folds, known as crypts, which can trap debris and bacteria. In some children, deep crypts can harbor strep bacteria, making complete eradication difficult for antibiotics. This allows bacteria to persist and potentially lead to repeated infections.
A child’s immune response to Group A Strep can affect their susceptibility. Research suggests children with recurrent tonsillitis may have an impaired immune response in their tonsils, including reduced levels of strep-specific antibodies. This suggests their immune system might not develop a robust or lasting protective response to all bacterial strains, making them vulnerable to repeated infections.
Strategies for Preventing Re-infection
Consistent hygiene practices can significantly reduce the risk of strep re-infection. Frequent handwashing with soap and water is important, especially after coughing or sneezing and before eating. If soap and water are unavailable, an alcohol-based hand sanitizer can be used.
Children should avoid sharing personal items such as eating utensils, cups, and drinks, as strep bacteria can easily spread through shared saliva. Regularly cleaning and disinfecting high-touch surfaces in the home, particularly during active infections, helps minimize bacterial spread. This includes doorknobs, light switches, and toys.
Completing the full course of prescribed antibiotics is important, even if the child starts feeling better. Stopping antibiotics prematurely can lead to bacterial survival, potentially causing a relapse or allowing the bacteria to develop antibiotic resistance. Replacing a child’s toothbrush after a strep infection, or two to three days into antibiotic treatment, is recommended to prevent re-infection from lingering bacteria. For persistent recurrent infections, testing asymptomatic household contacts may be considered to identify potential carriers.
When to Seek Specialized Care
If a child experiences frequent strep throat infections, consider seeking specialized medical advice. Recurrent strep is generally defined as seven or more infections in one year, five or more in each of the past two years, or three or more in each of the past three years. Discussing these patterns with a pediatrician is a good first step to assess the situation and determine if an Ear, Nose, and Throat (ENT) specialist referral is appropriate.
An ENT specialist can further evaluate the child’s condition and explore underlying causes for frequent infections. In severe cases of recurrent strep, a tonsillectomy—surgical removal of the tonsils—might be considered. This procedure is typically reserved for situations where recurrent infections significantly impact a child’s health, such as frequent school absences, or when other measures have not been effective.
The primary goal of a tonsillectomy is to eliminate the tonsils as a reservoir for strep bacteria, thereby reducing the frequency of throat infections. A specialist can also help rule out other conditions that might mimic strep throat symptoms or contribute to a child’s susceptibility, ensuring a comprehensive approach to managing recurrent infections.