Rapid Strep Test Positive But No Sore Throat

Occasionally, I see patients who have received throat swabs for strep that have come back positive... even if they have no signs or symptoms of pharyngitis.

In this situation, there are 2 main actions a physician may take (I am biased towards one):

1) Prescribe antibiotics until throat cultures are normal
2) Do nothing

Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for???

Also, a person can be a carrier for strep without suffering any health problems. As such, even if the strep test is positive, but if the patient has no symptoms, I do not recommend treatment. (Which again begs the question of why bother getting a strep test if no treatment will be recommended regardless of the test result.)

I would go so far even to say follow-up cultures are NOT necessary after antibiotic treatment for strep throat if a patient does not have any more symptoms and exam is normal.

Which is why I find it surprising when children and adolescent patients receive multiple courses of antibiotics when they feel perfectly fine, but have received treatment just because a strep test came back positive.

Of course... that's just my opinion as I do acknowledge that there's another school of thought which supports antibiotic treatment of all strep positive cultures with follow-up cultures to ensure eradication.

Depending on the doctor you see, you will get different opinions. But it is good for patients to be aware of the varying views on this topic given how common sore throats are.

NYT: Wolfgang Amadeus Mozart Death Due to Strep Throat?

Well according to a NYT article published on Aug 17, 2009, yes he potentially did. In the article titled "What Really Killed Mozart? Maybe Strep," the journalist reports on a paper published in the Aug. 18 issue of The Annals of Internal Medicine where the researchers have done an epidemiological analysis that suggested he was a victim of an epidemic streptococcal infection.

Read the NYT article here. Read the actual paper abstract here.

This story illustrates how far we have come in controlling what is now considered a benign infectious problem which can be easily treated with antibiotics or tonsillectomy.

Image taken from Wikipedia.