Strep throat is a common bacterial infection. While acute symptoms may lessen over time, relying on the illness to clear completely on its own is not recommended. Antibiotic treatment is necessary, not just to alleviate immediate symptoms, but primarily to prevent the development of severe, long-term health complications. Untreated strep throat carries a significant risk that outweighs the convenience of avoiding treatment.
Understanding Group A Streptococcus
Strep throat is caused by the bacterium Streptococcus pyogenes, also known as Group A Streptococcus (GAS). This bacterial infection differs fundamentally from the majority of sore throats, which are caused by viruses and do not respond to antibiotics. The infection typically presents with a sudden onset of intense throat pain, difficulty swallowing, and a fever. Unlike viral infections, strep throat usually lacks respiratory symptoms like a cough, runny nose, or hoarseness. Identifying the cause is important because only the bacterial infection requires specific antibiotic therapy.
Symptomatic Relief Versus Bacterial Eradication
The body’s immune response often controls the acute infection, leading to confusion about strep throat resolving naturally. Even without antibiotics, symptoms usually improve and may clear up entirely within three to seven days. However, the disappearance of symptoms does not equate to the full eradication of the bacteria. Group A Streptococcus can remain present in the throat, a state known as colonization, even after the patient feels better. This persistence maintains the risk of developing serious long-term complications. Furthermore, an individual who remains colonized with GAS stays contagious for several weeks, potentially spreading the bacteria to others.
Preventing Severe Long-Term Complications
The primary reason for treating strep throat with antibiotics is to prevent serious complications that arise from the immune system’s reaction to the lingering bacteria. The mechanism behind these complications is an autoimmune reaction, where antibodies created to fight GAS mistakenly attack the body’s own tissues.
Acute Rheumatic Fever (ARF)
The most severe complication is Acute Rheumatic Fever (ARF), which typically develops two to three weeks after an untreated infection. ARF is an inflammatory disease that can affect the joints, skin, brain, and heart. Heart inflammation (carditis) can lead to permanent damage of the heart valves, known as Rheumatic Heart Disease.
Other Complications
Another serious complication is Post-Streptococcal Glomerulonephritis (PSGN), which involves inflammation of the kidneys. There is also a suggested link between strep infection and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). This condition is characterized by a sudden onset or worsening of neuropsychiatric symptoms, such as obsessive-compulsive disorder or tic disorders, following a strep infection.
Testing and Treatment Protocol
Diagnosis of strep throat begins with a rapid strep test, which uses a throat swab to detect GAS antigens, providing results within minutes. If the rapid test is negative, a throat culture is often performed, especially in children, to confirm the diagnosis, as the culture is more sensitive and takes one to two days.
The standard treatment involves a 10-day course of an antibiotic, typically penicillin or amoxicillin, which remains highly effective against GAS. Clinical improvement usually occurs within 24 to 48 hours. It is important to complete the entire 10-day regimen, even if symptoms disappear quickly, to ensure complete bacterial eradication and maximally reduce the risk of developing complications. Patients are generally no longer contagious after 24 hours of antibiotic therapy.