Differentiating between the 3: sore throat – strep throat – tonsillitis

 Hylton I Lightman, MD, DCH (SA), FAAP

It’s no revelation that nasty sore throats are a part of kids and life. It can happen a lot, especially once your child begins attending play group or school.  After all, sharing germs is part of growing up.  And sharing germs has its good points but that’s for another time.

Sore throats happen even to doctors’ kids; one of our own is suffering from one at this moment (and the strep tests were negative).  But not all sore throats mean a strep throat.

It’s hard to sort through when medical intervention is needed and when it’s not needed.  It’s exacerbated because the terms sore throat, tonsillitis, and strep throat are used interchangeably.

How’s a parent to sort through all this? 

Sore Throat in general refers to a viral infection.

When a virus is responsible, no specific medicine is required (not good news for Moms and Dads who beg for prescriptions).

Antibiotics only work for bacterial infections, not viral ones.

Allow about 7-10 days for your child to get better.  It’s not uncommon for a viral sore throat to be accompanied by a cold and, possibly, a mild fever.  Generally, they aren’t too sick but they can eat your heart out.  Be sure they hydrate well and get extra rest.

Coxsackie is a virus seen most often during the summer and fall months.  It may cause a slightly higher fever in a child, as well as more difficulty swallowing and a sicker overall feeling.

Coxsackie infection can also be accompanied by blisters in the throat and on the hands and feet (which is why it’s also known as “Hand, Foot and Mouth Disease”).

Mono, or Infectious Mononucleosis, can cause a sore throat together with tonsillitis.  Most young children who are infected with the mononucleosis virus have few or no symptoms.  

Tonsillitis refers to tonsils that are inflamed.

Signs of tonsillitis include:

• Sore throat, red or swollen tonsils
• Yellow or white coating over the tonsils
• Uncomfortable or painful swallowing
• Swollen lymph nodes in the neck, or a fever

Lymph nodes can become enlarged out of nowhere and shrink without treatment.  More than not, the lymph nodes can remain enlarged for a longer period.

Strep Throat is caused by “GAS” – Group A Streptococcus.

In some measure, the symptoms of strep throat depend on the child’s age:

• Infants and toddler may have a low fever and a thickened or bloody nasal discharge. These children are generally cranky, lack appetite and have swollen neck glands.  Some toddlers complain of tummy aches rather than sore throats.

• Children ages 3+ years are often more ill and have extremely painful throats, fevers over 102 degrees Fahrenheit (38.9 Celsius), swollen neck glands, and pus on the tonsils.

It’s important to differentiate between sore throats and strep throats because the latter are treated with antibiotics.  

How is strep throat diagnosed? 

If your child has a sore throat that persists (meaning one that does not go away after his first drink in the morning), you should call your pediatrician.  This means you should call even if there’s no accompanying fever, headache, stomachache, or extreme fatigue.  It’s a more urgent call to the pediatrician of your child seems quite ill as demonstrated by drooling or difficulty breathing.

It is not a dire emergency to go to an urgent care for a throat culture in the middle of the night except if, as mentioned, drooling and difficulty swallowing are issues.  A peritonsillar abscess has to be excluded in those situations via a throat culture.

Your pediatrician will examine your child and may perform a throat culture to determine the source of infection.  Most pediatric offices perform rapid strep tests that provide results within minutes.  If it’s negative, it is presumed to be viral and antibiotics are not needed.  Some pediatric offices will do a dual strep culture, meaning cotton-tipped applicators touch the throat and tonsils simultaneously so if the rapid test is negative, the tip of the other applicator is smeared onto a special throat culture dish that allows strep bacteria to grow if they are present.  The culture dish is usually examined 24 hours later to see of bacteria has grown.

Strep throat is treated with antibiotics which are taken by mouth.  It’s most important that you make sure your child complies with the full course of treatment even if the symptoms getter better or appear to disappear.

You are compromising your child’s welfare by not making sure they comply with the full treatment protocol.  Left untreated, the infection may worsen or spread to other parts of the body which can lead to more serious problems.

Untreated strep infections can lead to rheumatic fever, a disease which can cause permanent damage to the heart.  Rheumatic fever is rare in the United States but a strep throat left untreated or treated improperly can result in this sickness that doesn’t have to be.  It is rare for children under 2 years of age to get Rheumatic fever.

Please know that most throat infections are contagious.  They are passed primarily through the air on droplets of moisture or on the hands of infected children or adults.  Therefore, it makes sense to keep your child away from people who have symptoms of this condition.  However, and please, don’t shoot me – I’m only the messenger, most people are contagious before their first symptoms appear.  Often, then, there’s really no practical way to prevent your child from contracting the infection.

Since GAS throats are so highly contagious, it’s recommended that children stay home for a minimum of 24 hours.  I know this can cause havoc with working schedules outside the home, etc., but again, I’m only the messenger and I’m here to advocate that all children are healthy.

A tonsillectomy is recommended when there have been 7 documented strep throats within a 12 month period.  

Remember:  Many sore throats can be viral.  However, there are other causes and a chronic sore throat may be because of silent laryngoesophogeal reflux or even a malignancy, G-d forbid (usually associated with other symptoms and signs).  

Stay in touch with your doctor.

As always, daven.