I saw a patient this morning who I diagnosed with viral pharyngitis, not (bacterial) strep throat. She said she felt embarrassed that she came in to see me. I reassured her the importance of coming in to figure out  if she has strep throat, otherwise known as Group A streptococcal tonsillopharyngitis.

The symptoms of strep throat are

• abrupt onset of intense sore throat (most patients would rather drool than swallow),
• pus on the tonsils,
• tender lymph nodes in the neck and
• fever.

My goals with treatment are to decrease

•  the duration and severity of pain,
•  transmission to others,
•  the consequences if not treated. . . rheumatic heart disease and kidney failure.

A rapid strep screen can be done in most physician offices. It is fast and very sensitive to picking up streptococcal infections.

There is a 35% transmission  rate to nearby contacts of the ill patient. Antibiotics significantly decrease this rate as studies show 80% of patients are not contagious 24 hours after receiving penicillin.

The treatment of choice is penicillin. Yup! Still first line treatment since 1950. I prefer one shot of penicillin in the muscle—one little “pinch” and then it’s done. Or the patient can opt for 10 days of twice daily dosed oral medication.

Sore throats are important.