Okay. So I went out of town this weekend (drove to Memphis, had a fantastic time! I barely slept) and felt absolutely awful on Monday. Well, of course I did, weekends like that will do that to you. But on Tuesday I was still beat, and my throat felt…just a little achy, as sometimes happens. Oh, I thought, I’m coming down with something.
When I happened to yawn in front of the mirror, things didn’t look right. So I got a flashlight and looked. Damn! Strep throat. I’ve seen it before, I’ve had it lots of times, the kids have had it…but this is the first time it doesn’t feel like swallowing razor blades. I call the Dr and get right in.
She tells me she doesn’t think it’s strep, since it doesn’t hurt, takes a culture and gives me a scrip for amoxycillin to take until the culture comes back, since you don’t want to mess with strep.
Now, my Dr. is no dummy, but I’m baffled. She agreed it looked like strep, seemed to think mono was a possibility but unlikely given my age. No other possiblities came up. When I left the office I was assuming it would come back positive, but now I’ve had a chance to think about it (always dangerous) and I’m wondering–what else looks like strep, but isn’t?
One cannot diagnose strep by looking. The only sure diagnostic test is a rapid strep assay or a strep culture.
I’ve seen hundreds of nasty, purulent throats, dripping with pus, with big lymph nodes and fever, only to see negative strep cultures. They’re almost all viral in these cases, usually the same strains that can cause “colds” but also the virus which causes mononucleosis. And if you treat mono with amoxil (often used for strep) you may do more harm than good, as you will frequently cause an uncomfortable rash.
So remember, sore throat /= strep. Pus-filled tonsils /= strep. Swollen lymph glands /= strep. I’d guess that strep is cultured out about one third of the time. The rest are almost all viral.
So if the amoxycillin doesn’t work (in my past experience with strep, there’s a huge improvement within twenty four hours on antibiotics), and I don’t break out in a rash, then I have a cold? It’s odd that the puss and the fatigue (and some hoarseness, which I forgot to mention earlier) are pretty much my only symptoms. I guess colds can be pretty weird, huh.
I’ll know for sure when the culture comes back in a few days. Thanks Qadgop!
My doctor told me (about three years ago) that the rapid strep test (actually, I think he called it “quick strep”, in case that makes a difference) was about 85% accurate. That may have been the false negative rate (mine came back negative).
I’m not familiar with that specific test, but typically, rapid tests like this are designed to have a very low false negative rate, but may often have a fairly high false positive rate. That is, you make sure that no one who really has it slips through, even if it means you accidentally treat someone who doesn’t really have it.
I used to get strep-like symptoms all the time due to colds or sinus infections, or even allergies. My sinuses would drain into my throat, causing sore throat and swollen, white tonsils. I have had strep many times and tonsillitis and other colds, and the only thing that differentiated them to me was the test results. Antibiotics won’t help if it’s viral. I actually had to ask my Dr. to stop prescribing me antibiotics every time if I didn’t need them, as I ended up being on antibiotics all the time and became very intolerant after too long.
Don’t they usually do both tests when they do a throat culture? At our doctor’s office, they swab your throat twice. My daughter once had the fast test come out negative (so no antibiotics) but we got a call the next day saying the slow test was positive, so we got the prescription then. They must have had enough false negatives to warrant doing both tests.
The rapid strep test takes about 20 minutes or so to perform. However, if the result is negative the usual procedure is to automatically perform a throat culture so that the rare false negative doesn’t mean the patient isn’t treated appropriately. A throat culture and organism identification can take up to four or five days depending upon a number of things.