At this time of year, sore throat is one of the most common reasons for people to attend their doctor, for advice, treatment and often a medical certificate for work. In about 90% of cases sore throats are caused by viruses, so it’s all about painkillers, TLC and patience. Antibiotics don’t kill viruses, so are entirely pointless in most cases. Fortunately, people are becoming much more aware of this, and of the dangers of unnecessary antibiotics. Whilst antibiotics can cause side effects such as rashes, stomach upset and diarrhoea, we now know there are harms to wider society too. We’ve all heard the horror stories of “super-bugs”, which are caused when bacteria are over-exposed to antibiotics and gradually develop resistance to them. These bugs can be very dangerous if they invade the body- as doctors have limited ways to fight them if standard antibiotics no longer work. Such infections are a particular threat to babies, the elderly, or those whose immune systems are underperforming due to illness, cancer treatment or certain medications.
But what about the 10% of sore throats that ARE caused by bacteria- namely, streptococcus? Well, even in these cases, the body will often clear the infection if given time. It does this by sending white blood cells (known as neutrophils) to attack the invading bugs. Often (but not always) the symptoms of a strep throat will be worse than a viral infection- with high fevers, enlarged tender glands, bad breath and sometimes a skin rash. One of the most useful investigations we can do for our patients- to decide if their sore throat is viral or bacterial- is a rapid or “on the spot” test for streptococcal infection. This involves a quick swab of the throat- the swab is placed in a liquid, which flows into a panel that will, after a few minutes, show if strep is present. It looks the same as a pregnancy test- one line is negative, two lines is positive. This test means we can confidently tell a patient whether or not an antibiotic is needed. It is pretty cheap to run, though it is not (as yet) covered by Medicare. But most patients seem to prefer to spend their dollars on the test rather than similar amounts on potentially pointless, potentially harmful antibiotics. So next time a sore throat strikes, remember to ask your GP if they have a rapid test for streptococcal infection.
It’s also worth remembering that a trip to the GP surgery is not always necessary these days. If the pain is manageable, and you are able swallow and drink enough fluids, then an online doctor can provide your medical certificate, and you can recover in the comfort of home.