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Strep Throat

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Most cases of sore throat are caused by viruses, generally the same viruses that cause colds. One familiar type of sore throat, however, is caused by bacteria in the streptococcus family: streptococcal pharyngitis, commonly known as strep throat. It is relatively common in children.

Symptoms of strep throat include intense throat pain (generally developing suddenly), difficulty swallowing, and fever ranging from 101°F to 104°F. In children, headache, abdominal pain, nausea, and vomiting may also occur. The back of the throat generally (but not always) becomes beefy red in color, possibly with white or red dots. However, none of these signs or symptoms is absolutely characteristic of strep throat. In some cases, none of these symptoms is present. Ultimately, diagnosis of strep throat must be made through a laboratory examination of material swabbed from the back of the throat.

The primary significance of strep throat is not the throat infection itself, but rather a delayed complication called rheumatic fever. Strep throat itself will disappear in 3 to 5 days even without treatment. However, when a certain group of streptococcal bacteria are involved, called Group A beta-hemolytic streptococci , there is risk of a severe, dangerous complication developing about 1 to 5 weeks later, when all seems to be well. This is the feared second effect of strep throat known as rheumatic fever.

The initial attack of rheumatic fever involves five major signs and symptoms:

  • Carditis—inflammation of the heart, often causing a heart murmur
  • Chorea—rapid, purposeless, nonrepetitive movements that are not under conscious control
  • Migratory polyarthritis—severe joint pain, redness, and swelling that moves from joint to joint
  • Subcutaneous nodules—nodules under the skin
  • Erythema marginatum—a serpentine, flat rash

These symptoms will eventually subside. However, when they are gone, the valves of the heart may be permanently damaged, necessitating open heart surgery.

About 3% of untreated Group A beta-hemolytic strep throat cases lead to rheumatic fever. 1 Children ages 4 to 15 are most at risk. Adults with strep throat may develop rheumatic fever, but the chance is extremely low. Rheumatic fever is rare in the US because of prompt treatment of strep throat, but it is not rare in developing countries, where it is one of the leading causes of heart disease.

The cause of rheumatic fever is interesting. It is thought that certain strains of strep bacteria contain glycoproteins that, from the perspective of the immune system, resemble glycoproteins found in the heart, joints, and/or nerve tissue. When the body makes antibodies to attack the strep bacteria, those antibodies also damage the body.

The only known way to prevent rheumatic fever in people with strep throat involves using antibiotics at relatively high doses and for a prolonged period of time. The goal is to entirely eradicate the invading bacteria, so that the body does not feel a need to make antibodies against it.

Proposed Natural Treatments

The unique relationship of rheumatic fever and strep throat is confusing, and may lead you to use alternative treatments for it in a way that is not helpful.

Here’s how the misconception usually goes: for most diseases, when symptoms abate, the risk is over. Based on this natural understanding of illness, many people use herbs or other natural treatments for strep throat, then feel safe when throat pain and fever disappear.

However, for strep throat, the situation is different. As discussed above, symptoms of strep throat disappear on their own, without treatment, in 3 to 5 days. The big risk comes 1 to 5 weeks later, when rheumatic fever may strike. Antibiotic treatment for strep throat is not primarily intended to treat the strep throat itself (although it does that), but rather to prevent rheumatic fever. There are no herbs or supplements known to prevent rheumatic fever.

Some people try to treat strep throat with herbs believed to stimulate the immune system, such as echinacea . However, this approach has a serious problem: if echinacea did manage to increase the immune system’s activity, the result would be to increase the intensity of rheumatic fever, not decrease it! Remember that rheumatic fever is caused, in a sense, by an overactive immune system, not an underactive one.

The bottom line: Strep throat caused by Group A beta-hemolytic streptococcus cannot be treated with alternative medicine. Conventional diagnosis and treatment is necessary to ensure safety.

However, if tests are done and a case of strep throat does not appear to be caused by Group A beta-hemolytic strep, other forms of treatment may be appropriate.

The herb Pelargonium sidoides might actually shorten the duration of non-Group A strep infection, according to a double-blind, placebo-controlled study of 143 children. 2 Whether it is helpful as supplementary treatment to antibiotics for children undergoing treatment for Group A strep remains unknown.

The popular herb tea Throat Coat might help sooth sore throat discomfort. Throat Coat contains herbs traditionally thought to soothe inflamed mucous membranes. One small double-blind study did indeed find that Throat Coat was superior to a placebo for this purpose. 3 It seems reasonable to use Throat Coat along with conventional treatment even for Group A strep infections. However, this tea contains licorice , which can be toxic if taken to excess.

For more information on treatments, see the article on Colds and Flus .

Revision Information

  • 1

    Fauci S, Harrison T. Harrison’s Principles of Internal Medicine . 14th ed. New York, NY: McGraw Hill; 1998:1310.

  • 2

    Bereznoy VV, Riley DS, Wassmer G, Heger M. Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial. Altern Ther Health Med . 2003;9:68-79.

  • 3

    Brinckmann J, Sigwart H, van Houten Taylor L. Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med . 2003;9:285-298.