COVID-19 is a highly prevalent viral respiratory illness caused by the novel coronavirus, SARS-CoV-2. Strep Throat is a common bacterial infection of the throat and tonsils caused by Group A Streptococcus (GAS) bacteria. Both pathogens circulate widely and cause significant upper respiratory symptoms. Since both are highly contagious and affect the same body system, simultaneous infection with both the virus and the bacteria, known as co-infection, is possible and has been documented in clinical cases.
Understanding Viral and Bacterial Co-Infection
Co-infection with a virus and a bacterium is a medically recognized phenomenon because these two distinct classes of pathogens operate on different biological mechanisms. Strep Throat is caused by bacteria, while COVID-19 is caused by a virus, which must hijack host cells to replicate. The immune system must mount separate defenses against each type of pathogen simultaneously.
A viral infection, particularly one affecting the respiratory tract like COVID-19, can weaken the body’s natural defenses. The virus may damage the mucosal lining of the throat and airways, creating a favorable environment for bacteria, such as Group A Streptococcus, to colonize and cause a secondary bacterial infection. Research suggests that the co-occurrence of COVID-19 and GAS may be more common than initially thought.
Symptom Presentation During Co-Infection
The presence of both infections complicates the clinical picture because many symptoms overlap, making self-diagnosis impossible. Both Strep Throat and COVID-19 frequently cause fever, fatigue, and a sore throat. Strep Throat is often characterized by a sudden, severe sore throat, pain when swallowing, and visible signs like red, swollen tonsils that may have white patches or streaks of pus.
Co-infection may present with a combination of unique symptoms from both conditions. A patient might have tell-tale signs of Strep, such as swollen lymph nodes in the neck and tiny red spots on the roof of the mouth, combined with symptoms more specific to COVID-19, like a cough, congestion, or the loss of taste or smell. When simultaneously infected, the presence of one set of symptoms can potentially mask the severity of the other, or the dual infection may result in a more intense overall illness.
Diagnostic Testing for Both Conditions
Given the extensive overlap in symptoms, a healthcare provider cannot determine the cause of the illness based on physical examination alone, making dual testing necessary. For COVID-19, diagnostic tools include Rapid Antigen Tests (RATs) for fast results and Polymerase Chain Reaction (PCR) tests, which are considered the gold standard for accuracy. These tests typically use a nasal or nasopharyngeal swab to detect the SARS-CoV-2 virus.
For Strep Throat, the initial diagnosis usually involves a Rapid Antigen Detection Test (RADT) using a throat swab to quickly identify the Group A Streptococcus bacteria. If the rapid test is negative but Strep is strongly suspected, especially in children, a throat culture may be performed for a more definitive result. Medical providers often collect specimens for both COVID-19 and Strep testing during a single office visit to ensure both viral and bacterial infections are checked.
Managing Dual Infection Treatment
The treatment strategy for a co-infection must address both the bacterial and the viral components of the illness. Since Strep Throat is caused by bacteria, it must be treated with a full course of antibiotics, such as penicillin or amoxicillin, to prevent serious complications like rheumatic fever. Patients must complete the entire prescribed course of antibiotics, even if they feel better quickly, to ensure the bacteria are fully eradicated and prevent antibiotic resistance.
For the COVID-19 viral infection, treatment is often supportive care, including rest, hydration, and over-the-counter medications to manage fever and pain. Depending on the patient’s risk factors, a healthcare provider may prescribe specific antiviral medications, which must be started early to be effective. A COVID-19 diagnosis also requires adherence to current isolation guidelines to prevent further community spread.