Recurrent infections with a sore throat can be a frustrating and disruptive experience. Strep throat is caused by the bacterium Group A Streptococcus (GAS), or Streptococcus pyogenes, which primarily affects the tonsils and pharynx. While most people recover fully after a single antibiotic course, experiencing multiple episodes suggests an underlying issue that allows the bacteria to persist or repeatedly re-enter the body.
Is It Always Strep?
Recurrent strep throat is often a misinterpretation of a positive test result, as many viral infections mimic strep symptoms. If a person is a carrier of GAS while battling a viral illness, a strep test will return positive, leading to an incorrect diagnosis of a bacterial infection. Physicians may suspect a viral cause if the patient also exhibits cough, runny nose, or conjunctivitis, as these respiratory symptoms are rarely associated with acute strep throat. Rapid antigen detection tests (RADTs) provide quick results but can sometimes miss a true infection, necessitating a more sensitive throat culture to confirm the presence of GAS.
The Role of Chronic Carriers and Re-exposure
Chronic Carrier State
The chronic carrier state is a frequent reason for repeated positive strep tests, where an individual harbors GAS bacteria without developing acute symptoms. A practical definition of a carrier is an individual who tests positive for GAS after completing an adequate course of antibiotic therapy for a previous infection. Asymptomatic carriers are generally at low risk for developing serious complications and usually do not require antibiotic treatment. However, the presence of the bacteria means they can transmit the organism to close contacts, who may then develop a symptomatic infection. Repeated exposure often occurs in high-contact environments like schools or households where an untreated carrier may be constantly shedding the bacteria.
Relapse Due to Incomplete Treatment
Another factor in recurrence is the immediate relapse of the infection, often caused by incomplete adherence to the antibiotic regimen. When a person stops taking antibiotics early because their symptoms have improved, a small number of bacteria may survive, multiply, and quickly cause a return of the infection.
Addressing Persistent Infections
Targeted Treatment
For individuals who experience multiple, documented episodes of true strep throat, medical management focuses on either eliminating the persistent source or removing the tissue that harbors the bacteria. If a carrier state is suspected, particularly when a family is experiencing frequent infections, a physician may recommend screening all household members for GAS. Targeted treatment for a confirmed carrier is sometimes pursued using specialized antibiotic regimens, such as a 10-day course of oral clindamycin or a combination of penicillin or amoxicillin with rifampin, which are more effective than standard penicillin alone at eradicating the bacteria from the throat.
Prevention Strategies
Simple preventative actions can also help reduce the cycle of re-exposure and reinfection. Practicing meticulous hand hygiene and avoiding the sharing of utensils or drinks with others can limit the transmission of the highly contagious GAS organism. After a confirmed infection, it is a common precautionary measure to replace the toothbrush, as the bacteria can theoretically linger on the bristles and lead to reintroduction of the pathogen.
Tonsillectomy Criteria
When all other medical and preventative strategies fail, and a patient experiences true, documented, recurrent strep infections that severely impact their life, a tonsillectomy may be considered. Medical guidelines often recommend this surgical option when a patient meets specific frequency criteria. These criteria include seven or more documented strep episodes in the preceding year. Alternative criteria are five or more episodes per year for two consecutive years, or three or more episodes per year for three consecutive years.