Recurrent Strep Throat: What to Do When Strep Comes Back

The period between mid-autumn and early spring may be called “cold and flu season,” but if you have school-aged children, you probably know that “cold, flu, and strep season” is a more accurate descriptor for these high-infection months.  

Although kids can get strep throat at any time of year, the infectious bacteria that causes it circulates more widely and continuously between December and April. 

Sore throats and suspected strep infections are the top reasons parents seek same-day sick visits at The Center for Advanced Pediatrics every winter. Here, our expert team discusses why some kids seem prone to recurrent strep infections — and explains what you can do about it.

A short tutorial on strep throat 

Strep throat is an acute (short-term) infectious illness that comes on quickly and makes swallowing painful. Step is caused by certain strains of Streptococcus pyogenes bacteria, also known as group A streptococcus (GAS). 

Group A strep bacteria

GAS is frequently found living on the skin, in the nose, and at the back of the throat. Not all GAS bacteria are the same, however — some grow quickly, others are better at evading the immune system, and under certain circumstances, some can cause disease.  

A common childhood illness

When GAS bacteria infect the back of the throat, their rapid multiplication produces byproducts that inflame the tissue and make it feel sore. Strep throat typically causes:  

• Persistent or worsening throat pain
• Swollen lymph nodes along the neck
• A visibly red throat, inflamed tonsils 
• A sudden fever that peaks on day two

Anyone can get strep throat, and indeed, there are millions of cases every year in the United States. Most cases, however, occur among kids between the ages of 5 and 15. Strep infections account for up to 35% of sore throats in school-aged children. 

Antibiotic treatment 

Strep throat is treated with antibiotics — usually a form of penicillin called amoxicillin. Prompt diagnosis and treatment are important, as a lingering strep infection can lead to complications like rheumatic fever and kidney inflammation.

When strep throat comes back

Many parents are surprised when their child comes down with strep on the heels of a recent infection, or worse, seems to get strep throat every few months. Unfortunately, recurrent strep is relatively common. Here are the main reasons:

1. Partial treatment

Most kids with strep begin to feel better after taking just a few doses of their prescribed antibiotic. However, to kill the infection, your child needs to take the entire course. 

Taking only part of an antibiotic treatment can temporarily suppress a strep infection without killing it completely. Often, the lurking bacteria roars back to life quickly, sending you back to our office.

2. Antibiotic failure

Amoxicillin is the gold-standard treatment for strep throat, and luckily, GAS bacteria haven’t yet developed resistance to this medication. Kids who are allergic to penicillin, however, need to take a different, non-penicillin antibiotic. Unfortunately, GAS bacteria are resistant to most other antibiotics, including erythromycin and clindamycin. 

3. Simple reinfection 

Strep is highly contagious, and it can linger in communities. Sometimes, kids get recurrent strep simply because they catch it again (and again) at school or from their friends or siblings. Strep can also live on surfaces for days — including your child’s toothbrush. 

4. Strep carrier status

Your child — or a person they’re in close contact with — could also be a “strep carrier,” or someone who has GAS bacteria in their oral cavity all the time but doesn’t have symptoms. If your child catches the infection from a strep carrier who isn’t sick, you won’t know where the illness came from.   

If your child is a strep carrier themselves, they’ll always test positive for strep — even when they have a sore throat caused by a virus or when they’re not sick at all. 

Resolving recurrent strep throat 

Ensuring your child takes their entire course of antibiotics is the first step in preventing recurrent strep. If strep recurs after non-penicillin antibiotics, your child may need a different medication to kill the infection.    

You can further reduce your child’s risk of recurrent strep by:

• Promoting good infection control habits (i.e., proper hand washing)
• Cleaning shared surfaces thoroughly to kill off lingering bacteria
• Providing a new toothbrush before the end of antibiotic treatment
• Avoiding close contact with sick people; staying home when sick

Sometimes, we may also recommend testing your child for strep when they’re well to determine if they’re a strep carrier.

The bottom line? Recurrent strep isn’t usually a sign that something’s wrong with your child’s immune system, and unless they get strep many times a year, a tonsillectomy (tonsil removal) isn’t typically recommended.  

For help with recurrent strep, call or click online to schedule a visit at The Center for Advanced Pediatrics in Norwalk or Darien, Connecticut, today.