Two Questions May Rule Out Strep Throat

Researchers say home test could determine when a sore throat doesn't warrant a trip to the doctor

  • Print

MONDAY, Nov. 4 (HealthDay News) -- Your throat is on fire. It hurts to swallow, and you're losing your voice. Is it time to see a doctor for antibiotics?

In the near future, researchers report, it may be possible to click on an app, answer two questions about your symptoms and find out whether a seriously sore throat is actually a strep infection.

"Those questions would be: Do you have a cough, and have you had a fever in the last 24 hours?" said study author Dr. Andrew Fine, a pediatric emergency medicine specialist at Boston Children's Hospital. High fevers are a hallmark of strep infections, while coughs are not.

In a new study of more than 70,000 patients with sore throats, those two questions and an accounting of how common strep infections were within a local area ruled out cases of strep throat nearly as well as lab tests did.

"This enables us to use the test of time," said co-study author Dr. Kenneth Mandl, a professor of bioinformatics at Harvard. "If we determine that you're low risk and most cases will not have an important complication from strep anyway, then you can be followed clinically rather than come in for a test right away, and you may improve."

The researchers think that if the new test was widely used, it could save hundreds of thousands of unnecessary trips to the doctor each year and cut down on the overprescribing of antibiotics.

The study will be published Nov. 5 in the Annals of Internal Medicine.

The question of what to do for adults who have bad sore throats is a tough one, even for doctors.

About 15 million Americans see a doctor for a sore throat each year, and 70 percent of them get antibiotics to treat it, according to the Infectious Diseases Society of America. That's far more than the 20 percent to 30 percent of children and 5 percent to 15 percent of adults who actually benefit from taking the powerful drugs.

The problem is that most sore throats are caused by viruses, not bacteria, so antibiotics don't help clear up the infection. Taking antibiotics when they aren't needed can cause severe diarrhea and it contributes to the problem of antibiotic resistance -- when bacteria can no longer be killed by the drugs that are available to fight them off.

But cases of strep throat, which is caused by bacteria, can be more dangerous.

"There are both medical, as well as considerable public health, reasons that we are concerned about strep throat," said Dr. Edward Kaplan. A pediatric infectious disease specialist at the University of Minnesota, in Minneapolis, Kaplan wrote an editorial that accompanied the study.

These infections are highly contagious, and they may spread throughout the body, causing rashes, joint pain and lasting damage to the heart or kidneys.

Such serious aftereffects are rare, Kaplan said, but "they're still common enough to cause mischief."

Kaplan pointed to outbreaks of rheumatic fever caused by strep infections in Utah in the 1980s and 1990s, which sickened hundreds of adults.

The fear of missing strep infections combined with patient expectation that they'll get an antibiotic leads a lot of doctors to overtreat sore throats, he said. So, tools like a home test app could fill a need.

The problem, Kaplan said, is that the test requires information about how common strep infections are in a local area, but strep infections are not reported publicly.

In the study, researchers relied on data generated by MinuteClinics, a chain of urgent care centers located in CVS drugstores.

MinuteClinics give every patient who comes in with a sore throat a test for strep bacteria. Researchers divided the number of positive results by the total number of patients tested in the last two weeks to calculate risk scores.

The study found that 90 percent of patients who were at low risk for strep based on their home test score also had negative lab tests for strep at MinuteClinics.

But that kind of universal testing clashes with current clinical guidelines.

In a sense, the accuracy of the test depends on overtesting in the first place, which drives up health care costs, said Dr. Robert Centor, an internist at the University of Alabama at Birmingham. He wrote a second editorial on the study.

Centor thinks it would be much less expensive to get doctors to just follow clinical guidelines, and to prescribe generic antibiotics when strep is detected.

Centor also wondered whether people would actually use such an app, which only applies to people over 15 years of age.

"It fails the eyeball test to me. Does it look like people will do it?" he asked.

The study authors were more hopeful. They say health care is changing to reward doctors who provide good care without overtreating their patients.

"We think that tools that improve the accuracy and the judicious use of testing will actually be quite welcome in most segments of the medical community," Mandl said.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on strep throat.

Fact Check

Fact Check

Have you found an error, or know of something we’ve missed in one of our stories?
Please use the form below and let us know.

* Required
  • Please post the headline of the story or the title of the video with the error.

  • Please post exactly what was wrong with the story.

  • Please indicate your source for the correct information.

  • Yes


  • This will only be used to contact you if we have a question about your submission, it will not be used to identify you or be published.

  • Cancel

Having problems with the form?

Contact Us Directly
  • Print

You can comment on most stories on You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

You can comment on most stories on You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

Have Your Say

New to commenting? Check out our Frequently Asked Questions.

Have Your Say

Comments are open to Winnipeg Free Press print or e-edition subscribers only. why?

Have Your Say

Comments are open to Winnipeg Free Press Subscribers only. why?

The Winnipeg Free Press does not necessarily endorse any of the views posted. By submitting your comment, you agree to our Terms and Conditions. These terms were revised effective April 16, 2010.


Make text: Larger | Smaller


Gary Lawless & Ed Tait try not to bleeping cry over the woesome Jets

View more like this

Photo Store Gallery

  • A pelican comes in for a landing Wednesday afternoon on the Red River at Lockport, Manitoba - Standup photo- June 27, 2012   (JOE BRYKSA / WINNIPEG FREE PRESS)
  • A Canada Goose cools off in a water pond Monday afternoon at Brookside Cemetary- See Bryksa’s Goose a day Challenge– Day 27-June 25, 2012   (JOE BRYKSA / WINNIPEG FREE PRESS)

View More Gallery Photos


Are you in favour of the Harper government's new 'family tax cut'?

View Results

View Related Story

Ads by Google