Day 7 Wish: Doctors Would Test For Strep With Every Sore Throat

Day 7: Doctors would test for strep for all sore throats.

How can you tell a viral sore throat from a strep throat?  You can’t except with a throat culture.  So why do so many primary care providers diagnosis sore throat as viral without a culture?

My simple wish is PCPs would do a culture with every sore throat and to educate parents to come in each time for a test.  It is important because strep doesn’t always present as a raging sore throat with fever.  That is the easy diagnosis.  It can be fleeting, only hanging around for a day or so.  No fever or maybe low grade or swollen glands.

Why do I think it is important?  Strep untreated can get into the nervous system and the heart by attacking the basal ganglia of the brain.  It can cause Tourette like symptoms, hyperactivity, psychiatric symptoms like OCD and heart valve damage.  It is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections or PANDAS.  And it is often missed as a differential diagnosis when present.  It all starts because a simple culture was not done.

Insurance and evidence based medicine thinking are also at fault in this equation.  Insurance pressures the PCP to not over test and evidence based medicine doesn’t support cultures for every presenting sore throat.   Nor does it support the diagnosis in the differential of a child presenting with sudden onset of unexplainable psychiatric symptoms.

A rapid strep test and culture sent to the lab to verify,  if positive and treated with antibiotics can avoid the potential of healthcare nightmare.