Strep throat is a bacterial infection of the throat and tonsils caused by Group A Streptococcus (GAS) bacteria. The infection is typically identified by a rapid onset of a very sore throat, fever, and inflamed tonsils that may show white patches or streaks of pus. While these respiratory and localized symptoms are the primary indicators, many people also experience digestive upset. Understanding the distinct causes of gastrointestinal issues during a strep throat episode is important for proper management and recovery.
Is Diarrhea a Primary Symptom of Strep Throat?
Diarrhea is generally not considered a characteristic or common symptom of the Group A Streptococcus infection itself, particularly in adult patients. The bacteria primarily targets the tissues of the throat and tonsils, causing localized inflammation and pain. Gastrointestinal symptoms, when they do occur, are typically limited to stomach pain, nausea, or vomiting.
Younger children, however, are more likely to present with these gastrointestinal issues than adults. In some cases, young patients may also experience diarrhea, though this is not a typical sign. Diarrhea can often be a consequence of the accompanying fever and general illness. If diarrhea is present alongside a sore throat, it is often more indicative of a co-occurring viral infection, such as the flu or a common cold.
The Link Between Antibiotics and Digestive Upset
The vast majority of diarrhea cases experienced by people with strep throat are a direct consequence of the prescribed treatment, not the bacterial infection itself. Strep throat requires antibiotics, and these medications can cause a condition known as Antibiotic-Associated Diarrhea (AAD). This type of digestive upset is a common side effect, affecting roughly one in five people taking antibiotics.
The mechanism behind AAD involves a significant disruption to the gut microbiota, the complex community of beneficial bacteria living in the digestive tract. Broad-spectrum antibiotics, such as amoxicillin or cephalosporins, are designed to kill the pathogenic Group A Streptococcus but cannot selectively spare the helpful bacteria in the gut. The resulting imbalance reduces the population of friendly bacteria that normally aid in digestion.
When the natural gut flora is suppressed, it can lead to functional disturbances in the intestine, such as issues with carbohydrate or bile acid metabolism, resulting in watery stools. While most AAD is mild and resolves quickly, the imbalance can also allow harmful bacteria to overgrow. The most concerning of these is Clostridioides difficile (C. diff), which releases toxins that attack the intestinal lining, leading to more severe symptoms like frequent, painful, or bloody diarrhea.
Managing Diarrhea During Strep Throat Treatment
If digestive upset occurs while taking antibiotics for strep throat, maintaining hydration is the first step in self-care. Replacing lost fluids and electrolytes is important to prevent dehydration, which can be accomplished with water, clear broths, or commercial electrolyte solutions. Avoiding sugary drinks and fruit juices is advised, as the high sugar content can pull water into the intestines and worsen diarrhea.
Dietary adjustments can also help manage symptoms, focusing on bland, easily digestible foods.
Dietary Recommendations
- Foods like bananas, rice, applesauce, and toast are recommended as they are low in fiber and can help firm up stool.
- Dairy products, high-fat foods, and highly processed or spicy foods should be temporarily avoided.
Taking a probiotic supplement, such as those containing Lactobacillus or Saccharomyces boulardii, may help restore the natural balance of gut bacteria and reduce the duration of AAD. These should be taken a few hours apart from the antibiotic dose to maximize their effectiveness. Patients should contact a healthcare provider immediately if diarrhea is severe, lasts more than 48 hours after starting treatment, is accompanied by a high fever, or contains blood.