Your throat is killing you, and judging from how badly it hurts, you think it might be strep…but are there any other clues to tell you when to head in to see your doctor? Well, yes, there are! Turns out there are four signs that strongly suggest your sore throat might be caused by “strep” bacteria:
1. Fever (TAKE your temperature! True fever is temp > 100.4*)
2. NO COUGH
3. Swollen, red tonsils (with our without bonus “pus” on them)
4. Tender, enlarged “glands” (lymph nodes) in the front of your neck
If you have only a couple of these symptoms, your doctor may offer to do a rapid strep test to help decide whether or not to treat you with antibiotics. How accurate are these rapid strep tests? VERY- especially if they are positive.
A positive test has a 95% chance that you do, indeed, have strep. On the flip side, if the rapid test is negative, there is still up to a 10% chance that your test is a false negative, meaning you do indeed have strep but the test is inaccurate. Note that if you have an overcharged gag reflex, a false negative might be because the person swabbing your throat was unable to fully view and adequately reach your tonsils.
Additionally, only Group A strep (which is the classic “strep throat” that can lead to scarlet fever) is identified on rapid tests. Other types of strep (Groups B, C, D, and G) can also cause throat infections, but will not be picked up.The definitive test is a traditional throat culture, where that same throat swab is smeared on to an agar plate and we wait several days to see which bacteria grows.
Most sore throats are NOT strep throat, and the severity of your pain does not help diagnostically. Allergic post-nasal drainage can be intensely painful, but your throat will be visually unimpressive- no bright red, oozing tonsils nor any big, tender lymph glands in your neck. Upper respiratory viruses (like the common cold) classically show up as pink to light-red throats with mildly tender or enlarged neck glands, plus a pesky cough.
Nothing in medicine is completely black and white, so some people with strep throats may have a slight cough, while others with red, oozing tonsils do not have strep (because it’s mono or another infection.) However, knowing these hallmarks of strep throat should help you decide when it’s time to head in to see your doctor.
BOTTOM LINE: Strep throat is most likely if you have fever, sore throat, painful & swollen glands (lymph nodes) in the front of your neck, and NO COUGH.