Let’s talk about strep throat. I am not a big fan of rapid strep tests. A lot of times, my nursing colleagues get them for me and there’s nothing wrong with that. Here’s the problem: when someone has a nasty-looking pharyngitis, the tonsils hurt and the nurse takes a Q-tip and goes, “Got it. I got a rapid strep.” That’s not a rapid strep.
If you’re going to get a rapid strep you need to really get one. Anything less than that and it’s probably not valid. Even the company says that if the test is negative, do cultures anyway. That’s especially true in critical access emergency medicine. Do not be the PA that yesterday does a throat culture and I have to deal with the results today. I hate that.
This is the criteria we use to see if a patient has strep. It’s not great criteria, but it’s the best we’ve got.
- Cough: Do they have a cough? Strep should not cough. If the patient is coughing, the problem is vocal cord south. It’s a PERC negative.
- Exudates: Do they have purulent-looking tonsils?
- Nodes: Do they have cervical adenopathy?
- Temp: Do they have a fever>
- Or could they have mono?
I’m looking for three out of the first four criteria. If the patient is between the age of 3 and 12, they get an extra point. If they have three criteria, there’s a 30% chance of strep. Four criteria is a 52% chance.
You need to be mindful of every sore throat. Could it be mono? You need to push on their liver and spleen and document it. Every case of strep throat gets a belly exam. You don’t want to send strep throat home when it’s really mono. They have a big spleen, you don’t pull them from sports and they rupture their spleen.
Treating Strep Throat
We treat strep to decrease symptoms, suppurative complications, the contagious nature of the disease and incidence of acute rheumatic fever. Acute rheumatic fever is still a problem in many parts of the world. Benzylpenicillin really does take that down from 2.8% to 0.2%. Rheumatic fever happens about three weeks after the strep infection.
I don’t think rheumatic fever is a huge deal, but I want to share something with you. I think part of enjoying your job is becoming very, very proficient. Become so good everyone wants to work with you. Become so good at sore throats that everybody wants to consult you for sore throats.