As temperatures outside begin to dip and as another winter approaches, we again face the onset of a new cold and flu season. While most people will experience a sore throat with the common cold which is of viral origin, others will experience a sore throat from bacterial infection (Group A streptococcus), which can lead to more debilitating symptoms.
The confusion for most people with sore throats relates to the similarity of symptoms with a sore throat of viral and bacterial origin. This makes it difficult to establish an accurate diagnosis without a visit to a clinician. After clinical examination and reference to agreed upon guidelines, no confirmatory testing may be needed or treatment required. As a result, patients often find themselves in a quandary, unsure whether to spend the time and money to seek further medical care.
To address this problem, investigators at Harvard Medical School have looked into the use of a home tool to assess the likelihood that the sore that is of bacterial origin, warranting further treatment. They have found that by combining several factors into a simple measurement instrument, it is possible to accurately do so. They considered symptoms such as coughing, runny nose, hoarseness and ear pain and concluded the most predictive symptoms of a sore throat of bacterial infection are:
• Absence of coughing
• Age – Older than 15
• Recent local incidence of strep. throat
A major benefit to this tool is that it does not depend on any medical knowledge or the need for physical examination by either the patient or clinician. There is no need to feel if the throat lymph nodes are swollen or if the tonsils are draining. Instead of such examination findings, the home score substitutes data of recent levels of confirmed streptococcus infections in the community. It is claimed that the instrument determines the risk of strep. throat with the accuracy that approximates a clinician’s examination.
A Strep A home test provides for self-triage and the following advantages.
• Reduces unnecessary visits to clinicians
• Reduced need for confirmatory throat culture or streptoccal DNA testing
• Reduces unnecessary prescribing of antibiotics
• Reduces bacterial resistance to antibiotics
• Reduces disruption of normal bacterial population and side effects
• Reduces medical care costs
Currently, there are several obstacles to more widespread utilization of this home strep. First, the home tool is not applicable to children under 15 years of age who are more likely to experience strep. throat and are aggressively treated. The main issue with its utilization in adults is that clinicians and individuals do not have ready access to recent data of streptococcus infection in the community. It’s assumed that most hospitals and large practices already have access to data to allow them to calculate their own incidence rates. It is further anticipated that with increased conversion to electronic medical records as well as more consumer oriented technology with its medical apps and web-based personal medical portals, this will become a non-issue. Until then, personal knowledge of local strep. throat incidence and the symptoms listed above can serve as to guide, though an incomplete guide, in assessing low risk of strep. throat in adults.
- Jacob J. Klausner