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STREP OR JUST A SORE THROAT?

Q. I would like to know if pharyngitis is a common illness and what causes it? Since I moved here, I have had it twice in two years. I never had it before, so I wonder what could be causing it. I spend much of my time indoors at home so I wonder if it could be something in my room.

- T. N., Savannah, Ga.

A. Recurrent upper respiratory infections are quite common, accounting for over 10 percent of all medical office visits. Once a year is not exactly recurrent, but I do understand your concern.

There are two types of infections that cause a sore throat - bacterial and viral. A sore and inflamed throat can be caused by an infection by bacteria known as streptococci, in which case, the infection is usually known as group A beta-hemolytic streptococcal pharyngitis (GABHS), or strep throat.

A sore throat, even one erroneously called a strep throat, can also be caused by viruses. In fact, it's unusual, based only on symptoms, to distinguish between a sore throat caused by a viral infection and one caused by streptococcal infection.

Four symptoms characterize a sore throat caused by streptococcal infection - fever higher than 100.4, no cough, presence of discharge (exudates) and tender cervical nodes. Other symptoms include a general feeling of illness (malaise), chills, headache, nausea and rapid heartbeat.

A stuffy nose, laryngitis, cough and lack of exudates suggest a viral infection, such as the common cold, or an allergic reaction.

The best way to confirm a diagnosis is by tests. The classic technique is to take a sample from the throat by a sterile cotton swab and place it in a Petri dish containing a growth medium to grow overnight (culture). Newer and faster tests are also available.

However, neither the cultures nor the newer tests are 100 percent accurate. In addition, the culture takes time - results are available only after overnight - whereas the newer test gives results almost immediately.

Ordinarily, lack of a rapid, accurate diagnosis, which is important in developing a treatment plan, could be a problem. The clinician should know whether it is a viral or bacterial infection, because antibiotics are effective only against bacterial infections, not viral infections.

However, when suspicion of streptococcal infection is high based on symptoms, and when the risk of side effects from medication is low (no drug allergies or adverse reactions), antibiotics are routinely given without confirmation.

In addition, if someone has a viral infection, sometimes a secondary bacterial infection may occur, which would require antibiotics.

Other treatments of a sore throat include appropriate analgesics and anti-inflammatory drugs. Gargling with warm salt water and anesthetic lozenges and gargles often reduce the sore throat pain.

It's important to remember that pharyngitis is an infection that has to be transmitted, not the result of an allergic reaction. Nevertheless, your new environment may contribute to your episodes of pharyngitis.

For example, someone new that you're living or working closely with could be a "carrier" (i.e., someone who has an infection and is able to transmit it to others but who doesn't have any symptoms). Because carriers don't have symptoms, they don't know to get treatment.

Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, Ill., 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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