Why may children repeatedly contract strep throat?

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GAS is the most common bacterial cause of acute sore throat, which doctors call pharyngitis.

According to the Centers for Disease Control and Prevention (CDC), GAS is responsible for around 20–30% of sore throats in children, in comparison with around 5–15% of sore throats in adults.

Group A streptococcal throat infections are more common among school-aged children and individuals directly related to them. They rarely occur in children younger than 3 years of age.

Some children may experience multiple episodes of being unwell relating to a positive strep throat test. These episodes of sore throat may be due to recurrent GAS infections or repeated viral infections. Children with viral infections that cause a sore throat who repeatedly test positive for strep throat may be carriers of strep rather than having recurring strep throat infections.

Causes

Some potential causes of recurrent strep throat and its associated complications include those below.

Immunological differences

A 2019 study investigated factors that may contribute to GAS-induced recurrent tonsillitis (GAS-RT) in children. The researchers examined tonsil samples from children aged 5 to 18 years who underwent tonsil removal due to GAS-RT or other medical reasons. They found that tonsil samples from children with GAS-RT had the following characteristics:

• Fewer certain immune cells: The tonsil samples contained fewer antibody-producing immune cells. Antibodies help fight bacteria and viruses.
• Antibody impairment: The samples showed impaired development of the antibodies that target GAS.
• Smaller germinal centers: The lymphoid tissues contained fewer germinal centers. These are sites where immune cells develop their defenses against specific pathogens, thereby helping protect against infections.
• Gene variants: Samples showed the presence of gene variants that alter the body’s immune response to GAS.

The CDC notes that an individual can also be a carrier of GAS, meaning they may test positive for strep throat without displaying any symptoms.

Being a carrier can also make it difficult for doctors to determine the cause of a person’s sore throat. This is because a carrier may test positive for strep throat even if their symptoms are due to a viral infection. A positive test result may encourage doctors to prescribe antibiotics. However, since these medications are not effective against viruses, the person may experience a persistent or recurrent sore throat.

GAS bacteria are highly contagious. People may transmit them through direct contact with others or through respiratory droplets when talking, coughing, or sneezing.

A person may develop symptoms of strep throat within 2–5 days of exposure to GAS.

Strep throat is generally a mild disease. Symptoms commonly include:

• fever
• sore throat
• pain when swallowing
• red, swollen tonsils
• white patches or pus on the tonsils
• tiny red spots, which are known as petechiae, on the roof of the mouth
• tender or swollen lymph nodes in the front of the neck

Children may develop additional symptoms, such as:

• skin rash
• headache
• stomach pain
• nausea
• vomiting

Some people with strep throat do not show any symptoms. However, those with symptoms are more contagious than those without symptoms.

Children with strep throat require antibiotic treatment. According to the CDC, antibiotics can help:

• reduce symptoms
• speed up recovery time
• prevent rheumatic fever and other complications in young children
• help prevent the spread of GAS
• prevention of rheumatic fever

A person should feel better within 1–2 days of starting antibiotic treatment.

The following people may have an increased risk of contracting strep throat:

• children between the ages of 5 and 15 years
• parents and caregivers of school-aged children
• people who spend time in crowded settings such as schools and day care centers

According to the United Kingdom’s National Health Service (NHS), the following hygiene practices can reduce a person’s risk of contracting or spreading the GAS bacteria that causes strep throat:

• using a tissue to catch coughs and sneezes
• properly disposing of used tissues
• washing the hands with soap and water for at least 20 seconds
• using an alcohol-based hand gel when handwashing is not possible
• keeping away from others when feeling unwell
• avoiding sharing the following items with people who are unwell:
  • cutlery and utensils
  • cups and glasses
  • bedlinen and towels

If a person has a diagnosis of strep throat, taking antibiotics can also help prevent the GAS bacteria from spreading to others.

Strep throat is an infection that occurs due to the bacteria group A Streptococcus. It is very common among children. Research suggests that certain immunological differences may make some children more susceptible to repeated infections.

Most children recover from strep throat without medical treatment, though antibiotics may be necessary for pharyngitis due to strep. These medications can help alleviate symptoms, speed up recovery time, and prevent transmission to others.

Good hygiene practices can reduce a person’s risk of contracting strep throat and spreading the infection to others. Examples include catching coughs and sneezes in a tissue, washing the hands thoroughly, and avoiding sharing personal items with people who are unwell.