The lump IS my throat...

July 31, 2006 5:46 PM

Doctor at the clinic said I don't have strep throat, but I'm not convinced. What else could this be? Should I take antibiotics? Other ways to fight strep?

He said I don't have the lesions (or whatever) on the throat or tonsils that go with strep. The reason I'm not convinced is I used to get strep all the time as a kid and this feels pretty familiar, and I'm pretty susceptible to bacterial infections.

Is it possible for absence of the lesions (or whatever) on the throat and tonsils to give a false negative, especially if you've got the other symptoms (swollen neck, fever, headache, earache, excruciating pain swallowing)? In retrospect I should've insisted on a swab.

He prescribed me antibiotics anyway (very strange, I know) - should I take them?

What else could this be if not strep?

Other things to do short of antibiotics?

Thanks for reading...

posted by poweredbybeard to health & fitness (21 answers total)

I had annual tonsil infections all through my childhood that were treated with antibiotics. I've also had viral infections that clear up on their own. They feel the same at the beginning, but if the pain keeps getting worse, in my experience that means it's bacterial. The viral infections seem to plateau at a level of pain that is treatable with ice cream and extra strength painkillers, while the bacterial infections eventually dominate your every waking thought if they go untreated.

I've heard gargling salt water is supposed to help bacterial infections, but I don't know its efficacy.

Unless he's an incompetent doctor, he must have had a good reason to not even swab. I'll leave it to our resident metadoctors to explain the perils of antibiotic overuse.
posted by cardboard at 6:02 PM on July 31, 2006

I've had the same thing happen - went in with what I was sure was strep, doc said no but did the culture anyway. I was right.

I guess it could be a viral infection - and yes, gargling with salt water is supposed to help the pain. I would say if it still feels like strep in 24 hours, insist on the swab.
posted by bibbit at 6:10 PM on July 31, 2006

This sounds exactly like when I had mono - have you been tested for that? (When i went in with those symptoms, almost exactly as you describe, the strep test came back negative and they only reluctantly did a mono test.)

What helped most with the swallowing difficulty was 4 advil every 6 hours - as recommended by the nurse. Oh, and lots of Jello and puffy cheetos.
posted by whatzit at 6:14 PM on July 31, 2006

Both times I've had peritonsillar abscess, I had strep symptoms with a negative strep test. Both times doctors refused to give me antibiotics (fears of bacterial evolution), and things got much much worse. Do you have any weird bulges on the roof of your mouth, back by the tonsil? My infection was enclosed in a pocket next to my tonsil (hence the bulges). Visual inspection AND even a swab could not detect it. If I had not gotten second opinions; finally taken antibiotics (and actually a steroid to decrease the swelling); they would have had to take out my tonsils.

I don't mean to freak you out (IANAD duh), and I have super-bad luck with misdiagnoses, but honestly I wish someone had given me antibiotics sooner.
posted by unknowncommand at 6:19 PM on July 31, 2006

I'm with whatzit -- the beginning symptoms of infectious mononucleosis are, or at least can be, identical to streptococcus. So identical, in fact, that my doctor told me "I am 99.9% sure that what you have is strep throat, but I'm sending it off to test for mono just in case."
posted by CrayDrygu at 6:21 PM on July 31, 2006

Recently, I thought I had strep and it was actually an ear infection. I had all the "usual" things I associate with strep (lots of pain swallowing, throat glands*, the grumpyness of being sick etc).

Have some tea with lemon and honey, or gingerroot and honey. Ginger root is quite strong, so use lots of honey. It's what stage performers use for sore throats (or so I'm told) and I find it works wonders. I also find that a cool towel around the back of my neck and resting where my throat hurts helps.

Secconding bibbit on going back if things don't change.

Feel better soon!

*Throat glands: when you feel the outside of your neck, just under your chin. When I get sick, that area puffs out and feels different. It's what ma always checked when I was sick... (IANAD, but She was a Nurse)
posted by cathoo at 6:25 PM on July 31, 2006

I didn't read all your symptoms that closely the first time. Don't let what I wrote make you think you shouldn't see another doctor if this is serious. It sounds like the clinic doctor didn't give you any diagnosis at all. Scratch incompetent and maybe insert "rushed".
posted by cardboard at 6:27 PM on July 31, 2006

Unless he's an incompetent doctor, he must have had a good reason to not even swab.

Probably. But he seemed pretty disinterested. And he said I should be taking things to fight the infection. When I asked him what those things might be, he said Tylenol or Advil. Now, I know Tylenol can bring down a fever, and that Advil can reduce swelling - but they don't fight infections. I was pretty unimpressed.

What helped most with the swallowing difficulty was 4 advil every 6 hours - as recommended by the nurse.

4 advils? The bottle sez 2. Does the analgesic effect last for longer if you take more of them?
posted by poweredbybeard at 6:28 PM on July 31, 2006

Oh and thanks for the answers so far, all.
posted by poweredbybeard at 6:34 PM on July 31, 2006

4 advise? The bottle sez 2. Does the analgesic effect last for longer if you take more of them?

Ibuprofen is typically dosed at 400mg per 4-6 hours, other applications, such as excruciating pain from a root canal or symptoms you're describing, you can up it safely to 800mg. I've seen people take much more then 800mg.

I heard that there's a military ibuprofen pull lovingly refereed to as ranger candy that is a 400mg or 800mg dose. IANAD, but I wouldn't suggest max dosage for a long time, could play hell on kidneys/liver.
posted by gregschoen at 7:12 PM on July 31, 2006

And, FWIW, in the cause of not promoting superbugs, whatever you do with other drugs, if you are prescribed with antibiotics:

Take them precisely in accordance with the prescription; do not skip any; do not stop short.

This message brought to you by my best friend's mom who is effectively ABD for an MD. (She's taught microbiology for almost 30 years.)
posted by baylink at 7:17 PM on July 31, 2006

Take them precisely in accordance with the prescription; do not skip any; do not stop short.

Ditto.

The main problem with people taking antibiotics, is not really them taking them, but rather stopping when they feel better.

This kills off all the weak bugs, and the stronger ones gain an immunity, thus antibiotic resistant bacteria.
posted by gregschoen at 7:23 PM on July 31, 2006

I've had strep throat infections a few times and IME it's best to start antibiotics ASAP. In a couple of my cases the quick while-you-wait culture came back negative and the 24 hour one came back positive. By that time the bacteria had an extra day to take hold.



One time the culture came back positive for staph! That was a nightmare. It felt like a dozen razor blades were twirling around in my throat. Motrin couldn't relieve that pain at all.


I vote for taking the antibiotics.
posted by Soda-Da at 7:57 PM on July 31, 2006

The worst sore throat of my life was the four days before I was diagnosed with mono. Far, far worse than strep throat pain. However, the back of my throat was coated with white gunk. The doctor took one look in my mouth and ordered a mono test. The sore throat went away very quickly - the mono stayed for three more weeks.

If I were in your position, I would ask for the swab and a mono test. Don't take antibiotics that you might not need, especially if, as you say, you get a lot of bacterial infections.
posted by peep at 8:53 PM on July 31, 2006

How weird -- I thought you might be my friend (that I took to the Urgent Care center this am). He also thought he might have strep throat. Turns out he has probable gonorrhea. So that *might* be an option (not to induce paranoia).
posted by Bear at 9:36 PM on July 31, 2006

I have had strep throat a number of times, once in combination with mono. That was fun, except exactly the opposite.

I know when I have strep - there's a funny taste in my mouth, and my body does the exact same thing every time, even if I don't get the tonsil lesions. If I were in your position, I would go back and insist on a swab. Every doctor I have ever seen when I had those symptoms did a swab even if they were already 100% positive it was strep (due to lesions + other symptoms). It's best to get one, even if it's just to rule it out.

Also, several doctors have told me that you can take up to 3200mg of Advil per day safely. That amounts to 4 200mg advil every 6 hours. You could do it as 2x200mg every 3 instead, if the pain is bad and you'd rather have a constant flow of ibuprofen to kill it.
posted by bedhead at 10:16 PM on July 31, 2006

I 4th/5th the mono test. I had the exact same thing, and it turned out to be mono. I was a little surprised, because I didn't have the extreme fatigue at all, but apparently that's not uncommon.
posted by equalpants at 10:52 PM on July 31, 2006

Do only Americans get strep throat? Seriously - never heard of it as a condition in Europe and some of the treatment suggested above sounds as if it is just for what we'd call a sore throat, and an other sounds like it is for more serious conditions like glandular fever. Does strep throat really exist?
posted by A189Nut at 1:07 AM on August 1, 2006

Does strep throat really exist?

A quick look at the Wikipedia will tell you that strep throat is an infection of the pharynx by the bacterium Streptococcus pyogenes. An even quicker Google search will lead you to the Mayo Clinic, the National Institutes of Health (US), and the Centers for Disease Control (US).
posted by equalpants at 2:29 AM on August 1, 2006

OK, so my last answer wasn't very nice. Apologies. Nevertheless, this is an unanswerable question. You went to the doctor and got a prescription for antibiotics. If you think you have strep and you want to get rid of it fast take the drugs. The strip test for strep is not perfect. A throat culture will tell you but at this point by the time the results from that are in you will either have recovered or have severe strep and won't be needing some test result to tell you what to do. Bottom line, who are you going to listen to - your doctor who actually physically examined your throat, and who has a medical degree, or a bunch of quacks on the internets who never met you, never received a medical education and never examined your aching throat?
posted by caddis at 4:25 AM on August 1, 2006

Why don't you go to another clinic and get a second opinion from a doctor or nurse practitioner? And / Or call this doctor's office and question the prescription and diagnosis. I have to agree with caddis's answer above here (I didn't see the first one that must have gotten deleted or something).
posted by dog food sugar at 8:54 AM on August 1, 2006