What is Rheumatic Fever? What Causes This Strep Throat …

What is Rheumatic Fever? What Causes This Strep Throat …

Chad Hayes, MD

demystifying pediatrics

The secret reason we treat strep throat


You may have read my recent post about ear infections and how they are over-diagnosed and over-treated. Guess what—ear infections are not alone. Strep throat is another common pediatric infection that is over-diagnosed and over-treated. In adult patients , it’s easy to make a case for not treating it at all. And although kids aren’t just little adults, and the evidence is a little less clear-cut, pediatricians may need to back off, too. I know you already don’t believe me (nor do some of my patients…or my mother), but let me make my case:

Group A Streptococcal pharyngitis (which will henceforth be referred to as “strep throat”) is a sore throat caused by a type of bacteria called Streptococcus pyogenes . The same organism causes other infections as well, but I’ll focus on the throat. Common symptoms seen with strep throat include sore throat, fever, headache, and nausea. This disease is more common in school-age children and teenagers than it is in adults, but rarely seen in kids under 3. It’s one of the most commonly treated conditions in a pediatric office. In children, about 25% of sore throats are caused by strep . There are a few other causes, but the vast majority of them are viral .

If your child is diagnosed with strep throat, he’ll probably be given antibiotics. But here’s the secret: the antibiotics aren’t really for his throat.

Surprised? I was, too, the first time I heard it. But the truth is, strep throat goes away all by itself. Antibiotics can reduce the duration of symptoms by about 16 hours , but really don’t help the throat much more than over-the-counter pain medicines. I know what you’re thinking: your child had strep throat, got antibiotics, and felt better the next day. But what would have happened if it hadn’t been treated? Well, it would have gotten better 3-4 days after it started . Most parents take their kids to the doctor a day or two after symptoms start; and by the time they make it to the pharmacy and give the medication, antibiotics just don’t make that much difference. If started earlier in the illness, they work better, but they may also keep your child from developing immunity to the infection and make her more likely to get strep throat again.

Strep throat can have some complications, though. It’s not just the sore throat we worry about. Rarely, kids can get peri-tonsillar abscesses in the back of their throats. These happen in about 0.03% of people each year, and can be pretty severe, often requiring surgery. It makes sense that treating strep throat with antibiotics would reduce the risk of these abscesses, but the evidence is not that convincing. Many of the infections are caused by other bacteria, and many of these cases begin as an abscess , without a preceding sore throat–which means we can’t prevent them.

But the real reason we treat strep throat is to prevent something called “rheumatic fever.” This is a problem that occurs when a someone’s body over-reacts to a strep infection and starts attacking itself. Rheumatic fever has a number of different symptoms, but the one we worry about most is damage to the valves in the heart. It’s hard to find statistics about rheumatic fever—because it almost never happens. It occurs in 15 per 100,000 hospitalized children in the US each year. It’s important to note that this number includes only hospitalized children, and that in a given year, most children are not hospitalized. In fact, 97% of children make it through the year without being hospitalized. This means that, in a given year, about 4.5 out of every million children gets rheumatic fever–or conversely, that of the 75 million children in the US , 74,999,662 of them will make it through the year without getting rheumatic fever. 40% of children with rheumatic fever don’t have any heart involvement. So the real number we’re talking about is about 200 out of 75,000,000 children each year. (This is admittedly rough math, but the best I can do with the statistics available for an incredibly rare disease.)

Some would argue that the reason for rheumatic fever’s decline is that we are so diligent at treating strep throat with antibiotics. The only way to know for sure would be to do a randomized controlled trial where patients with strep are assigned to “treatment” or “control” groups and then compare the results. The only studies that did this were prior to 1970, when a particularly nasty strain of strep was causing a lot of rheumatic fever. They were able to prevent just over half of these cases by treating strep throat with antibiotics. While there were a few other isolated outbreaks of rheumatic fever in the 1980’s, there hasn’t been a clinical trial in the past 45 years in which anyone (even patients treated with placebo) got rheumatic fever. That makes it hard to justify the claim that antibiotics are helpful. And when physicians in the UK decreased their antibiotic use for children with sore throats by 40%, there was no increase in either rheumatic fever or peri-tonsillar abscesses. In reality, the decreased rates of rheumatic fever probably have more to due with mutations in the strep bacteria and improved hygeine.

Think this is getting complicated? What if I told you that 10-15% of healthy children (without sore throats) are strep carriers?  This means that the strep bacteria just hangs out in their throats without causing symptoms. It also means that any time a doctor swabs that child’s throat, the test will be positive—even in the 75% of sore throats that are caused by a virus . And I haven’t even brought up the fact that many children (and even more adults) are treated for strep without any test at all–or worse, with a negative test.

Antibiotics are not without harm. They cause anaphylactic (allergic) reactions, diarrhea, rashes, and other side effects far more frequently than they prevent rheumatic fever. When over-used, they lead to antibiotic-resistant bacteria that will cause far more deaths than rheumatic fever. If the economic cost of antibiotics and subsequent office or emergency room visits for their side effects is factored in (we’re talking hundreds of millions of dollars per year), the argument becomes even more convincing. While antibiotics may be justified in developing nations with the rates of rheumatic fever are higher, or during local outbreaks of rheumatic fever, I would argue that they are not worth the health risks or the economic cost for the typical case of strep throat.


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Category: General Health

As always, your comments are welcomed (even if you happen to disagree). I’ll get back to you as soon as I can. Please try to keep it civil–I reserve the right to delete comments that are offensive or off-topic.

54 thoughts on “The secret reason we treat strep throat

  1. I have a question about the strep throat test. First of all let me say that I live in a rural area and my kids don’t see a pediatrician, they see a nurse practitioner at a FQHC. I took my 4 year old in a few weeks ago for sore throat, fever, lethargy, etc. The NP said the strep test only tests for strep A and that strep goes all the way up to G so even if it’s negative, they can still have one of the other streps. Is this not the case? Also, she said that strep throat has a certain smell and she could smell it on his breath. Are you familiar with a “strep smell”? Thanks for answering my questions, I love your blog!

    • Lauren–thanks! It’s true that the rapid strep tests look only for group A Strep (GAS). There are other many other species of strep bacteria . But while several of them cause other diseases, they are less likely to cause typical “strep throat” symptoms. There have been a couple times when I got a culture back that grew one of these other species, which leaves us in an awkward position of wondering what to do with the answer to a question we didn’t mean to ask.

      If we are treating for symptoms (and the culture was done because of strep-throat-type symptoms) it’s reasonable to treat. But if we’re treating to prevent rheumatic heart disease, we don’t have any evidence that these other strep species will cause it. It’s a tricky topic, and there’s no great consensus about what to do. (It’s also one of those interesting topics where we get to make real doctor decisions based on clinical judgment instead of guidelines and protocols.)

      That said, it just doesn’t come up that frequently. These other species aren’t major players in the throat, and I certainly wouldn’t go looking for them. The number one reason for sore throat is a viral infection. And if the rapid strep test is negative, a virus is your most likely culprit.

      And with regard to the smell, yes–it’s real. I’d never make the diagnosis based solely on that. But it’s definitely a thing. And there’s a reason none of the major perfume manufacturers have patented it.

  2. I am 50 years old. Born in Milwaukee, WI and raised in Waukesha, WI. I was diagnosed this summer with rheumatic heart disease. Had a pediatrician, had vaccines, etc. Have 3 leaky valves, 1 moderate. Diagnosed by the chair of cardiology at Washington Hospital Center in DC. I am not sure your statistics are correct until we see how many in the US are diagnosed from my era or even other younger folks. I was born in 1964. There were pockets of thematic fever in the 60’s. No one ever heard a murmur on me. I don’t remember ever being “super” sick. Yes, I had some sore throats but I was an active teenager. I was smart, in sports etc. I went on to nursing school at Marquettte University and married a doctor. I find all ages of people on forums with RHD. I am glad I was careful with my kids and we do not push antibiotics but who is to say who will get RHD and who will not.

    • Debbie–thanks for your comments. I certainly appreciate your perspective, and it’s shared by the majority of physicians in America. RHD is more common in undeveloped nations, and occurs in outbreaks as you mentioned. The thought is that there are certain strains of strep that tend to cause it more. And it’s possible that one of these strains will become more common and we’ll experience a resurgence (I hope not). In those situations, treating certainly makes sense. But the risk to a child today in the US is minimal.

      I’m not against treating strep–I just think that we need to weigh the risks and benefits, as well as the accuracy of our diagnoses. We get a lot of false positive tests in kids (and many doctors will treat without a test). The current rates of rheumatic heart disease are low enough that it’s extremely unlikely–but not impossible–for someone to get it. And even in the original studies, we only prevented about half the cases of RHD.

      You’re exactly right though, the numbers are not precise, because we don’t have enough information to do the math. And even if something is 1/1,000,000, somebody is bound to be the 1. If the goal is to prevent rheumatic heart disease, it’s much safer to treat. If the goal is to minimize antibiotic side effects or resistance, it’s better not to treat. But reality falls somewhere in the middle, and it’s not entirely straight-forward. My stance certainly places me in the minority; I think it’s perfectly acceptable to choose either path–but only after considering all the factors.

      Thanks for reading and taking the time to comment. Wish you the best!

  3. I always thought that my father, born in 1912, developed rheumatic fever (as a child? as a young man?) from a strep throat because antibiotics were not yet developed. If it’s true that, perhaps, some nasty strain of strep from 1912 to 1940 was causing rheumatic fever, do you know what would have been the treatment in those days, if any? (By WWII, my father was rejected from enlisting because he had developed rheumatic heart disease. His severe, crippling rheumatoid arthritis developed by the 1950s, during which he died a young man. Apparently, heart valve surgery was in its infancy and unaffordable.)

  4. Thanks a lot for the article. I’m a 25 year old adult who has recently been diagnosed with strep (using the rapid strep test). I was very reluctant to take the antibiotics since previously antibiotics gave me a nasty Clostridium difficile infection that was very hard to get rid of. After reading your article, I’ll be thinking longer and harder about whether I should take the penicillin course prescribed to me.

    • I had C diff too & it is something wicked. I thought I would die…I didn’t know what I had…over the period of 9 weeks I went from Emergency room to Emergency room hearing everything from anxiety to gall bladder….the health department interviewed & literally saved my life…I weighed about 80lbs when they finally contacted me saying they had gotten my results form the lab that had processed my stool sample…ridiculious b/c the doc that ordered it never told me I had it nor treated me….instead I was out through a colonoscopy & lots of other tests I still owe for not to mention I had to drink tha t stuff for the colonoscopy while I had cdiff….to end this rant….I had cdiff for over 2 months full blown….I thought I was having a heart attack toward the end & called an ambulance which took me to the hospital that told me I had already been seen multiple times & it was anxiety & sent me out….I refused to leave…crying I was left to the waiting room or sidewalk where I collapsed & laid until my husband drove up to pick me up….he had to work & take care ofor our 5 month old twin sons & a 5 year old son….thank GOD I am here…I have so much to b thankful for… that Health Dept official saved my life…literally.

  5. What are your sources for this article? I’m currently in discussion with my group about changing practice to cut down on antibiotic usage and any additional sources to back my position would be helpful. Thanks in advance.

    • They’re all linked within the post–some links go to my other posts, but many are original sources or review articles from peer-reviewed journals. Thanks for reading, and good luck making changes! -Chad

  6. I’m 56 and am having a second bout of strep throat within a month. Penicillin was prescribed the first time, which I did finish. When I was 20, I had untreated strep that turned into rheumatic fever. I have a mitro valve prolapse from this, which was diagnosed 20 years later. Should I take another round of penicillin? I work as a k4 teacher with 20 , 4/5 year olds.

  7. I was severing so much and nothing else was working for over 2 days so I went to get check out and was given antibiotics. I never get sick and I’m not a fan of them but was in so much pain decided to start taking them. Now at day 3 of pills, day 5 of pain, fever is gone, I’m finally able to eat again and the pain is almost gone. My question is do I really need to keep taking the antibiotics? They always say that you have to finish the whole prescription but there’s no way I want to take these another 10 days and risk killing my good gut flora any more. And I want to immune system to come back up to normal again. Would it be okay to stop them after a week?

    • Only if you want the strongest of the bacteria to survive and reproduce; thus ensuring a stronger bacteria population for the future. Otherwise, finish the dose as instructed. I personally don’t approve of antibiotics in 75% of the cases they’re prescribed, but once you start a course you need to finish it.

  8. Hello! In mid May two of my children had step and went on amoxicillin. About 5 days after their visit to the doctor I had a sore throat and also tested positive for strep. The kids finished their meds and a few days later their sore throats and fevers came back so we went back to the doc, had another positive test, and they are now on Cephalexin. I was still on penicillin when they had their second test but finished it up a few days ago and today I am feeling awful…pretty positive I have strep again. wondering if the fact that the strain of strep I have is obviously antibiotic resistant makes it more important that I do or don’t go on antibiotics again…one factor that is making me want to go on them is to shorten the contagious period so I won’t miss as much work…and won’t risk re spreading it to my family (my husband thinks he’s immune as has never had it, and we have an 11 month old that has managed to not get it, although he’s in my space all the time)…but I’m also worried that if we finish another round of antibiotics and it comes back a third time I will just have a total melt down! And we’ll have created a super bacteria. does the fact that I just had strep and treated with antibiotics matter? And is it common that the re-surgence would be more severe? It def seemed like it was for the kids (vomiting and high fevers the second time) and I think it is for me too (although it’s really hard for me to tell if I’m making it seem worse bc I’m also really upset about not being overt it yet!)

    • Ditto. Same thing going on w us. Don’t agree w you, doc. True bacterial Strep can turn into very serious infection. Please advise.

    • Have your husband and infant been tested? They can be asymptomatic carriers. Also, do you have animals? They potentially can carry as well. Not needing to treat them like us, however if they share food with your kids (babies are worst about the bite for me, bite for doggy game) it is possible. Unlikely but possible. And washing/replacing pillows; telephones, throw pillows and places where you lounge/sleep/play should be disinfected. Toothbrushes replaced? Pens/pencils are #1 object to hold virus/bacteria that we get sick from. Your work environment should be disinfected thoroughly. It may take several rounds of disinfecting everything with every sick person.

  9. Our daycare has had strep throat for the last 1.5 months. It keeps going around and around. How do we get rid of it? Our provider is cleaning and bleaching everything. Can someone be a carrier and spreading it to everyone? One kid has yet to get it.

  10. Daughter and I got strep.
    I didn’t treat mine because it was just a very sore throat with no fever or actually feeling bad- though it ended up hurting for two weeks, having that red bumps in the back, and I lost some weight I shouldn’t because swallowing hurt. Going to the doctor is expensive and we don’t have a lot of money.

    I got my daughter in immediately because her school said she couldn’t go back until 24 hours after the fever was gone after they called me to pick her up with a 103F fever. She actually more bothered by the vomiting and the severe headache than the throat that was just a little sore. I got her in immediately, and antibiotics immediately- so there was no sick day before making it to the doctor. I was very glad I did because that night she was up just above 105F often through the night, as we stayed up with baths and alternating slightly higher doses of ibuprofen and tylenol (on the doctor’s advice. He also said we didn’t need to take her to the hospital as long as we could keep the fever to 105F or below… that fevers under 107 aren’t likely to cause permanent damage, and that it was just a matter of giving the antibiotics time to start working.) It was a scary night.
    The next day, she was all better. She still couldn’t go to school by school policy but felt well. I couldn’t have handled several more days of that for it to cure without antibiotics and she would have missed school even longer. With as long as I had symptoms, I don’t believe she would have cleared it in less than 24 hours without antibiotics… in the exact number of doses the doctor said it would take.

  11. What about whether someone is asthmatic or have some other respiratory issues? Would a case of strep require more aggressive treatment with antibiotics?

  12. What a great piece and article here- cant wait to check out more. Webmd is a joke! I hope most people here are realizing that! My dr and my sons pediatrician are both also telling me that strep will NOT go away without antibiotics and its frustrating me a great deal. I love sites/groups/ people that will back up their claims with actual studies and info (like on here!). Thank you guys! Everytime i take an antibiotic i get even worse (with diff symptoms) once im off of them and it is hard to get your healthy bacteria in your body back up to par. With my kid i use a ‘one more day rule’ before giving antibiotics unless there are signs of other complications. With he help of home remedies and quality essential oils and reaources like this, i’m glad to say that my son has been antibiotic free for the last 5 years (he’s 8).

  13. Ok still going back and forth now with dr’s and debating on giving my son the antibiotics. He had a slight fever w his strep 9 days ago (no antibiotics given yet- dr waited til 9 days later to call and tell me he had strep). After 3 days his throat felt fine, BUT he bites his nails and 4 days ago a few of his fingertips became infected. But have been showing signs of improvement everyday. Dr told me that strep / infection will absolutely NOT go away without antibiotics and reamed me when i said i’d rather wait and not do the antibiotics. My own dr basically said the same thing. And my mom. He’s never had strep and has been prescription antibiotic free for YEARS. 1. Any opinion on if i should pump him full of antibiotics as the flu (and strep) is going around? 2. Is he still contagious 7 days after fever?

  14. Last week my 2 boys complained of sore throat and both clearly not well. One with a 102 fever and the other 100. I had them swabbed the next day bc I knew strep was going around. The rapid test was initially negative but then doc called me saying they ended up turning “slightly positive”. So I then had a throat culture done on them (by now they are both fine and no fevers). Turns out 1 is positive and 1 was negative (the one that seemed worse!) my ped wrote a script for the both of them after the final resis came back which was Monday. I have not given it to them because they are totally fine and it was never really that bad. Maybe 24 hrs of not feeling well. It was nothing compared to what I experienced with strep throat years ago. I was so torn on what to do but after reading this article I feel better about my decision.

  15. I have an uncle who had a heart transplant due to damage caused by rheumatic fever. I also developed what we now call PANDAS after a case of strep throat as a child. My daughter is currently being treated for a case of strep throat, her second in three months. Before this she had not been on antibiotics for well over a year. Could I have a swab done when she does not have symptoms to make sure she is not a carrier? Given my family history with strep should we be more cautious/watch for more serious signs when she has a strep infection?

  16. Hi, happy to have found this article. i am a mother of two and i am trying to avoid the over prescribed antibiotic epidemic for my children. antibiotics have really messed with my body and now i suffer from chronic issues. doctors in the 80s gave antibiotics to us like water. 🙁

    So recently i had a wicked sore throat. Swab result-positive. Got talked into antibiotics by two different doctors. Started the Amoxicillin on day 4 of the sore throat pain, even after i sorta started to feel better. Regardless, i continued the meds and Finished the 10 day cycle. Throat felt 90% better. Gut, yeast… well that part i was trying to mend. 1 week after completion of the amoxicillin, sore throat and headache returned. i’m not sure what to do. Another round of antibiotics may throw my entire body out again and i haven’t even healed from the first round. yet, i am told the risk with strep is too dangerous to gamble with. No one in my family got strep (2 grade school kids managed to stay healthy). it’s obvious i have a very low immune system as i’m always the one who’s sick in the house (i do realize this may all stem back to those 80’s and 90’s and all those meds i took). what now? Will this second round of strep be even stronger then the first? has my body lost the ability to fight off this infection naturally because i introduced the lovely antibiotics (that failed)??? any advice?

  17. Informative article, especially since I had strep throat and rheumatic fever at eleven which did damage my heart.

  18. I have a question regarding Strep Throat. I went to the DR. after 10 days of chronic coughing (mostly at night, after I laid down). My throat was scratchy for a few days-but NOT painful-at all. I had no other symptoms and didn’t even feel tired. Only reason I went to the DR. is because my dry cough was keeping me upmost of the night,and I wasn’t sleeping much for 10 nights.
    My question is -is it possible to get strep throat without pain? I had strep throat 1-2 times a year, every year, from age 11 to age 19.Then I outgrew it or something. The pain when I was younger was excruciating. I find it so hard to wrap my mind around the fact that I had zero pain with strep throat this time-just lots of dry coughing. Has anyone ever heard of this? please advise.
    Also,I do not drink or smoke,nor am I overweight nor have I ever been overweight or unhealthy.

    • I could literally have written exactly this post. Same history, same scenario for me. I did get tested. And it was positive. I had strep. I was in shock, since I had had it so many times in the past I thought I knew, but it was different for some reason. Wondering if it us because I have my tonsils out now or if it was just a certain different strain of strep that acted differently? Just guesses, I’m no doctor…

  19. I have a question about strep. I know it is more common in school aged children; my almost 3 year has signs of strep, i.e. extremely sore throat, fever, adversion to water (but will drink other things like tea and juice), lethargy, and patchy white spots of back of tongue. I am a nurse and have not taken her to the doctor because I do not want her to get antibiotics. It would take 2 years for her gut to heal from that. I was hesitant in my decision, until reading your post, so thank you! I also have a 15 month old; what can I do to prevent him from getting strep from my daughter? Or at least, what can I do to decrease his length and severity of illness. Thank you.

  20. I have been hospitalized twice for strep throat related illnesses, with the last admission being for a strep induced pericarditis and rheumatic fever which occurred from delaying antibiotic treatment and waiting for it to go away on its own(the first also was a delay due to being a poor college student). And I had my tonsils out 41 years ago. The problem with statistics is that someone has to be in the population that can die from the bacteria and the last person I would want to play Russian roulette with by not starting antibiotics is my child. I did that for myself and it nearly cost me my life.

  21. Hello, I am happy I was able to find your article! I do have some questions regarding my situation, since I went through a very long battle with strep throat. I’ve had it 7 times in a row when I was a kid(within the same year) and afterwards I was tested to see if I was a carrier, and it was negative. It took me so long to knock the illness off, and I have a very healthy immune system. All the while I took plenty of medication, but after the meds finished, I would almost immediately be sick with it again. Now that I am 17, after a long time being strep-free, I feel the familiar stabbing in my throat , and haven’t gotten out of bed to tell my parents yet. Should I wait it out, or should I receive medicine again. I am afraid of reliving that experience.

  22. I have strip throat sunday Jan 1,2017. Went to the dr. Wednesday Jan.4,2017. They did a culture to sent off will get results Monday 9,2017. The gave me Amoxicillin 875mg. Today is Sunday Jan 8,2017. I still have strip throat with sinus infection ears hurt,Chest cold body aches. Terrible cough with green mucus. Cant sleep.

  23. My daughter just come off antibotics for strep a week ago and this morning woke up with a fever of 103 and very sore throat should she go back to doctor?

  24. I listened to articles like yours for years. I’d like you to research a diagnosis called PANDAS/PANS.
    My son was treated psychiatricaly for 5 years while his severe bouts of ODC and aggression got worse and worse.
    Antibiotics brought my son back to me. Strep and various other pathogens can cause psychiatric disorders and failure to fully understand the impact something is having on an individual in favor of a generalized save money practice is irresponsible.

  25. i was reading that strep goes away after 3-7 days without antibiotics but you are still contagious for 2-3 weeks. Your thoughts?

  26. While I do agree antibiotics generally are overused, I disagree that they are overused in children with strep throat. You mention rheumatic fever and the incidence rate being low. To me a low incidence does not negate the ravaging effects of the disease should it occur.
    I also did not see mention of PANDAS. You can read about this on the NIMH website. Strep can add structures molecularly to mimic cells in our body, and our body can then attack the strep and those cells for months. This occurs primarily in children and can cause symptoms of OCD, Anxiety, and ADHD like symptoms for 1-6 months in children.
    Regardless of the sore throat symptoms, treating strep is important to lessen the potential damage it can do. Sure we want that sore throat to lessen for their comfort, but most importantly we want to limit disease spread and time strep is in the body. A child on antibiotics for 24hrs is less likely to give strep to someone else, and possibly not contagious at all. Provided the child feels better they miss less school and pass the illness to fewer people.

  27. Sir, your article is full of seemingly accurate facts and statistics. Your argument is logical. But children (especially mine) are not faceless numbers in a statistic. I wouldn’t risk one of my children becoming 1 in a billion to develop rheumatic fever. 200 in 75 million is still 200 too many for the families of those children. Irreversible heart damage, or other potential damaged organs, that could handicap a child for the rest of their life, is not acceptable even by the tiniest margin. Yes, of course there are less cases due to diligent treatment of strep throat. I also agree that there are physicians who overall are not careful enough with antibiotics. The world will never be perfect. I find this article cold an unfeeling, like lonely numbers on a chalkboard. Please remember the heart of medicine is people.

    • Tanya–thanks for your comment. Again, I’m not saying that we shouldn’t treat strep throat with antibiotics…just that it’s a little more complicated than most people think. For one, we’re treating things that aren’t strep throat (viruses in a strep carrier who always has a positive strep test, kids with negative tests and doctors who treat anyway). Besides that, the risk of rheumatic heart disease (today, in the US) is so low that it’s not that straightforward. There are very real risks to children from antibiotics, beyond creating resistance and mild diarrhea. There are life-threatening allergic reactions, severe complications like Stevens-Johnson syndrome, DRESS syndrome, or C. difficile colitis–and these risks are probably higher than that of RHD.
      I understand when you say that risk isn’t acceptable, but risk must be accepted. When you put your child in the car to go to the doctor’s office, you place his/her life at risk (a greater risk than any of the things is listed above). Go to the pool or the beach, and you risk drowning. Life is risky, and our goal isn’t to eliminate that risk–because we can’t–it’s to minimize it and weight that risk against the potential benefits of whatever treatment we are considering.
      So it’s not that I care about numbers instead of people, it’s that I care enough about the people to look at the numbers and try to act in the individual patient’s best interest. Hope that clears it up–promise, I’m not cold and unfeeling. 🙂

  28. As a parent, if my child is one of the 200 out of 75000000 cases of rheumatic fever, I am not willing to give up my child’s health for unproven possible hypothetical the “benefit” of reducing bacterial resistance to antibiotics. Diarrhea for a day is definitely worth the risk. My uncle died from complications associated to rheumatic fever. It is not worth the risk. No way. Now, if you chose to not treat your child, that is your business. If you child dies from it. Let me know how you feel about this then. Not treating people with antibiotics is not the answer. There is an answer but that is not it.

  29. Thank you. Very helpful to have my non-medical opinion confirmed by an MD. Though I will not tell my kids not to take antibiotics ever, just sparingly. I hardly ever use them myself either. I do think our area is going through a pretty serious bout of strep throat right now though, lots of people have it, unfortunately.
    Thank you again.

  30. All of you, Doctor included, should look up it is ordered that my son has and thousands of other kids. It is called PANDAS. “They” say it happens to 1 in 200 kids, but that’s only because it’s underdiagnosed and misdiagnosed. It’s basically like rheumatic fever but it affects the brain instead of the heart. Treating for a positive strep test is very important! It tends to run in families that have a history of rheumatic fever and scarlet fever. 🙁 http://Www.pandasnetwork.org

    • Sorry, I did talk to text when composing comment above. And forgot to check it before sending. I was trying to say my son has a disorder called Pandas.

    • Mandy–appreciate your comments. I am very aware of PANS/PANDAS. But there remains a lot of research to be done. The 1 in 200 statistic is some REALLY rough math based on one person’s estimate of the percentage of OCD/tic disorders that may be caused by this group of disorders. I have no evidence to back me up (because there isn’t any), but I would guess that’s almost certainly a huge over-estimation. We also need more data to conclude that treating strep prevents or significantly reduces the risk of these disorders. I’m not saying that they aren’t important…just that we need a lot more information.

  31. I am a 42 year-old middle school teacher and I inevitably contract strep throat with typical strep symptoms and a positive rapid test every year. In the past, the urgent care physician prescribed Zithromax and the symptoms were gone the next day. The last couple of times I was treated with Penicillin. The symptoms lasted 3 to 4 additional days after the shot. It feels like I have strep again (yay me) and wonder about just letting my body do its thing and fight it off. I am tired of getting strep annually and some research I have found points to the ability of my body to develop an immunity if I just let my immune system fight it off. Is it possible to develop an immunity to Group A strep? What do you think my risks are as an adult of developing rheumatic fever?

  32. Hi! I’ve heard that gargling with diluted apple cider vinegar can help. Is there any validity to that? Thanks!

  33. Hey doc. I tead a study this week that amoxcillin does not kill gut flora but does increase bacteria resistant “genes” when they did cultures so its on the top ten bad list of sntibiotics or something. Sorfy I should find the link. Could that be why some of these people get it back stfonger after completing the course? I was very disappointed in my 4 year olds doc who doesn’t usually prescribe antibiotics but saw a few flecks on my daughters throat and prescribed amoxi. I waited 24 hours (id already waited a few days but as soon as I heard the crackling in her throat and fever got worse I took her in). So she’s all better and hopefully gained some immunity like she has in the 2 years without antibiotics so far. She had bronchiolitis at 6 months Im amazed how quickly she got better this time.

  34. No reputable physician will answer a specific medical question without seeing the patient. Stop asking. Any answer you receive is dangerous advice. It’s one thing to advise generally (for example: telling someone to finish a course of antibiotics they have been prescribed by an actual physician and have already started) but to answer a medical question relating to a specific situation shows poor judgment and you should be extremely suspicious of their qualifications. This why the posts with these questions are not answered by the doctor who wrote this and other questions are. Stop asking online. Any answer you get is a bad answer. Go to a professional.

  35. Hello! I am 25 years old and got “diagnosed” with strep 5 days ago. As to why I put “” is because they the urgent care clinic I went to did not test me for it, she just looked at my throat and assumed I had it. I’ve been on penicillin for 5 days now and my throat still is very painful with clear pus pockets and very enlarged. Now I have a constant cough and stuffed up nose! My question is, is it possible for me to have gotten a common cold on top of my “strep” and that’s why my throat is still on fire or is this something I should look into? Thank you!

  36. Amoxicillin do not work for strep Throat I know im 25 now I have strep throat sent i was 11years old. In my life i got strep throat over 50 times im not lying in my first year of turning 11 i got strep throat 12 times once of month sometimes twice a month they said i was to young to get surgery so they was just giving me prescriptions
    Long story short each year same strep throat until St John Hospital Gave me some antibiotics that was 950mg this time my strep throat was serve this one really worked i didn’t get strep throat for three years straight it was just normal colds but yes i think the reason why i kept getting it cause when i was 11 I had strep throat i didn’t see the doctor until 3weeks later cause my mom and family that is was a normal cold which it wasn’t. Strep throat do not heal itself in my cause it didn’t I thur up every thing i ate and it did not make it any better ..

  37. My youngest son was around 12 years old and complained of pains in his knees. He had strep throat 3 or 4 times when he was younger. I took him to the doc several times during his teen years and always told it was growing pains. At 17, he was complaining of chest pains and achy arms and knees. One morning on a doctors program, the doctor said, ” If your child is over 15 and complains of chest pain and aching bones, then seek medical treatment immediately because it was not growing pains.” I took him to another doctor who ran blood test, then called me back and said he had rheumatic fever because of having strep throat years before and now he damaged heart problems. I was so angry that a simple blood test and antibiotics could have helped save my son from this damage if only the doctor would have checked him thoroughly. My daughter n laws father died from complications of rheumatic fever in his late thirty’s. So yes I worry when someone gets strep throat and they go to the doctor . That is 2 out of a number that I know of who had complications from rheumatic fever because they didn’t get treatment properly.

  38. My mother suffered from heart problems he entire life, and died at 57. Her cardiologist believed it began when she contracted Rheumatic fever at 4 years of age. After decades of medical treatment she had a Mitral valve replacement at 46, in 1976. Her heart slowly died around that valve and we lost her 11 years later. I couldn’t help but think of that every time one of my children, and now grand children (that she never had the opportunity to see) developed strep. Having lived first hand through the devastating effects that Rheumatic fever can cause, I would choose antibiotics over permanent heart damage every time.

  39. I currently have strep. I usually don’t test positive on the rapid but come back on the overnight culture. I know for a fact when I have strep. And when my rapid comes back negative I demand the overnight and they usually just give me the scripp for abx since they can see it is obviously strep (white spots on tonsils, swollen red, uvula swollen, fever, red spots on hard pallete, etc). I get it once or twice a year or so as I work in a preschool. This time I came back positive on the rapid and started abx… you know why we overprescribe abx that has nothing to do with rheumatic fever? Sick days and work.

    A kid can go back to school with strep with abx for 24 hrs. An adult in a school same thing. If I hadn’t had a fever and felt good enough to go in today I could have. And no one could stop me. I have no sick days left, this is costing me a lot of money. This is what parents face too. Their little one is sick but if they start them on abx they can send them to school 24 hours later. And they usually lie about being 24 hours fever free. And we can tell. Your child usually needs that extra day. But they don’t give it Because they can’t or don’t feel that they can take the time off. Or because the schools have these ridiculous 10 sick days policy before they start intimidating parents about not passing the kids. The same thing happens with pink eye. I told my doctor it was probably viral as I had a virus and they gave me drops anyway. My school said it’s ok you can come back on drops.

    If we really want to reduce abx use then we need to examine our sick policies in schools and businesses. And honestly, teachers, nurses, and doctors should have far more sick days than other workers who are not constantly exposed to illness. I have had strep two times this year, so I have missed 5 days of work due specifically to strep. I have 9 sick and personal days combined. One day to fix my car, two days of personal vacation time, one cold and one stomach virus because I work with two year olds. That puts me over my sick days already. Hopefully I don’t get sick again… with a room full of sick kids who don’t know how to cover their noses yet and still put everything in their mouths. When the parents don’t feel like they have choices and send kids to school sick we all get sick. And then we all end up on abx because we can’t afford to be out either.

  40. My five year old daughter had untreated strep for three months before it was diagnosed on culture as “massive strep a infection”. It cleared after antibiotics. Her symptoms were afternoon malaise and low grade fever of 99.2 (all summer long) thus written off by several doctors until enlarged lymph nodes appeared prompting the swab. Can she later develop heart valve issues from the untreated strep? Is Rheumatic Fever an actual diagnosis and separate sickness from the original strep illness? Can one get Rheumatic damage years and years after the original untreated strep?

  41. I was diagnosed with strep throat today. It doesn’t hurt,but I have already had bacterial endocarditis once. I have had this rough feeling rash that has come and gone for a couple of months.

  42. I looked into this because my daughter, 12, has Crohn’s disease. She is currently asymptomatic. This week she was diagnosed with strep throat & the doctor was adamant that the threat from RHD was greater than the threat from antibiotic + crohn’s. I disagreed but had no numbers to back myself up, so I took the script. I gave my daughter one pill and she is in agony. I’m waiting for a call back from her GI, but I thought this was another aspect of antibiotic use that could be addressed.

  43. Is there any concern in not treating strep throat with antibiotics, if symptoms persist longer than 3 weeks? What about 4 weeks? That is is there a time when antibiotics become appropriate given the duration of strep? (Note, our son has autism and we do our best to not have him take antibiotics but it has been 3 weeks, with a positive strep test, and he is not yet over it. Thanks.

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