That’s because Streptococcus pyogenes doesn’t have a resistance to penicillin (yet!!), so it’s the go-to drug for treatment and no susceptibility testing is necessary. If you’ve got a penicillin allergy, you’ll usually get erythromycin or tetracyclines, but there is a risk of resistance with those antibiotics. Strep confirmed by culture in your average micro lab will not generally include a reflex susceptibility test.
Just to show how tricky Medicine can be, my poor 4-year-old granddaughter came down with strep throat and scarlet fever about 10 days ago. Within a couple of days, she complained of tingling lips, which apparently was the beginning of scalded skin syndrome. The tingling lips may have just been one of those weird nonrelevant symptoms, though.
They didn’t have to put her in the hospital, by the way, and she’s getting better, but she was one pitiful little sweetie for a few days.
Thank you! Ignorance fought.
Hey, Alice, I hope you’re better!
I had a crazy throat infection last August, not strep, that entailed an urgent care trip on a Sunday morning. I was sure it was strep, because I had a painful tonsil with a sharp pain when I swallowed, which is how strep has presented to me in the past (had it twice). This was a little different in that the pain was starting to radiate upwards toward my ear. Strep swab was negative. The Sunday morning doctor decided it was an ear infection, despite me being 40 and having no ear infection history, ever, and that I explained the pain had started in my throat and was radiating upwards, not the other way around. She gave me a z-pack and guaifenesin and sent me on my way.
Tuesday I had a visit with my regular doc, told her I was in a lot of pain, it had gotten worse, I was having a hard time swallowing, my voice was hoarse and I couldn’t eat. She said continue with the azithromycin, scripted a lidocaine gargle, and should be better in a day or so.
Forward to Wednesday, 3am (14 hours after seeing my regular doc). I had last eaten Sunday night. I had last had anything to drink Monday morning, and was swallowing just enough water to get the z-pack pill down. Speaking was difficult, breathing was starting to get difficult! I thought I had explained to my regular doc how bad it was, but apparently since I wasn’t writhing on her floor she didn’t think it was that bad. I have a fairly high tolerance for pain, I guess.
Went back to the ER, and was semi-admitted to my own ER room, my BP was something crazy like 190/120 (I really was in a lot of pain). IV fluids, a steroid injection, and morphine, hooked up to a stat monitor, with my own awesome nurse taking vitals every 30 minutes. Later, a CT scan, since the swelling was so bad the doctor was worried there might be an abscess. There wasn’t, and with a couple liters of fluids on board and the steroid working, I had fallen asleep while waiting a couple hours for the CT. Switched the antibiotic to Clindamycin, gave me some vicodin to take home, and I was bouncing around cleaning the house the next day. (my discharge BP was 114/72)
So, throat infections, IMO, are nothing to take lightly (final bill: $5,000). Never did figure out what caused the infection in the first place, or what bacteria it was, but based on how it reacted to the right antibiotic it must have been bacterial. All I know is, it was just an inkling on Saturday and by Wednesday I was in seriously bad shape.
I hope you come back to the thread to tell us you’re better Alice!
May I please piggy-back on this thread to ask a related question?
I used to get sore threats rather frequently (though not for some years --<knock on wood>), both strep and otherwise. It seemed that I could always tell whether the infection was strep or not. The strep throat was always much more painful than a non-strep sore throat, but there was more to it than that. It seemed I could remember the precise sensation of pain from previous strep throats. I can’t describe the pain – I’ve “forgotten” it, partly because I never tried expressing it in words – but imagine I’d know at once if I got another strep throat. My “evidence” may be ridiculed as anecdotal (and indeed I suppose some of the “non-strep” sore throats might have been strep throats too mild for me to bother with strep test), but this is how it seemed to me.
Does this seem correct? That a patient can distinguish by memory strep from non-strep sore throats?
Yep - you got it in one! As to the tingling, it hasn’t happened again and I seem to be tolerating the Biaxin (DOH!!:smack:) fine. My throat also feels great and my glands are no longer swolen at all.
I guess we’ll see what happens in 5 or so days when I finish this course of treatment.
Or, based on how it reacted to the steroid, it could have been viral, too.
Quite the harrowing tale! Glad you survived.
I greatly doubt it. I’ve had patients declare their sore throat had to be strep, based on how horrible they felt. Temperatures of 104, glands swollen to golfball size, pus coating the entire retropharynx, etc. Only to have negative strep cultures, and sometimes positive Mono tests. Other times elevated lymphocytes, consistent with other viral infections.
Many symptoms are due to the body’s defense mechanism fighting off the infection (collateral damage, as it were), not due directly to the pathogen attacking the body in a certain way.