Strep and/or Pharyngitis
April 15, 2006 10:46 PM   Subscribe

Strep throat and/or pharyngitis question: I'm in Nepal in the midst of an uprising and I've been fighting off a throat thing for months. It's difficult to go see an ENT specialist during a general strike, so I thought maybe someone could give me some medical advice. More inside.

Starting in January, I had what I thought was a case of strep throat: red patches with pus inside my throat, swollen lymph nodes in my neck, malaise. I took a course of azithromycin since I'm allergic to penicillan, and it seemed to knock it back, but then it came back a couple of weeks later. I tried azithro again, but it didn't seem to do any good. It sort of went away on it's on, but then came back yet again. This time I went to the main travel clinic here and they performed a strep test which was negative. I was prescribed Keflex under the assumption that it was indeed strep, but the previous course of antibiotics masked the results. Keflex was ineffective, and I returned @ a week later. This time, it was a different doc, and she thought that it was either allergies or due to the pollution here in the Katmandu Valley or a combination of both and gave me an antihistimine that didn't do boo. The red patch had cleared up, but there were little white nodules on my phranyx that the doctor said was causing the throat pain.
Finally, once the general strikes started, and the red patch on the left side of my throat came back, and the little tiny nodules on my phranyx have never gone away. I am in the midst of a course of erythromycin since I have access to a pharmacy, but no access to a decent clinic. It doesn't seem to be effective, but I'm going to finish out the suggested 10 -day course. Now my mouth feels raw and my palate feels somewhat scalded.

Should I insist on getting a throat culture done? They refused to do this since the strep tests were negative. Does anyone have any suggestions? I'm baffled, and not supersick, but I am tired and my throat feels raw constantly. I'd like to stick it out here in KTM for research reasons, but I can also go to Bangkok briefly for medical treatment. Any advice would be greatly appreciated.
posted by AArtaud to Health & Fitness (7 answers total)
Cant you travel across the border into India for medical treatment? Its not that far, medical care in India actually really good and its much closer than Bangkok. Just a suggestion.
posted by special-k at 12:52 AM on April 16, 2006

Strep is usually quite susceptible to antibiotics, esp. azithro. On average, in the absence of fever or significant malaise, it's doubtful strep is still a factor. The overwhelming majority of pharyngeal discomfort is not strep, and if it is infectious, is viral.

Local irritants, i.e. from pollution, woodsmoke, animal dander, etc. are possible and likely factors. If you smoke, you have practically guaranteed that whatever this is will have a difficult time clearing up, so stop.

Infectious sources typically are not chronic. Continuing to throw antibiotics at this, in the absence of a true source, also risks a bout of C. Diff Colitis.
Another consideration is Thrush, i.e. oropharyngeal candidiasis. Typically the tongue, throat, and lower pharynx is inflamed and swallowing is painful. Your local UC can treat this if it's suspected, and there's little risk to an errant course of clotrimazole lozenges. Finally, in rare cases sinusitis could be a cause, and the drainage is irritating the throat without producing a sense of sinus plugging or pressure.

You absolutely should insist on a throat culture. A rapid strep is simply a quick assay for strains of Group-A beta-hemolytic strep, and nothing else. Not other strep varieties (although some will show this), and certainly not yeast or other bacteria. Viruses will not be cultured, of course. But there is useful info to be gained there, certainly.

The more esoteric differential is long - reflux, allergies, etc. and would probably necessitate an ENT consult where they can scope the nasal/sinus passages and pharyngeal tissues.

Best of luck.
posted by docpops at 7:55 AM on April 16, 2006

Strep infections tend to be self limited and last only a few days. The reason to treat strep is to avoid the complication of rheumatic heart disease that can result if strep runs completely amok.

Other possible causes of long term sore throat include but are not limited to:
  • GERD: reflux of stomach acid at night can cause sore throat in the morning and coughing particularly at night
  • Allergic rhinitis: drainage of mucus down the throat can cause a great deal of irritation
  • environmental irritants: if there are fires burning and the air is this with smoke or other pollutants, these alone can cause the lining of the throat to be irritated
All that said, it's important to see a physician. The need for a throat culture would be reflected by physical findings suggestive of infection (ie. bright red mucosa, purulent drainage, enlarged lymph glands) and the judgement of the clinician.

Seeing a physician is kindof unavoidable for a definitive diagnosis.
posted by shagoth at 8:09 AM on April 16, 2006

I'll throw in nutritional: do you take a multivitamin?
posted by gramcracker at 8:44 AM on April 16, 2006

iiNad ...
For months I was _sure_ I was really getting sick: allergic rhinitis was my personal scourge, until it was pointed out to me that it was easily controlled with claritin. Now one claritin per day and I'm fine. You might try that as a low-cost interim experimental measure.
posted by anadem at 7:16 PM on April 16, 2006

Thanks for the detailed responses. I suspect now that it might be allergic rhinitis aggravated by the pollution in the valley. It's always dry here in the winter but this winter was recordbreaking in the aridity.

I'll have to go to Bangkok for examination and treatment, and it seems that Zyrtec alleviates some of the throat pain, and I was hesitant to try that at first. I am unable to move around the Valley or the country for that matter due to general strikes so India is out unless I fly there. Thanks again.
posted by AArtaud at 1:22 AM on April 17, 2006

Try calling CIWEC in KTM to see if they can advise, they normally give advice over the phone if they currently have staff in (Tel 4424111). There are currently some taxis and rickshaws running so if they are open you might try going there first before booking a trip to Bangkok.
posted by MrC at 3:49 AM on April 17, 2006

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