Strep Throat - Diagnosis

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How is strep throat diagnosed?

There are two common tests used to establish whether an individual with symptoms of strep throat infection has a strep throat. The traditional test, a throat culture, involves the doctor obtaining a swab from the back of the throat and tonsils. It takes approximately 36 to 48 hours to determine the presence or absence of the GAS bacteria. This test is considered the "gold standard" in diagnosing strep throat.

Many medical offices, clinics and hospital emergency departments use a rapid strep test (RADT - rapid antigen detection test) in an effort to provide a more timely diagnosis for their patients. The throat swab is obtained similarly to that for a traditional throat culture, but a RADT "kit" is employed to help determine the presence or absence of the strep bacteria. The turn around time is generally 10 minutes. The RADT is less precise when compared with a throat culture. Most RADT tests are about 95% accurate in determining the presence of strep bacteria. Most guidelines recommend that a negative rapid strep test be confirmed with a throat culture. Of note, antibiotic pretreatment prior to obtaining a throat swab for strep bacteria can interfere with throat culture results, and thus the ability to correctly diagnose and treat a strep throat infection. Antibiotic treatment prior to a rapid strep test is less likely to have a false negative result since the test is designed to document the presence or absence of the GAS bacteria. Residual dead bacteria in the patient may allow a positive result.

The above tests are designed to determine whether an individual currently has a strep throat infection. Sometimes it may be necessary to determine whether a patient has had a recent history of a strep infection. In that case, two blood tests are available: (a) an ASO (anti streptolysin O) titer, and/or (b) an anti DNase titer. The antibodies that these tests are sensitive to are not commonly present until a few weeks following an acute strep infection. These tests may be ordered when evaluating a patient who may have developed delayed complications (such as rheumatic fever or glomerulonephritis) after a strep throat infection.

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Comment from: Jun, 55-64 Male (Patient) Published: April 11

I submitted to a throat culture and 10 minutes later, the results came back positive.

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Comment from: Sir Kyle, 19-24 Male (Patient) Published: September 23

I got strep throat. I never get sick. I started feeling a little sore last Tuesday, also noticed a few little white spots in my throat so I knew it was an infection (I figured it was strep based on pictures from online). Being me, I tried to fight it out. I was at home bed resting, drinking lots of water even though it hurt terribly, I was eating a variety of soups, drinking honey tea with lemon, gargling warm salt water and occasional peroxide, washing my hands 5 times more often than usual. I even bought a brand new pack of toothbrushes and used a new one each time I brushed to keep any lingering infections out. I saw and felt improvement on my right side on Sunday night, I thought I had beaten it. I woke up yesterday morning (now Monday) and my left tonsil and lymph node in my neck was rock hard and causing the worst radiating pain throughout my neck/face/mouth/throat, it was all connected, and it just stabbed each time I swallowed. I can honestly say this is one of the most painful things I have ever had to endure. My entire body would jump each time I swallowed, at this point even water hurt. I had so much pressure in my head and the pain was just radiating, nothing was helping. Monday night I got no sleep, rolling in bed sweating from my entire body, gargling warm salt water and having to jump in the shower to wash off my sweat. Tuesday I went to the doctor, was in and out in maybe 10 minutes. He gave me penicillin, 500 mg to take 4 times daily for 10 days. So far I have only taken 2 since I got them this morning, but the swelling from the infection has gone down and the pain is nearly unnoticeable. The doctor told me I had a bacterial infection based on the swab test. He said had it been a viral infection, it may have passed on its own.

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