This is a guide to help you decide whether or not you have to call your doctor...

Sore throats are caused by all sorts of things. Most commonly they are caused by viruses, allergies, or drainage from a runny nose. Bacteria can also cause a sore throat.

Group A streptococcus bacteria can cause a severe sore throat, accompanied by fevers, headache, and/or rash and this is what we commonly refer to as "strep throat." When a sore throat is caused by Group A streptococcus bacteria, we treat it with antibiotics. It is important that we do treat this type of infection, because untreated strep can lead to more serious medical issues.

Sore throats caused by drainage from a runny nose from a virus such as the common cold or allergies will eventually clear up on its own. Fortunately, we can often make the symptoms better with medications such as acetaminophen or ibuprofen, throat sprays, and medications which help with the drainage. Enjoy a salt water gargle? Well here is a great article about how doing just that can decrease your risk of colds by 40% this winter!

https://well.blogs.nytimes.com/2010/09/27/gargling-with-salt-water-for-c...

There are lots of other great home remedies, and I won't go into them all, but I wanted to give you a tool which may help you decide whether or not to call your doc. This is calculator made for docs which helps us calculate the likelihood of strep and how to test and treat based on that likelihood:

https://www.mdcalc.com/centor-score-modified-mcisaac-strep-pharyngitis

This is what you have to know in order to use it appropriately, AND if you have doubts, you should always call your doc, just to make sure you are making the right decision. Kids are MUCH more likely to get strep throat and it is always a good idea to see a doctor when your child has a fever and a sore throat or a sore throat that persists more than a few days.

1. Age:

3 to 14 years (+1 point)

15 to 44 years (0 points)

45 and above (-1 point)

As you can see above, children less than 3 years old are unlikely to get strep throat but those between 3-14 get 1 point because this is the age at which it is most likely. If you are above 45, then we actually deduct a point, because strep is unlikely in this age group. Lucky you!!

2. Exudate or swelling on the tonsils

Yes (+1 point)

No (No points)

Exudate is pus on the tonsils. Go get a flashlight and look in the mirror a the back or your throat. If your throat looks like picture #2, left side, which says bacterial above it, give yourself a point. This is a bit tricky though, and if you are really unsure and your tonsils are huge and red and unhappy looking, then I would probably give myself a point anyway.

3. Tender/Swollen anterior cervical lymph nodes

Yes (+1 point)

No (0 points)

In picture #3 the examiner is feeling for anterior cervical nodes. These are lymph nodes, called glands, which are present under the jaw line on both sides. Commonly, they become very large and very tender when strep is present. If this is the case, you get another point.

4. Fever more than 100.4 F

Yes (+1 point)

No (0 points)

Yes, your doc is going to ask you if you have measured your temp and no is the wrong answer. A thermometer is dirt cheap at the pharmacy and you need one to be a good patient, sorry but it's true. So get one, and if you are freezing with 6 blankets on you or burning up then please measure. Doctors consider a temperature to be over 100.4F and don't tell us that yours is different than the rest of the population. That may be true but you only get a point if you are over 100.4F. Just telling it like it is...

5. Cough present

You have a cough (0 point)

You don't have a cough (+1 points)

This one is easy. Having a cough tells us that it is actually less likely you have strep throat. Most people who have strep throat, do not have a cough.

So, you have added all your points...what does it mean?

-1 points: 1% - 2.5% likelihood of strep, No further testing nor antibiotics.

0 points: 1% - 2.5% likelihood of strep, No further testing nor antibiotics.

1 point: 5% - 10% likelihood of strep, No further testing nor antibiotics.

2 points: 11% - 17%, Optional rapid strep testing and/or culture.

3 points: 28% - 35%, Consider rapid strep testing and/or culture.

4 points: 51% - 53% likelihood of strep, Consider rapid strep testing and/or culture.

5 points: 51% - 53% likelihood of strep, Consider rapid strep testing and/or culture

Ahhh! Lost yet? Ok, so what I tell my patients is that if you have 2+ points call your doc. That way, you can go over the symptoms together and decide on whether more testing is necessary.

I hope this little sore throat tutorial has been helpful. At the very least, I hope it helps you to understand that there is a way to objectively evaluate one's symptoms and predict the likelihood of disease which requires antibiotics. Again, most sore throats are caused by viruses or the drainage causes by a cold or allergies. Stay well this winter with good hand washing, sleep, a healthy diet, exercise and salt water gargles. Helps to be happy too .. :)

Posted by Dr. Carly Bown

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