Talk:Streptococcal pharyngitis/Archive 1

It is delicious cake. You must eat it.
There was this sentence in the "Transmissions" section: "The cake was made of 3 layers of bread with filling, which consisted of mayonnaise, caviar, cream, mimosa salad, liver pate, and cucumber, and there was a layer of mayonnaise, ham, meatballs, eggs, and prawns." Obviously this was false, and I deleted it. However, what about the other data about the cake? Is that verified?

68.38.225.254 (talk) 03:49, 16 January 2008 (UTC)Sharon

The cake is a lie. —Preceding unsigned comment added by 82.6.100.137 (talk) 13:19, 7 January 2009 (UTC)

Discussion
Just a quick Q, but how is that image in any way indicative of strep throat vs. a viral infection? You're just going to confuse people.

I think the sources should be cited for this page- how do we know if it's accurate? Emily 00:07, 8 March 2006 (UTC)
 * Perhaps Web MD Strep Throat page should be cited? It's showing on my browser as http://www.webmd.com/hw/strep_throat/hw54747.asp but this might not be a permenant link. Joncnunn 13:26, 6 April 2006 (UTC)

Virus?
"If left untreated, the strep throat virus can lead to post-streptococcal glomerulonephritis, or failure of the kidneys." But, strep isn't a virus, it's a bacteria, according to the rest of the article. Jsnow 05:01, 8 March 2006 (UTC)
 * I'm going to go ahead and replace the word "virus" with "bacteria" just to be on the safe side for now. If anyone can shed some light on this, please do so. TuckJ 00:07, 9 March 2006 (UTC)TuckJ 0:06 9 March 2006 (UTC)
 * It's certainly a becterium, not a virus. Just an error, thanks for fixing it. 192.116.237.116 15:02, 31 July 2006 (UTC)

Rapid test
"The throat of the patient is swabbed for culture or for a rapid strep test (5 to 10 min) which can be done in the doctor's office." That is, taken and sent to lab for results, or can the general practitioner see the results immediately? Xerai 14:07, 17 May 2006 (UTC)


 * I had it last week, and it's immediate. He left with a swab and returned a few minutes later saying the test was positive for strep.

From the article: In the UK, rapid strep testing is not available to general practitioners
 * Why not? — Omegatron 19:34, 7 November 2006 (UTC)

I have been told by my GP that the rapid test is often inaccurate, inclined towards giving false negatives. Twice at school I have contracted strep throat, and twice tested negative at the school health centre with the 'rapid' test (and been given a lecture on how not every sore throat is strep), only to go to my GP a couple days later and get a Dx of strep, put on antibiotics, and the sent-out swab comes back positive. Once is a mistake...twice is just stupid. My advice would be to go pay for the real test at a real doctor's; don't waste your time (and possibly money -- the rapid test I get for free at my school) on the rapid test. A lot of walk-in clinics use the rapid test, too. Ask for the real one. —Preceding unsigned comment added by 172.163.140.28 (talk) 05:23, 26 September 2007 (UTC)

Questionable statement
The article contains a sentence about a different disease: "Mononucleosis itself, however, can be extremely dangerous if left untreated.". Ah? The Mononucleosis article seems to explain that this is a very common and while it is not pleasant, it is far from "extremely dangerous". Also the article explains the it is a virus, and that no treatment is known. So almost every part of the sentence in this article appears false... 192.116.237.116 15:02, 31 July 2006 (UTC)
 * I agree. Treatment for mononucleosis is supportive, and current antivirals apparently make little difference in the course of the illness. Whatever the case, the statement is off topic in an article about strep throat. I'm going to go ahead and delete it since no one has offered a reply to the above post. 71.221.255.155 03:55, 14 November 2006 (UTC)

Questionable statement
"In the UK, rapid strep testing is not available to general practitioners and a clinical decision must be made whether to treat while waiting up to 7 days for a swab result to be reported, treat without confirmation from tests, or wait for confirmation. This is criticized for encouraging overuse of antibiotics (see antibiotic resistance)."

Better: "The UK does not have the same tradition of concern about strep throat, and a general practitioner may not understand why a mildly sick patient would visit the surgery instead of using home remedies or over-the-counter drugs."

Reference the NHS Direct website which tries to advise people when they need to visit a paid-for-by-taxes doctor (as opposed to US references on when to visit one who will make money from the visit). http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=343&sectionId=7066
 * Do you really believe that the occasional really sick UK child given unnecessary antibiotics causes more drug resistance than every US schoolchild receiving repeated courses of antibiotics supposed to be taken for 10 days when they are usually better in a couple of days and thus many courses are not completed, potentially leaving resistant bacteria in each such child?

Oak 15:30, 7 November 2006 (UTC)
 * That would be incorrect. You have cited "sore throat", you should look under "streptococcal infections", which states "streptococcal infections are treated with antibiotics". The condition is not something of the sort where one can get better without antibiotics, instead it will "led to serious conditions such as rheumatic fever (infection affecting the heart and joints)". I know quite a bit about the subject; I have been infected three times within the past three and a half months and now my tonsils must come out otherwise another infection may lead to a critical level of antibodies from my immune system resulting in them attacking my heart and joints. Oddly enough, my strep throat cases have largely been atypical, with only a mild sore throat for a day or so and no fever at all, the only clue I had was the pus accumulating on my tonsils. 71.219.93.220 06:14, 23 December 2006 (UTC)
 * To be honest I have NEVER heard anyone in the UK talk about Strep Throat - I think the page should reflect this some how - we simply have a sore throat --C Hawke 11:58, 30 April 2007 (UTC)
 * If it is a bacterial infection, would it not be the same as tonsillitis? I currently present all the symptoms for "strep throat" and have been diagnosed with tonsillitis, and am taking liquid penicillin. I believe that strep throat is just referred to as being the same as tonsillitis here in the UK.  J o s h  04:00, 16 June 2007 (UTC)
 * I was diagnosed in the UK as having strep throat yesterday. A second doctor today wondered whether it might be tonsillitis instead. So I guess they're different. —Preceding unsigned comment added by 81.187.54.34 (talk) 20:10, 16 January 2009 (UTC)

Symptoms
The following is taken from the section titled symptoms-- ''Drinking hot liquids helps. Orange juice and grapefruit juice should not be consumed, because the acids in them may irritate the throat''. These two sentences are about treatment and should be moved out of the symptoms section as they have nothing to do with symptoms. —The preceding unsigned comment was added by 213.65.230.31 (talk) 15:21, 3 February 2007 (UTC).
 * I removed the sentence "Drinking hot liquids helps." I see no references backing this statement, so I opted not to move it into Treatment, either. I feel the second sentence, "Orange juice and grapefruit juice should not be consumed, because the acids in them may irritate the throat" is obviously off topic, but irritation of the throat due to already having the illness can still be viewed as a symptom. So, maybe just rephrase it to present the actual symptom first in the sentence? Jitunu 03:20, 10 April 2007 (UTC)
 * Drinking hot liquids does help, as I currently am experiencing this, and I have found hot liquids to control pain in my throat. However, I can't find any sources to confirm this to wikipedia standards. Oh well. :~)  J o s h  04:04, 16 June 2007 (UTC)

Penicillin
This treatment section makes a pretty strong statement about penicillin being the standard of care. I am not a physician but my family and I have suffered strep infections more than once and never been prescribed penicillin. My wife, a nurse, indicates that this is definitely not standard in the U.S. any longer.

Presumably this needs to be changed (preferably by somebody more knowledgeable than me). Mcorazao 20:35, 30 March 2007 (UTC)
 * I don't think that's true everywhere in the US. My family, my sister's, and her boyfriend's family just went through a repeating bout of strep throat (the docs figured out it was drug-resistant) and all of us who weren't allergic were given penicillin.  Our doctors all said that was standard.  And we do live in the US.
 * In the UK, penicillin is the standard of care. Liquid penicillin is prescribed for those who have problems swallowing.  J o s h  04:05, 16 June 2007 (UTC)

I am a physician assistant and see plenty of "strep throats" in our office. Penicillin in the prefered antibiotic unless the patient is allergic to penicllin, according to The Sanford Guide to Antimicrobial Therapy 2008.--Ossiesan (talk) 22:45, 23 October 2008 (UTC)

UK usage
As mentioned by another editor above (in the "Questionable statement" section) the phrase "strep throat" is much less commonly used in Britain than it is in the US - it will be used by doctors when a precise description is needed, but is rare in everyday speech. Indeed, the NHS Direct page dealing with streptococcal infections has to say "strep throat (sore throat)" on the first appearance of the term, to make sure lay readers know what's being discussed.

Note also that although that NHS Direct page does indeed mention antibiotic treatment as standard for streptococcal infections, the more general NHS Direct page on sore throats in general says that "It is extremely rare for antibiotics to be needed. This is only the case when the sore throat is the result of a serious bacterial infection." And this BMJ page is entitled simply "Sore throat (Strep throat).

I have a feeling, though can't prove it, that usage of the phrase "strep throat" has increased somewhat in the UK since the advent of the internet (which has made many US-English phrases more recognisable here). But I was at a large UK university for several years in the mid-1990s, and I don't think I ever heard the term used except by a doctor or nurse. I did ponder sticking a "globalize" tag on the article, as it is US-centric in this regard, but I don't think it's all that serious. It would be nice to have a little about UK practice, though. 86.136.255.6 22:57, 28 May 2007 (UTC)


 * I'd agree, I consider the term almost unheard-of in common parlance in the UK. Cheers, DWaterson 22:30, 10 August 2007 (UTC)

ya, me n all, never heard of it before I started chatting to americans online, in the UK it would just be 'sore throat' Restepc 03:01, 22 September 2007 (UTC)

International precise names take priority over US slang
"Strep throat" is just an abbreviated term. As per WP:MEDMOS, "The article title should be the scientific or recognised medical name rather than the lay term" and goes on to indicate one should use "The World Health Organisation International Statistical Classification of Diseases (ICD 10)". Hence just as the article is Myocardial infarction and suitable redirects are provided, so this article should be named as per the given, i.e. "Streptococcal pharyngitis", although suitable additional term "Streptococcal sore throat" is given which allows at least some variation in usage of terms in the article for a better read. The article needs aggressive copyediting: removing chatty style "like in one study", instruction and direct reader advice, list of symptoms jumping from throat to systemic effects and back again. As a start rename to correct term "Streptococcal pharyngitis". David Ruben Talk 22:25, 4 April 2008 (UTC)

Red and Black(?) Dots
I believe there is a factual error in the article, and as I don't want to presume to know more than the author, I've chosen to raise the issue in discussion rather than edit the page directly.

The article mentions symptoms including red and black dots, but I don't think this is correct. One of the sources of the article, a fact sheet from US National Institute of Allergy and Infectious Diseases, states the following:

"If you have strep throat infection, you will have a red and painful sore throat and may have white patches on your tonsils." 

Though I've never heard of black dots as a symptom of strep throat, that doesn't mean they're not. Can anyone else confirm this? Either way, I'm certain that white patches (pustules) are a symptom of the illness. As I had strep throat numerous times as a child, and my son comes down with it every spring, first-hand experience also confirms this. Qmendoza 22:07, 24 August 2007 (UTC)

Early Detection of Strep Throat
As a child, I had strep many times until my tonsils were removed. After about the second time (at around 6 yrs of age), I found that when eating certain foods (specifically a pear and a butter cookie) I could detect the strep bacteria before I had any of the commonly reported symptoms, by a terrible after-taste that would be present after eating either of the two foods listed above. On one occasion, at about age 10, I reported this "taste" and predicted that I had strep, but the throat culture results were negative. Within 48 hours, I began to present with more symptoms, and a follow-up culture was positive. This occurred consistently through at least 15 episodes of strep throat that I can remember, but I have never seen that listed as a symptom anywhere. Has anyone else who frequently experienced strep had a similar observation? —Preceding unsigned comment added by Thomajam (talk • contribs) 13:58, 7 September 2007 (UTC)

The overuse of Antibiotics
As a Swedish medical student currently doing rotations on a GP clinic I would like to take the opportunity to describe the Swedish approach to the Strep tonsillitis issue.

The developing antibiotics resistance is a major problem in the world today, perhaps the biggest medical challenge in the future. This is a fact that us medical students are brainwashed with. Even though it is undoubtedly less of a problem in Sweden than in other European countries, big efforts are made to bring down the use of antibiotics. One of the ways is to reduce treatment of tonsillitis and otitis media (ear infection).

What we are taught is to not treat these infections with antibiotics (usually PcV), unless:
 * The patient is less than 2 years old
 * The patient has problems with eating and/or breathing because of the swelling
 * Symptoms are severe, as in high fever.
 * The disease is relapsing.

Studies show that usually a treated tonillitis patient only gains 1 or 2 days in comparison with the untreated patient. And since complications of the sort mentioned before are extremely uncommon these days (maybe that's just here? I don't know...) that is hardly even taken into account.

What are the policies in your countries? Zaimon 10:15, 5 October 2007 (UTC)

I am not a doctor, but the standard of treatement seems to be moving somewhat in that direction in the US. Mild strep infections are sometimes allowed to cure, but there is stilla a rheumatic fever controversy. Pawsplay (talk) 13:39, 21 March 2008 (UTC)


 * In the U.S., antibiotics are the standard treatment - usually penicillin or erythromycin. I don't think it's wise to "allow it to cure" on its own (this is also the position that almost every doctor in the US takes). Usually the infection will just get worse if left untreated, and since it's bacteria, you can reinfect yourself or others. I wouldn't say that using the two standard antibiotics I've mentioned qualifies as "overuse" of antibiotics. Fuzzform (talk) 23:23, 31 March 2008 (UTC)

Illustration
An additional photographic image is needed to illustrate a case of Strep Throat in which the tonsils are coated with the white patches or streaks of pus. Copyright issues make adding an image a complex undertaking. Greater detail is also needed in the general description of the disease, directed toward the layman. SDBrewer (talk) 19:21, 29 November 2007 (UTC)SDBrewer


 * The current image is pretty bad. White spots are indicative of strep, and the picture not only shows no white spots, but it shows no clear indication of strep. Next time I get strep (which will hopefully be never), I'll take a picture of my throat. The white spots are what allowed me to diagnose it in the past, both in myself and others. See the comments above for a citation about these white spots. Fuzzform (talk) 23:13, 31 March 2008 (UTC)


 * Actually, that looks like a pretty good picture of strep. Whenever I go to my doctor with a sore throat, she sometimes says to my mom, "Well, there is no redness, so it's not strep." I can infer that a red throat indicates strep throat, and this throat is PRETTY red! Besides, I don't know how we can get another picture. --Listen to your Princess, dear Wikipedians. (talk) 18:25, 4 April 2008 (UTC)


 * the picture illustrates strep very well.no, there is no patchy exudate, or pus in tonsillar crypts, but, when i was taught physical diagnosis many years ago, the characteristic we were told to look for was the 'beefy' red appearance of the mucosa. i.e. the pharynx looks like raw meat.Toyokuni3 (talk) 22:30, 24 June 2008 (UTC)

Celsius
I think having imperial measurements in a medical article is bad form. As I understand it no one uses F for temperature any more - not even US doctors. They socialise it for their patients of course but still record, calculate and measure in C (according to another wiki article). So why not get rid of F here? Jim77742 (talk) 08:39, 30 June 2008 (UTC)

Poorly Written Complications Section
I realise wikipedia is a resource for the public, but the section above is *ridiculously* convoluted and stupid. The complications are as follows : Acute Rheumatic Fever, Scarlet Fever, Streptococcal Toxic Shock Syndrome, Acute/Post-Streptococcal Glomerulonephritis and PANDAS Syndrome (which can lead to OCD symptoms, as previously mentioned).

I have hereby re-written this section, and deleted the differentiation between infectious and non-infectious complications. If anyone would like to correct me, I'd be only too happy to hear your arguments. Russthomas1515 (talk) 12:48, 6 October 2008 (UTC)


 * Ok, it's re-written. Now I'm still a bit of a noob...I have a link to UpToDate where I got this information: "http://www.utdol.com/online/content/topic.do?topicKey=upp_resp/4610#3" but I'm unsure as to how to enter it into the article. Can someone help? Russthomas1515 (talk) 13:04, 6 October 2008 (UTC)


 * Ok, I gave the ref tag a go. Hopefully it worked. Russthomas1515 (talk) 13:07, 6 October 2008 (UTC)

Cayenne Pepper cure?
Wow, this one really grates on me. under the treatments section, somebody mentions that cayenne powder in hot water is reported to cure strep. Their only source is a blog, and even the sentence is poorly written. I removed it. If anybody has more sources for this, feel free to add it. —Preceding unsigned comment added by 173.20.4.42 (talk) 01:21, 17 December 2008 (UTC)

Apparent major error in Transmission section
The transmission section claims "In addition, it may be spread through contamination of pillow cases, toys, toothbrushes and other often-used materials.[10]", where reference 10 points to a paper "Recurrence rate of streptococcal pharyngitis related to hygienic measures" published by "Falck G, Kjellander J, Schwan A (1998)" in "Scand J Prim Health Care 16 (1): 8–12.".

However if you download and read the paper, it appears on the face of it to claim the exact opposite: that there is [i]no[/i] evidence for transmission through these items. I quote from the summary at the start of the paper:

Objective – To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients’ own streptococci remaining on a toothbrush or in the bedclothes. [ ... ] Measurements and main results – [ ... ] There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures. Conclusions – Hygienic measures have no decisive inﬂuence on the risk of recurrence of streptococcal pharyngotonsillitis.

It appears to me that the above sentence from the transmission section reverses the conclusion of this paper. 82.6.100.137 (talk) 13:17, 7 January 2009 (UTC)


 * I think you're misinterpreting the paper. It's talking about reinfection of a person by their own streptococci, whereas the WP article is talking about infection other people. Isvara (talk) 20:21, 16 January 2009 (UTC)


 * The paper might seem contradictory if you don't take into account the subtle difference between bacteria in the environment and infection. Although the bacteria can be reduced in the environment by hygienic measures, the authors apparently conclude that they don't reduce the infection. From the last page:"The results of the environmental sampling did not agree with our previous experience (7). One explanation may be that Trypticase–Soy broth was used by mistake instead of Todd–Hewitt. Among the families in which GAS was found in the environment, those not given hygiene instructions predominated. Although the number of families was small, the findings are in agreement with previous studies (1) showing that the occurrence of GAS in the environment can be reduced by hygienic measures. Change of bed linen in our study had no influence on the recurrence rate, in agreement with the finding by Perry et al. (2) that GAS-contaminated blankets did not spread infection. Nor could we show that the toothbrush constitutes a risk of GAS recurrence within the family. Our results do not, however, exclude the possibility that GAS infections of the respiratory tract might be spread by contaminated moist objects such as dummies and plastic toys, especially as small children are saliva-promiscuous. The risk of such spread of infection is greatest where several small children are gathered together and share toys and, perhaps unwittingly, dummies and toothbrushes. Although the hypothesis tested was found not to be valid, this study has provided an answer to the question whether hygienic measures in the home have any influence on the rate of recurrence of streptococcal pharyngotonsillitis. We may now conclude that hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis. Hygienic measures probably do not prevent spread of streptococcal infections within the family, but the toddlers’ dummies may be a risk." The paper starts by noting the difference between dried and moist bacteria:"In the 1950s and 1960s hygiene instructions were given to patients treated with penicillin for pharyngotonsillitis caused by group A beta-haemolytic streptococci (GAS). The instructions were based on the earlier theory that streptococci in the environment constitute a secondary reservoir and give rise to new infections (1). To reduce the risk of recurrence, the patients were instructed to boil their toothbrush and change sheets and pillowcases during penicillin treatment. After Rammelkamp and co-workers showed, in a series of experiments in the mid-1950s, that dried streptococci in dust did not give rise to infection, unlike moist secretion (2–4), these instructions fell into oblivion. The question of whether the contaminated environment is of importance for the spread of GAS infection has recurred in the literature (5–7). As long ago as in the 1920s, the possibility that the toothbrush might constitute a risk of spread of infection was discussed (8). New studies have shown that toothbrushes can be heavily contaminated with potentially pathogenic microorganisms (9). Theoretically, the toothbrush might constitute a risk of infection, especially as it is known that GAS occur in large numbers in saliva in connection with infection (10)." Anyway, it seems pretty ambiguously-worded to me. II  | (t - c) 00:46, 2 June 2009 (UTC)

Ears locking up?
Anybody know what this expression means? It doesn't seem to be a medical term and Google turns up nothing related to any medical condition. I'm going to remove it from the list of symptoms if there isn't something concrete about this symptom that someone can find a valid reference to. Daydreamer302000 (talk) 14:56, 18 March 2010 (UTC)

See also - really?
In the See Also section, I found this:
 * Herpes, as the symptoms of these two ailments are very similar, do not mistake one for the other.'

I know I'm not a doctor, so maybe I'm missing something, but how exactly are these two diseases have similar symptoms?? Is this vanadlism, or perhaps a serious edit by a person who wrote this thinking about mononucleosis (HHV-4) rather than Herpes Simplex (HHV-1 or HHV-2) which are what we normally called Herpes? In that case, it's a good thing Chicken Pox (HHV-3) wasn't also added to the "See Also" list ;-) 84.108.167.132 (talk) 12:25, 19 February 2008 (UTC)

Psoriasis is also included in the see also section, in addition to herpes, and since neither of these conditions are related to streptococcal pharyngitis, I plan on removing them. Immunize (talk) 18:17, 13 February 2010 (UTC)

2009 Review article
Here is a free review article on this topic  Doc James  (talk · contribs · email) 14:32, 1 May 2010 (UTC)

Fact and citation check
(Part of the WikiProject Medicine effort)

Lead section
The introductory paragraph needs to be fleshed out, in keeping with Wikipedia’s lead section guidelines.
 * The first citation used in the body of the page (http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/nine/100014400.htm) does not specifically reference Group A Streptococcus as the etiological agent of strep throat. While the link is not inaccurate, the CDC’s general overview of Group A Strep infections (http://www.cdc.gov/ncidod/dbmd/diseaseinfo/Groupastreptococcal_g.htm) would be a better source (and one with much more information than a medical dictionary).


 * In addition to the CDC page, WebMD’s overview of strep throat (http://www.webmd.com/oral-health/tc/strep-throat-topic-overview) could be included. These would provide two general references that would support the addition of a few more sentences introducing strep throat (perhaps about its confusion with other infections/conditions causing similar symptoms or its contagiousness).
 * I have added a tag encouraging the addition of proper citations, since only the medical dictionary definition was listed. These citations can be the ones suggested here and need not be placed after every single sentence or in the exact location of the tag.
 * The combination of the CDC and WebMD sources at the beginning of the current, short paragraph should suffice to cover all the points within it. However, if more statements are made in the future, they may require additional sources.


 * The book “Streptococcal Pharyngitis: Optimal Management” by Pechere and Kaplan is also a good general resource and could be cited at the start of the section (http://books.google.com/books?id=YiYY86j9AosC&lpg=PA75&dq=strep%20pharyngitis&lr&as_brr=0&pg=PP1#v=onepage&q=strep%20pharyngitis&f=false).

Signs and symptoms section

 * The source listed after abdominal pain (http://www.myfamilywellness.org/MainMenuCategories/FamilyHealthCenter/ChildrensHealth/Strep.aspx) also mentions several other symptoms and could be a citation for the entire list, not just that entry.
 * ”pus” was misspelled and I corrected that so that it would redirect properly.

Cause section
I have placed a tag mentioning that there are too many primary sources in this section. Many of them are also only accessible as an abstract (e.g., the citation for spreading by close contact: http://www.ncbi.nlm.nih.gov/pubmed/15765640).
 * the first citation in the section mentioning Group A Strep (http://www.ncbi.nlm.nih.gov/pubmed/9612872) is a primary source and doesn’t need to be. The CDC page (http://www.cdc.gov/ncidod/dbmd/diseaseinfo/Groupastreptococcal_g.htm) would be a good reference for this statement.
 * The citation describing Streptococcus pyogenes as the species name for Group A strep is a primary source and could easily be replaced by a secondary source such as the Review of Medical Microbiology and Immunology by Warren Levinson, 2006, p.110 (http://books.google.com/books?id=Q_80CUAd_ikC&pg=PA113&dq=microbiology+pyogenes&lr=&as_brr=0&cd=3#v=onepage&q=microbiology%20pyogenes&f=false).
 * The statement dealing with spread by close contact contains another primary source (http://www.ncbi.nlm.nih.gov/pubmed/15765640) when a secondary source could be used (for example, http://www.journals.uchicago.edu/doi/full/10.1086/340949, used later).
 * The statement regarding familial recurrence based on hygiene practice should be clarified if it is to be kept. Since the source is primary, it may be best to replace this statement with a more general one describing how recurrence is possible (see, for example, the reference regarding persistence of Strep on toothbrushes).
 * Regarding foodborne outbreaks, the primary sources could be removed and replaced with Streptococcal pharyngitis: Optimal Management by Pechere and Kaplan, 2004, p. 184 (http://books.google.com/books?id=YiYY86j9AosC&pg=PA184&dq=strep+pharyngitis+food&lr=&as_brr=0&cd=1#v=onepage&q&f=false).

Diagnosis section

 * I suggest the following secondary source for a description of Centor’s studies describing the clinical criteria listed and the later McIsaac studies modifying the original Centor criteria: Streptococcal pharyngitis: Optimal Management by Pechere and Kaplan, 2004, p. 26 (http://books.google.com/books?id=YiYY86j9AosC&pg=PA27&dq=centor+criteria&lr=&as_drrb_is=q&as_minm_is=0&as_miny_is=&as_maxm_is=0&as_maxy_is=&as_brr=0&cd=1#v=onepage&q=centor%20criteria&f=false).
 * The throat culture citation (Smith, Ellen Reid; Scott Kahan; Redonda G. Miller (2008). In A Page Signs & Symptoms (In a Page Series). Hagerstwon, MD: Lippincott Williams & Wilkins. pp. 312) could use a better link to the actual source, since all that is hyperlinked is the ISBN. This should be included: (http://books.google.com/books?as_isbn=0781770432).
 * The citation for the study of the specificities of the rapid antigen test and blood culture is a primary article. The primary source could be kept if precise values of the specificity of the diagnostic tests is desired.  However, if a more general description of the two tests and their relative specificity and sensitivity is desired, here is an excellent secondary source: Maxcy-Rosenau-Last Public Health and Preventative Medicine, 15th Edition by Robert Wallace, 2008, p. 239 (http://books.google.com/books?id=5ACWr8YcB2AC&pg=PA239&dq=RADT+specificity&lr=&as_drrb_is=q&as_minm_is=0&as_miny_is=&as_maxm_is=0&as_maxy_is=&as_brr=0&cd=1#v=onepage&q=RADT%20specificity&f=false).
 * The main link for that citation is also dead, but the PubMed ID link is still working.


 * Another citation regarding the fact that coughing is not indicative of strep throat (as stated in the Differential Diagnosis section): The Harvard Medical School Family Health Guide by Anthony Komaroff, 1999, p. 1018 (http://books.google.com/books?id=85bncOnA-soC&pg=PT684&dq=strep+throat+coughing&lr=&as_brr=0&cd=6#v=onepage&q=strep%20throat%20coughing&f=false).

Treatment section

 * Instead of primary sources listing factoids about analgesics in unnecessary detail (http://www.ncbi.nlm.nih.gov/pubmed/12061352 and http://www.ingentaconnect.com/content/adis/cdi/1999/00000018/00000002/art00001), an overview reference could be used (http://www.webmd.com/oral-health/tc/strep-throat-treatment-overview).
 * These primary sources could be left if the specific percentage reduction of sore throat symptoms is necessary, but an overall summary sentence indicating that analgesics are only palliative would be better.


 * Statements regarding the minimization of antibiotic use could be generalized, and several secondary sources (e.g., http://www.annals.org/content/134/6/506.full.pdf) could be offered in place of specific primary research articles (http://www.ncbi.nlm.nih.gov/pubmed/10915082).


 * I agree that the primary sources are poor. Not a big fan of using unreferenced sources which may or may not be based on evidence such as webmd.  Will see if I can find a better source than the above. Doc James  (talk · contribs · email) 01:44, 2 May 2010 (UTC)

Prognosis section

 * The statement that strep throat is contagious for weeks without treatment is at odds with the literature cited throughout. I have tagged it with the “dubious” tag to indicate that it may not be entirely accurate.

'''I hope that these comments will be of assistance in improving this wiki. Special thanks to user Jmh649 for improving it greatly from what it was last night.''' Facthead82 (talk) 21:27, 1 May 2010 (UTC)
 * The source involving complications from strep throat (http://www.utdol.com/online/content/topic.do?topicKey=upp_resp/4610#3) was unverifiable (requiring a subscription). Instead, the book Taking Care of Your Child: A Parent’s Illustrated Guide to Complete Medical Care by Pantell, Fries, and Vicary, 2009, describes several possible complications clearly and freely on p. 336 (http://books.google.com/books?id=Tx5jNwpd6IIC&pg=PA336&dq=complications+strep+throat&lr=&as_drrb_is=q&as_minm_is=0&as_miny_is=&as_maxm_is=0&as_maxy_is=&as_brr=0&cd=1#v=onepage&q=complications%20strep%20throat&f=false).
 * List of complications includes two that need citations other than the more general one suggested above.
 * The PANDAS Wikipedia article gives more specifics, but a citation mentioning PANDAS directly should be included as a reference for its inclusion on the list (e.g., http://books.google.com/books?id=bAHTgmMCJDYC&pg=PA66&dq=strep+PANDAS&lr=&as_drrb_is=q&as_minm_is=0&as_miny_is=&as_maxm_is=0&as_maxy_is=&as_brr=0&cd=1#v=onepage&q=strep%20PANDAS&f=false).
 * The inclusion of herpes aggravation requires a citation. I was unable to verify this fact and have therefore tagged it with “verify source.”


 * Thanks Facthead. Will look these over in the next few days.  BTW I prefer using peer reviewed journal publications rather than textbooks or governments sites.  I will use the latter if I cannot find what I wish in the former. Doc James  (talk · contribs · email) 21:32, 1 May 2010 (UTC)

Technically correct but useless
The section on diagnosis may be technically correct (not that I could tell one way or another) but it's extreme and excessively technical derivation is useless to the majority of the public. If you can't come up with a "common person" summary, you might as well delete it. —Preceding unsigned comment added by 24.242.147.234 (talk • contribs) 00:47, 28 May 2007
 * Technically, it is correct, and although articles are meant to avoid the use of jargon, for very simplistic articles there is Simple English Wikipedia. I think the diagnostic criteria are fairly clear.Jhfortier (talk · contribs ) 04:38, 18 May 2010 (UTC)

GA Pass
I've reviewed and passed this article. It's been listed as GA on the main GA page, but reassessment from the Project Medicine page should be sought, as it's certainly not 'start' class any longer! Well done on this, and please consider doing another GA review to help clear the backlog. Thank you Jhfortier (talk) 06:10, 3 May 2010 (UTC)

Vaccine in Development
I have heard there is a possible vaccine in development for strep, I know it's a bacterial so I'm not sure if it is just hear-say or not, can anyone verify that this is true? --voodoom (talk) 05:58, 6 June 2010 (UTC)

Language Sections
This article seems to link to the Russian article on tonsilitis, not on strep throat. Is this the case simply because the two concepts are expressed with the same word in Russian?

Sofa jazz man (talk) 20:20, 7 June 2010 (UTC)


 * I do not know. Maybe ask over their? Doc James  (talk · contribs · email) 22:03, 7 June 2010 (UTC)

Strep throat and obsessive-compulsive disorder (OCD)
I heard an online program once (http://www.abc.net.au/rn/allinthemind/stories/2006/1789076.htm) and also seen in a Discovery Channel video called "All You Need To Know About, The Brain" that bacteria from strep throat can cause OCD if it enters the brain. I don't know anything else about it but I supplied a link to that radio program which talks about that. I think it should be mentioned - as some children who get strep throat, sometimes become OCD. —Preceding unsigned comment added by 64.180.85.99 (talk • contribs) 21:33, 24 April 2007

Croup
Should there not be linkages between this article and that, or am I misunderstanding something? Doc J? LeadSongDog come howl!  21:02, 21 July 2010 (UTC)
 * Croup is distinct from strep throat, in that croup is typically viral in etiology and is marked by stridor and a barking cough. Strep throat is of course bacterial in etiology, and has a different clinical presentation typically involving painful pharyngitis, lymphadenopathy, and fever. In strep, there is usually no associated cough or airway signs (e.g. stridor). I would assume there's no linkage in the article because there's not a lot of clinical overlap. That said, since our target is a lay audience, it might be useful to link croup as a "see also" or some such. MastCell Talk 21:19, 21 July 2010 (UTC)


 * MastCell's suggestion sounds good. Doc James  (talk · contribs · email) 22:58, 21 July 2010 (UTC)

disgusting pictures
is it really necessary to have those pictures up? looking at this article makes me feel sick — Preceding unsigned comment added by 64.56.229.219 (talk) 01:40, 23 September 2011 (UTC)

It is as it relates to the subject matter and gives visualization on what it looks like. 71.230.233.16 (talk) 15:12, 24 January 2012 (UTC)

To add
Doc James (talk · contribs · email) 15:22, 12 February 2012 (UTC)
 * 1) Comments that resistance does not occur to Pen V
 * 2) The time it takes for culture results to return

Antibiotic choice edit
The phrase, "First, general cephalosporins" should be changed to "First generation cephalosporins"

Msromike (talk) 16:39, 16 November 2012 (UTC)
 * Thanks Doc James  (talk · contribs · email) (if I write on your page reply on mine) 04:10, 2 March 2013 (UTC)

Typo change, grammar suggestion
"mouth" should replace "mount"

"If there is no fever, red eyes, hoarseness, a runny nose, or ulcers in the mount it is unlikely to be strep throat."

"If there is no fever, red eyes, hoarseness, a runny nose, or ulcers in the mouth it is unlikely to be strep throat."

however I propose an edit that clarifies:

"Strep throat is unlikely when any of the symptoms of red eyes, hoarseness, runny nose, or mouth ulcers are present. It is also unlikely when there is no fever."

Msromike (talk) 16:57, 16 November 2012 (UTC)
 * Done thanks. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 04:10, 2 March 2013 (UTC)

Addition - antibiotic resistance
Penicillin is recommended for initial treatment of group A beta-hemolytic streptococcus (GABHS.) Erythromycin is recommended for penicillin-allergic patients. Penicillin-resistant GABHS have not been reported in the United States, therefore extended spectrum antibiotics are not appropriate for uncomplicated GABHS pharyngitis.

Ref: Centers for Disease Control and Prevention, Acute Pharyngitis in Adults: Physician Information Sheet (Adults), June 25, 2012. Retrieved from http://www.cdc.gov/getsmart/campaign-materials/info-sheets/adult-acute-pharyngitis.pdf

Msromike (talk) 17:21, 16 November 2012 (UTC)
 * What change do you propose? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 04:12, 2 March 2013 (UTC)

I don't understand, I thought on Wikipedia I can edit articles. However, I don't see an edit link on top or in any of the sections. There is a grammar mistake that's bugging me. — Preceding unsigned comment added by 152.62.109.58 (talk) 06:17, 16 January 2013 (UTC)
 * Yes this article is semi protected which means that one must be an established editor to make changes. This does not take much effort. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:12, 2 March 2013 (UTC)

Main Paragraph
One of the lines in the opening section states that 37% of all childhood pharyngitis is caused by Streptococcus. However, if you look at the Pediatrics article which is cited, it actually says that in children with pharyngitis, there is a 37% Strep carriage rate. This needs to be compared with the 12% carriage rate amongst children who did not have pharyngitis, which is also mentioned in the Pediatrics article. This suggests that less than 37% of the sore throats were actually caused by Strep. — Preceding unsigned comment added by 76.75.148.30 (talk) 23:24, 18 May 2013 (UTC)

Centor chart not as cited
The Modified Centor Criteria that is cited in reference #4 (Diagnosis and Treatment of Streptococcal Pharyngitis BETH A. CHOBY, MD, University of Tennessee College of Medicine–Chattanooga, Chattanooga, Tennessee Am Fam Physician. 2009 Mar 1;79(5):383-390.) is not accurately reflected in the chart created for this wikipedia page. Specifically, the wikipedia chart makes no distinction between score of 0 and score of 1, while the chart in the actual article makes the distinction that culture for the virus is a reasonable option for a score of 1 (but not 0). Also, the cited article uses the language antibiotics/culture "not indicated" which should replace the "not needed" language currently in the wikipedia chart. "Not needed" is logically inaccurate, there will certainly be cases of score 0 where antibiotics are "needed", but because those cases are extremely rare the score of zero is taken to mean antibiotics are not "indicated" by the assessment.
 * Yes good point. Have added further text to clarify. "not needed" and not indicated are close enough. We much paraphrase our content to avoid copyright issues. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 20:24, 13 May 2014 (UTC)

Differing Statistics
Statistics in the lead and epidemiology section differ regarding how common strep throat is in adults and children. This difference should be resolved. TylerDurden8823 (talk) 08:21, 13 March 2015 (UTC)
 * Thanks done. Doc James  (talk · contribs · email) 22:55, 13 March 2015 (UTC)

Semi-protected edit request on 11 January 2016
The treatment of choice in the UK for strep-throat is Pen V, not amoxicillin.

D823fu (talk) 10:52, 11 January 2016 (UTC)
 * You have a ref for that? Doc James  (talk · contribs · email) 11:15, 11 January 2016 (UTC)
 * Red information icon with gradient background.svg Not done: please provide reliable sources that support the change you want to be made. --Majora (talk) 15:25, 11 January 2016 (UTC)

Gargles
In mild cases, in adults and children old enough to co-ordinate, gargles may be used. Traditional salt water is adequate, but there are various antiseptic anaesthetic combination gargles on the market that provide relief from discomfort as well as sufficient anti-bacterial action to assist the body in combating the infection.

from Dr Tim Metcalf, a GP for over 30 years who tries to use less antibiotics — Preceding unsigned comment added by 1.129.97.37 (talk) 23:41, 1 August 2016 (UTC)

and I should have said aspirin can be dissolved and used in a gargle — Preceding unsigned comment added by 1.129.97.37 (talk) 23:47, 1 August 2016 (UTC)