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People who still have their tonsils often get swollen tonsils when they have strep throat. There might not be any other redness and "oozing" except from the tonsils when there is strep. However, there is nothing about having your tonsils taken out that keeps you from ever getting strep again.

Streptococcus A bacteria are usually classed as suppurative and not suppurative, causing an "ooze" or not. The suppurative step bacteria can manifest as:

  • Tonsillitis,
  • Sore throat,
  • Impetigo (skin lesions that have an exudate that dries to a honey-brown crust),
  • Pneumonia,
  • Ear infections,
  • Sinus infections,
  • Brain infections (meningitis),
  • Bone infections (osteomyelitis),
  • Cellulitis (a severe skin infection), and
  • Necrotizing fasciitis (flesh-eating bacteria).

Non-suppurative step bacteria cause diseases like scarlet fever (which used to be a common cause of rheumatic heart disease), rheumatic fever, and acute glomerulonephritis (kidney disease).

The definitive test for strep throat (as people who get treatment for strep infections know) is a throat swab. This method detects not just active cases but also people who are carriers for the disease but don't have symptoms themselves. (Even if you live with a carrier, you aren't like to pick up the disease unless you have a serious challenge to your own immune system, for example, you have to go on chemotherapy or you get some other serious infection.) If you have strep throat, even if you feel OK, you need a full course of antibiotics, taking all the antibiotics your doctor prescribes, to keep from spreading the infection to others. If you are sick with strep, you need to take the full 10 days of antibiotics your doctor prescribes even if you feel better in three or four days, so you don't leave only the "baddest bugs" behind to multiply and come back with even worse symptoms.

If having your tonsils taken out does not guarantee that you will never, ever have a strep throat again, why have the procedure?

Tonsillectomy results in about two fewer cases of serious strep throat for about two years. Then there are few or no lasting benefits.
Often the procedure is more of a relief for parents than for the children who have it. Parents are just so tired of seeing their children sick that they are ready for a break. The surgery gives them one. It's not very pleasant for the child.

The problem is that tonsils themselves perform a role in the immune system. The tonsils host white blood cells known as M cells. These cells capture proteins on the surfaces of germs and deliver them to B and T cells that will launch at attack on the infection. The tonsils can also make their own T cells to fight infection.

In children, the tonsils are relative large in relation to the diameter of the throat. They can interfere with speech and swallowing, especially when they are inflamed. The tonsils continue to grow until just before puberty, but the throat grows faster. After puberty, the tonsils largely atrophy, although they can make their presence known by strep infections and smelly tonsil stones even in old age.

Although seeing a child deal with strep infections over and over again is distressing for parents (and for the child!), the reality is that most kids grow out of tonsillitis. If they can avoid serious complications until about age 13, then they almost certainly will have fewer and fewer problems with strep as they get older. And there are some simple interventions that can make any case of strep easier to manage that your doctor probably won't remember to share with you:

  • Change your toothbrush (or your child's toothbrush) after you (or they) have been on antibiotics for a few days. This is a way to avoid reinfecting the throat with strep.
  • Wash hands before touching face, especially when there is impetigo.
  • Never "guess" an infection is strep. Always have a throat culture done to make sure, so the doctor can prescribe antibiotics that work.
  • Always finish antibiotics! This one step will do more than any other to keep former strep sufferers strep-free.

 

 

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