Pharyngitis: bacterial or viral?

June 29, 8:57 PMInfectious Disease ExaminerRobert Herriman

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Photo: Dr. Heinz Eichenwald

We’ve all been through it. Feeling real bad with a fever and a brutal sore throat and all we want is relief with antibiotics. But is that sore throat caused by a bacterium that antibiotics can treat? Not always.

Acute pharyngitis is the most common infection in the upper respiratory tract. Though people who get a sore throat immediately think they have “strep throat”, the majority of the time a sore throat is caused by a virus.

The clinical presentations of streptococcal and viral pharyngitis overlap considerably.

Streptococcus pyogenes pharyngitis is suggested clinically by observing red or white patches in the throat, swollen lymph nodes, red/enlarged tonsils, pain when swallowing, a sudden fever and occasionally a rash.

Viral pharyngitis is most commonly caused by the Epstein-Barr virus and sometimes adenoviruses. Symptoms are very similar to strep throat; fever, sore throat, difficulty swallowing and enlarged lymph nodes.

There is no specific treatment for viral pharyngitis. You can relieve symptoms by gargling with warm salt water (one half-teaspoon of salt in a glass of warm water) several times a day and taking anti-inflammatory drugs or medications, such as acetaminophen, to control fever

Usually a laboratory test is necessary to determine if it is bacterial or viral. The typical testing performed is a rapid antigen test and/or a throat culture. If the rapid antigen test is positive, you have strep throat.

However, a negative rapid antigen test (which is highly specific but not sensitive enough to rely on a negative result) should be followed up by the gold standard for diagnosis of streptococcal pharyngitis, the throat culture. Here the swab will be put on special agar where the bacteria will grow and can be identified.

Strep throat will go away on its own without treatment within a week.

Streptococcus pyogenes can easily be treated with antibiotics such as penicillin, cephalexin, or amoxicillin. If you allergic to penicillin, erythromycin is an option.

Antibiotics can shorten the time you are contagious. You are usually no longer contagious 24 hours after starting antibiotics.

Antibiotics may also prevent the infection from triggering your immune system to attack itself and cause serious conditions such as rheumatic fever. Other complications are rare especially if the strep throat is not treated with antibiotics.

Antibiotics are not effective against viral infections and should not be prescribed. Overuse of antibiotics is a real problem and can cause problems with resistance which will make the antibiotic useless.

Non-prescription drugs such as acetaminophen or anesthetic throat sprays to help relieve the pain and discomfort caused by strep throat. Acetaminophen will also reduce fever.

According to Monica Rhodes, to avoid getting strep throat, it is a good idea to avoid contact with anyone who has a strep infection.

Wash your hands often when you are around people with colds or viral or bacterial illnesses. Do not share toothbrushes or eating and drinking utensils.

Bacteria are almost always transmitted by contact with tiny droplets from an infected person. Strep throat is passed from one person to another by contact with the tiny droplets of an infected person's cough, sneeze, or breath.

Bacteria can also live for a short time on doorknobs, water faucets, and other objects. If you touch an infected object and then touch your eyes, nose, or mouth, you can become infected with the bacteria or virus.

Keep up your body's resistance to infection with a good diet, plenty of sleep, and regular exercise. Managing stress can also strengthen your body's ability to fight off illness, such as strep throat.

Humidify your home during the dry winter months or year-round if you live in a dry climate. Moisture in the air (humidity) helps keep your mucous membranes moist and more resistant to bacteria. You can use a humidifier in the bedroom while you sleep. But use care if a person in the home has asthma or allergies, because mold or other particles that collect in the humidifier can make these conditions worse. Clean humidifiers on a regular basis.

Stop smoking, and avoid breathing others' smoke. Smoke irritates the throat tissues and may make you more susceptible to infection.