From the Guidelines
A sore throat with ulcers is less likely to be streptococcal pharyngitis. The presence of ulcers in the throat is more commonly associated with viral infections, particularly those caused by herpes simplex virus, coxsackievirus (hand-foot-mouth disease), or other viral pathogens 1. Strep throat, caused by group A Streptococcus bacteria, typically presents with inflammation, redness, and sometimes white or yellow patches (exudates) on the tonsils, but not true ulcerations. Other clinical features that suggest a viral rather than streptococcal cause include cough, runny nose, hoarseness, and conjunctivitis. This distinction is important because antibiotics, which are indicated for strep throat, are not effective against viral infections and should be avoided to prevent antibiotic resistance and unnecessary side effects. Some key points to consider in the diagnosis of strep throat include:
- The use of rapid antigen detection tests (RADT) and/or throat cultures to confirm the diagnosis 1
- The consideration of clinical features such as fever, tonsillopharyngeal erythema, and anterior cervical lymphadenitis, which may suggest a bacterial cause 1
- The importance of differentiating between viral and bacterial causes of pharyngitis to guide appropriate treatment and prevent unnecessary antibiotic use 1 If you have a sore throat with visible ulcers, it's more appropriate to focus on symptomatic relief with rest, hydration, over-the-counter pain relievers like acetaminophen or ibuprofen, and warm salt water gargles rather than expecting benefit from antibiotics. However, a definitive diagnosis should still be made by a healthcare provider, as some cases may require specific testing to rule out strep infection or to identify other causes requiring different treatment approaches.
From the Research
Sore Throat with Ulcers and Strep Pharyngitis
- A sore throat with ulcers can be caused by various factors, including viral and bacterial infections 2, 3, 4, 5, 6.
- The presence of ulcers alone does not necessarily indicate a streptococcal infection, as ulcers can also be caused by viral pharyngitis 3, 6.
- According to the studies, the diagnosis of streptococcal pharyngitis is typically based on a combination of clinical symptoms, such as fever, tonsillar exudate, and cervical lymphadenitis, rather than the presence of ulcers alone 3, 4, 5, 6.
- Clinical decision rules, such as the presence of fever, tonsillar exudate, and cervical lymphadenitis, can help assess the risk of group A beta-hemolytic streptococcal infection 6.
- Rapid antigen testing and throat culture can also be used to confirm the diagnosis of streptococcal pharyngitis 4, 5, 6.
Key Factors in Diagnosing Strep Pharyngitis
- Fever, tonsillar exudate, and cervical lymphadenitis are key factors that increase clinical suspicion of group A beta-hemolytic streptococcal pharyngitis 3, 6.
- A cough is more suggestive of a viral etiology, rather than a streptococcal infection 6.
- Patient age, with children and adolescents being more likely to have streptococcal pharyngitis, is also an important factor in diagnosing strep pharyngitis 6.
Diagnostic Tests and Treatment
- Rapid antigen testing and throat culture are recommended for diagnosing streptococcal pharyngitis 4, 5, 6.
- Penicillin and amoxicillin are first-line antibiotics for treating streptococcal pharyngitis, with a recommended course of 10 days 6.
- Steroids are not recommended for symptomatic treatment of streptococcal pharyngitis 6.