Streptococcal Infection – what you need to know

There is a lot on the news about the dangers of Streptococci in children.

I thought that a little more information and insight could help on this:

Streptococci are common bacteria, present in and on everyone pretty much all the time. Even the dangerous type is around all the time. The trouble is that Streptococcus Type A can cause Scarlet Fever. Now in pre-antibiotic times, Scarlet fever caused many deaths across the centuries, and was one of the world’s greatest killers, but also led to such effects as kidney failure, rheumatic fever with ongoing joint disease and heart valve disease.

However, antibiotics were discovered and widely used, so that scarlet fever and its most serious outcomes, were almost completely wiped out in those countries with access to modern medicines. The bacterium was still around just the same, but if a doctor thought there might be a streptococcal infection, they proceeded immediately to prescribe penicillin, and the patient recovered rapidly.

For years now, doctors have been told to avoid using antibiotics for sore throats, as nearly all are simple viral infections. So, it becomes much more important to make a correct diagnosis. Scarlet fever manifests a brilliant scarlet throat, not just the usual redness. In more advanced cases there may be a scarlet body rash as well. In times past that was a very serious sign. It is children and teenagers who are particularly at risk of scarlet fever. Adults will have been exposed to the bacterium over many years and have developed good immunity. The germ is so common however, that a large proportion of people carry the germs in the throat and nose all their lives. This is common and nothing to worry about.

It is wrong that the media cause widespread panic and alarm, this is extremely unhelpful and will put un-necessary pressure on heath practitioners. On the other hand, if we are all educated as to what to look for, and if physicians then prescribe as they should, then there is nothing to worry about.

If the clinical signs are present then a throat swab should be sent for culture, and Penicillin V prescribed straight away, which is not a wide spectrum antibiotic, so doesn’t spread resistance. The result of the swab test is then critical, since the antibiotic can then either be stopped, or if positive for Strep A, then the antibiotic must be continued a FULL two weeks, or the bacterium may not be properly eradicated. Also, in positive cases, close contacts should then have a swab test, since they may be silently carrying the bug and unknowingly be spreading it.

It is not necessary for widespread panic, as this is not a common problem. Nevertheless, it seems likely that the closure of schools and wearing of masks during the Covid epidemic prevented children from developing the level of natural immunity that they should normally have. See my comments upon the Covid epidemic that I have passed to the Inquiry. In addition, some doctors may have become too reluctant to prescribe. If in any doubt, a throat swab must be sent for culture, which can easily be taken by a nurse or assistant. It needs to be put in the correct transport medium and taken to the laboratory for testing.

See also my suggestions that I gave to the Government and the Royal College of General Practice, to recreate General Practice as we used to have it.