What Is a Strep Carrier?

By Howard J. Bennett, MD

When children get strep throats, they usually have some combination of the following symptoms: fever, headache, body aches, sore throat, stomachache, nausea, and painful lymph nodes. They don’t usually have a runny nose, hoarseness or cough.

When I see children with a possible strep throat, I start by doing a rapid strep test. If this is positive, I can be fairly certain the child has strep, and I treat him accordingly. If the rapid test is negative, I do an overnight throat culture and treat the child if the culture is positive for strep the following day.

Of course, things aren’t always so cut and dried. Most parents have heard about kids being “strep carriers” or having “asymptomatic strep.” But what do these terms mean?

A strep carrier is a child who has the strep bacteria growing in his throat. However, the child is not sick because the strep is growing at a very slow rate. If the child develops a sore throat from a viral infection and gets a throat culture, the test will be positive even though it was the virus that made him sick, not the strep. This creates a problem in terms of deciding whether to treat the child with antibiotics or not.

I become suspicious that a child is a strep carrier if he gets lots of strep throats over the course of a few months. However, the only way to make the diagnosis is to culture children after they finished their antibiotics. With a typical strep infection, the culture will be negative a week after the antibiotics ended. With strep carriers, the culture will be positive. Although the strep carrier state may resolve on its own, it can also persist for months.

Technically, strep carriers do not need to be treated because they are not contagious and aren’t sick themselves. However, because it can be difficult to distinguish between a strep carrier and someone with recurrent strep throats, many doctors (me included) try to eradicate the carrier state. The antibiotics we typically use for strep throats don’t work for carriers, so a different regimen is used. My preference is a 10-day course of an antibiotic called clindamycin.

“Asymptomatic strep” is harder to explain because it’s not a scientific term per se. In many cases, someone with asymptomatic strep is actually a strep carrier. In other situations, the child has an “acute” strep infection, but he just hasn’t gotten sick yet. It takes 2 to 3 days after exposure for a child to become sick with strep, so a certain number of kids may be asymptomatic because they just happened to get a throat culture right before they were going to become sick.

In most cases, I do not recommend culturing children for strep if they’re not sick. One exception is if I’m trying to diagnose a strep carrier. Another is when a family is going on vacation, and I want to prevent them from having to go to an urgent care center while they’re on out of town.

Although being a strep carrier can be a pain to deal with, keep in mind that it is not a serious problem.

© 2016 Howard J. Bennett. All Rights Reserved.

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