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Column originally published Oct 8, 1997

There Are Many Complications Of Strept Throat, Including Rheumatic Fever And Glomerulonephritis

Question: I have often heard people say that Strept throat needs to be treated with antibiotics. When I recently read that so many germs are resistant to antibiotics, I wonder whether it is necessary to treat a Strept throat that can get better by itself. Is it necessary to treat Strept throat?


Yes, Strept throat needs to be treated with antibiotics. You have raised a very interesting question here. Let me begin by explaining about Strept infection of the throat and its complications, and then get back to your question about germs becoming resistant to antibiotics.

Strept throat is an infection of the throat by the bacteria called Group A Streptococcus. As the name implies, there are many different groups of Streptococcus. Only a few of them can cause infection in human, and Group A Streptococcus is the most common one.

Many of us carry Group A Streptococcus in our throat and don’t get sick. This germ can be passed from person to person through respiratory secretions. When a susceptible person picks up the Streptococcus, the bacteria will grow in the throat and cause an infection. Symptoms of Strept throat include fever, sore throat, white spots on the tonsils and the throat, lethargy, sometimes pain in the stomach and vomiting.

As you can see, virus infection of the throat can look like Strept throat. This is especially true for Adenovirus, which can cause an infection almost identical to Strept throat. That is the reason why doctors often have to do throat culture to confirm whether the problem is due to Strept infection or viruses.

If the problem is truly caused by Group A Streptococcus, the best thing is to do is to treat it with Penicillin or similar antibiotics. Before the discovery of antibiotics, Strept throat can spread and form abscesses around the tonsils, pneumonia, scarlet fever, blood infection (also called septicemia) and meningitis. These are serious infections that can become fatal. Fortunately, since the discovery of antibiotics, most of these serious complications are becoming much less common, although they still occur from time to time. A form of serious infection of Group A Streptococcus is called fasciitis, or ‘flesh eating disease.’ It has received much media attention in the last few years.

There are still other complications of Group A Streptococcus which are less known to the public. They are acute rheumatic fever and post-Streptococcus glomerulonephritis.

Acute rheumatic fever occurs several weeks to months after Strept infection. Patients usually develop fever, pain and swelling of large joints like hips, knees, ankles, elbows, and wrists. About one-third of these patients will develop inflammation of the heart, with swelling of the heart valves. The joint problems often improve after several weeks, and can get better very quickly with aspirin. However, those who have heart complications may develop permanent damage to their heart valves. Some of them will require replacement of heart valves some years later.

Acute rheumatic fever used to be a very common complication of Strept throat many years ago. With improvement of nutrition and living environment, as well as the use of antibiotics for Strept throat, this complication has become very rare in North America in the last few decades (although it is still happening in developing countries). However, there have been small outbreaks of rheumatic fever in several parts of United States over the past ten years.

When I was working as an infectious disease consultant at IWK-Grace Health Centre this past July and August, I saw three children with acute rheumatic fever after Group A Streptococcal infection. One of them developed swelling and leaking of her heart valves. It is unclear whether we will have an outbreak of rheumatic fever in the Maritimes, but it is very important to treat Strept throat in order to prevent this serious complication.

Another complication is post-Streptococcal glomerulonephritis (inflammation of the kidneys). This can occur several weeks after Group A Streptococcus infection of the throat or skin (also called impetigo). These patients present with dark brown or ‘tea-coloured’ urine. Most of them will recover completely, although the process may take several months. However, a very small percentage of these patients can develop chronic kidney problems and kidney failure. Again treatment with antibiotics for the Streptococcal infection can prevent this complication.

I hope by now you can appreciate the importance of treating Strept throat. Of course, if virus is the cause of throat infection, there is no need to use antibiotics. There are only a few anti-viral medications that can treat certain viruses, but nothing is effective for viruses that cause sore throat.

You are correct in stating that many bacteria are becoming more resistant to antibiotics. It is suspected that antibiotics have been used too often to treat sore throats that are caused by viruses. As a result, many bacteria have developed resistance against antibiotics. However, it is important not to overlook Strept throat and treat it appropriately.