From the Guidelines
Yes, there is such a thing as being a strep carrier, and these individuals can harbor the bacteria for weeks or months without showing any symptoms of illness. A strep carrier is someone who has the Streptococcus bacteria (typically group A strep) present in their throat or on their skin without showing any symptoms of illness. These individuals can harbor the bacteria for weeks or months and may occasionally spread it to others, though carriers are generally less contagious than people with active infections. According to 1, about 20% of asymptomatic school-aged children may be carriers of group A streptococcal infection during the winter and spring.
Some key points to consider about strep carriers include:
- They are unlikely to spread the organism to their close contacts and are at low risk, if any, for developing suppurative complications or nonsuppurative complications (e.g., acute rheumatic fever) 1.
- Streptococcal carriers do not ordinarily require further antimicrobial therapy, as they have group A b-hemolytic streptococci present in their throats but have no evidence of an immunologic reaction to this organism 1.
- It is more difficult to eradicate group A streptococci from the upper respiratory tracts of streptococcal carriers, and many published studies showing relatively high rates of failure to eradicate group A streptococci from the upper respiratory tract with penicillin therapy were likely “contaminated” with carriers 1.
- For most carriers, no treatment is necessary unless they have recurrent strep infections or are spreading the infection to household members, and if treatment is needed, a physician might prescribe antibiotics such as clindamycin, azithromycin, or rifampin 1.
The carrier state occurs because the bacteria can establish residence in the throat without triggering enough immune response to cause symptoms or to completely eliminate the bacteria, allowing the organism to persist without causing disease 1. In general, chronic carriers are thought not to be important in the spread of GAS to individuals who live and work around them 1.
From the Research
Definition of a Strep Carrier
- A strep carrier is typically defined as an individual with a positive throat culture for group A beta-hemolytic streptococci (GABHS) but without a serologic response to the infection 2.
- This definition is based on the idea that a true streptococcal infection is characterized by a positive throat culture and a significant rise in streptococcal antibody titers.
Clinical Response to Antibiotic Therapy
- Studies have shown that patients with a positive throat culture and no significant rise in streptococcal antibody titers (i.e., strep carriers) may still exhibit a clinical response to antibiotic therapy, similar to those with true streptococcal infections 2.
- This challenges the traditional view that strep carriers should show little clinical response to antibiotic therapy.
Diagnosis and Treatment
- The diagnosis of GABHS pharyngitis is typically made using a rapid antigen detection test or throat culture 3, 4.
- Antibiotic therapy, such as penicillin or amoxicillin, is usually effective in treating GABHS pharyngitis, regardless of whether the patient is a strep carrier or has a true infection 3, 4, 5.
Implications of Being a Strep Carrier
- Being a strep carrier may not necessarily mean that an individual is immune to streptococcal infections or that they will not respond to antibiotic therapy 2.
- Further research is needed to fully understand the implications of being a strep carrier and how it affects treatment outcomes.