Dec 8, 2008 11:17 am US/Eastern
Dr. Mallika's Files: Case Of 'Wicked Sore' Throat
Each week Dr. Mallika Marshall shares cases based on true stories from a local urgent care clinic, exclusively on wbztv.com. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case:
A 23-year old woman comes to clinic saying that she has strep throat and needs penicillin. "I have strep throat every year and I always get treated with antibiotics." She says she has a "wicked" sore throat since yesterday with low-grade fevers. She says she looked in the mirror and noticed white spots on her tonsils. She also has a runny nose and dry cough. Her 6-month old baby also has a cough and runny nose.
On exam, she has moderate nasal congestion, and her throat is slightly red with white patches on both tonsils. She does not have a fever. A throat culture is performed.
Discussion
Based on her history and exam, this patient clearly has pharyngitis, a fancy term for a throat infection. It's characterized by inflammation of the pharynx or the back of the throat, the roof of the mouth, and the tonsils. Pharyngitis accounts for almost 10 million visits to the doctor each year. In fact, sore throat is one of the top ten complaints of people who go to emergency rooms.
Most people automatically assume that if they have a bad sore throat that it must be "strep throat" or an infection with a bacterium called group A Streptococcus. However, 85% of throat infections are caused by viruses. Even if your tonsils are bright red with pus on them, chances are, a virus is to blame. Viral throat infections usually peak in the winter and early spring and usually go away on their own within a week. And antibiotics will not help treat viral pharyngitis.
A minority of patients with sore throat will have strep throat which again, is caused by a bacterium. This type of throat infection should be treated with antibiotics to avoid long-term complications.
It is virtually impossible to distinguish between viral pharyngitis and strep throat by history and exam alone because the signs and symptoms of the two often overlap. However, a throat swab can identify strep throat. Some clinics offer Rapid Strep tests which can tell you within a few minutes if you're likely to have strep throat. Other clinics rely on a throat culture to make the diagnosis which can take 24 to 48 hours.
Given the problems with antibiotic overuse in this country, it is often wise for a doctor to wait for the results of the throat swab before administering antibiotics. Until the results are available, the pain and discomfort associated with pharyngitis can be controlled with pain medications, fluids, and a humidifier.
Follow-up
The patient was advised to take over-the-counter pain relievers, drink plenty of fluids, and rest until the throat culture results were available in 1 to 2 days. The patient was very unhappy that she was not going to receive antibiotics on the spot and left in a huff. Two days later, the throat culture came back "negative". The patient was called at home and reassured that her symptoms were probably due to a virus and should get better within a few days. Two days after that, she was pain free and able to return to work.
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