You're no stranger to the discomfort of a sore throat, right? What you might be unfamiliar with, though, is strep throat- an infection that attacks your throat and tonsils, provoked by the rather unwelcome group A Streptococcus bacteria. The CDC estimates that over 5.2 million outpatient visits are related to strep throat every year. 

The upside? Despite its potential to trigger serious complications, timely medical attention can usually nip it in the bud. Unfortunately for some, recurrent infection can become an issue, leading to multiple episodes of strep throat. 

In this article, we will discuss what strep throat is, the potential causes for recurrence, and how integrative modalities can help prevent future infections. 

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What is Strep Throat?

Strep throat, an ailment many of us might encounter, is an infection that primarily affects your throat and tonsils. This condition arises from an unwelcome visitor known as group A Streptococcus bacteria, a strain notorious for causing inflammation around your tonsils, leading to a severe sore throat, also known as pharyngitis. It's important to note that while uncommon, strep throat has the potential to instigate more severe illnesses like rheumatic fever, a condition that could harm your heart and heart valves. However, with prompt medical intervention, you can expect a full recovery from strep throat within seven to ten days. 

Strep Throat Symptoms

Strep throat presents a distinct set of symptoms and visual signs. A sudden, severe sore throat is often the first indicator, closely followed by a swift rise in fever. Other accompanying symptoms may include (3,4): 

• Chills
• Headache
• Loss of appetite
• Abdominal pain
• Nausea
• Vomiting

Interestingly, a cough isn't a common symptom of strep throat. If you're experiencing a cough along with cold-like symptoms, it might signal a viral infection, not strep throat (3,4).

Upon examining the mouth, you may notice a red, swollen throat and tonsils, possibly covered with white patches or pus streaks. You may also see tiny red spots, known as petechiae, on the roof of your mouth. In certain cases, a rash named scarlet fever may develop, beginning on your neck and chest and potentially spreading to other body parts (3,4).

Strep throat is generally mild but can be very uncomfortable. Your throat might feel extremely sore, swallowing could be painful, and your neck's lymph nodes might be swollen and tender. If a rash develops, it may feel rough, like sandpaper (3,4).

However, some individuals with strep throat may show no symptoms, yet they can still spread the infection. This is why immediate treatment for symptomatic individuals is crucial to prevent serious complications like rheumatic fever, which could result in permanent heart damage, or post-streptococcal glomerulonephritis, a kidney condition. Furthermore, untreated strep throat could lead to sinus and ear infections or abscesses on or around the tonsils (3,4).

Is Strep Throat Contagious?

Yes! Strep throat is indeed a contagious disease, transmitted predominantly through respiratory droplets or by direct contact with someone infected. The bacteria thrive in the nasal passageways and throat. Thus, activities such as coughing, sneezing, talking, or sharing personal items like cups and utensils can propagate the infection. It's important to note that even those without symptoms can spread the disease, but individuals showing symptoms are usually more contagious, making places like schools, daycare centers, and military training facilities hotspots for strep throat transmission (3,4).

How Long Does Strep Throat Last?

The duration of strep throat can vary, but with appropriate antibiotic treatment, most individuals start to experience improvement within a day or two. It's important to note that while initial relief might come swiftly, complete resolution of symptoms usually takes between seven to ten days from the commencement of treatment (3,4).

Why Do Some People Get Recurrent Strep?

The repetitive occurrence of strep throat, predominantly in children, has often confounded medical professionals. This common pediatric ailment is due to Group A Streptococcus (GAS) bacteria, but what makes some individuals, especially kids, more susceptible to repeated infections is an intriguing question.

Research points to two key factors that might clarify why certain individuals are more likely to experience recurrent strep throat:

Tonsil-Related Factors 

The tonsils, soft tissue masses located at the rear of the throat, often serve as the primary site for GAS bacteria propagation. Studies suggest that children prone to recurrent strep throat frequently show a higher concentration of GAS bacteria in their tonsils, even when they are not actively sick (6,7).

Immune Response 

The individual's immune response to GAS bacteria also plays a significant role. Some individuals may not mount a robust immune response, allowing the bacteria to persist. According to research, these people may lack sufficient production of antibodies against streptolysin O, a toxin produced by GAS bacteria, thereby reducing their ability to clear the infection effectively (6,7).

In a nutshell, the likelihood of recurrent strep throat in some individuals can be attributed to a combination of immunological factors associated with tonsils and specific genetic elements. These insights can be beneficial for devising personalized treatment plans, including potential vaccines and predictive indicators.

How is Strep Throat Diagnosed?

The diagnosis of strep throat primarily involves a clinical evaluation and testing. A healthcare professional will assess the symptoms, conduct a physical examination, and potentially swab the patient's throat to test for strep throat. Two primary tests are utilized for this diagnosis: a rapid strep test and a throat culture.

In a rapid strep test, a swab from the throat is analyzed. This test can quickly determine if group A strep bacteria, which are typically responsible for strep throat, are causing the illness. If the test returns positive, doctors can immediately prescribe antibiotics for treatment. However, if the test is negative and the doctor still suspects strep throat, a throat culture swab can be taken for further examination.

A throat culture requires a bit more time as it allows for any group A strep bacteria present on the swab to grow. Despite being more time-consuming, a throat culture may sometimes identify infections that the rapid strep test misses. This procedure is particularly important in children and teens, as they can develop rheumatic fever from an untreated strep throat infection. For adults, it is typically not necessary to do a throat culture following a negative rapid strep test since they are generally not at risk of getting rheumatic fever from a strep throat infection (8). 

Functional Medicine Labs That Can Help Individualize Treatment for Patients Who Get Recurrent Strep Throat 

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

ASO Titer Test

The ASO titer test measures antibodies produced by your body in response to a toxin known as streptolysin O, which is produced by group A Streptococcus (GAS) bacteria. Antistreptolysin antibodies can be detected in your blood by using the ASO titer test to determine if you recently had a strep infection. It is important to note, however, that it is not used to diagnose a current strep infection. This test is also ordered when symptoms of post-streptococcal complications such as bacterial infections, glomerulonephritis, and rheumatic fever occur (3).

Stool Testing

The Diagnostic Solutions GI-MAP test can be a valuable tool for understanding a patient's gut health. This test provides comprehensive insights into the microbial balance in the gastrointestinal tract, which plays a crucial role in overall health and immune function. In the case of recurrent strep throat, the data from the GI-MAP can shed light on potential dysbiosis or imbalances in the gut microbiome that may be weakening the immune response to strep bacteria.

Micronutrient Testing

The SpectraCell Micronutrient Test assesses the body's levels of vitamins, minerals, antioxidants, and other essential micronutrients within the white blood cells. This information can be important for those with recurrent strep throat, as deficiencies in specific micronutrients may compromise the immune system's ability to fight off and recover from infections.

Sleep and Stress Panel

The Ayumetrix Sleep and Stress Panel measures levels of cortisol, melatonin, and other key hormones associated with sleep and stress. Sleep quality and stress levels can significantly impact the body's ability to respond to infections like strep throat (14). 

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Conventional Treatment Options for Recurrent Strep Throat 

When someone keeps getting strep throat, doctors usually do another test for the bacteria causing it and typically prescribe another round of antibiotics. The type of antibiotics used can vary depending on the patient's past health history. If a person frequently suffers from severe strep throat even after taking proper medicines, a tonsillectomy may be indicated. This decision depends on many factors, such as the patient's age, how often they get strep throat, the seriousness of their infections, and their previous use of antibiotics (16,17). 

Integrative Medicine Treatment For Recurrent Strep Throat

Integrative medicine combines conventional medical treatment with complementary therapies. Treatment strategies may include dietary changes, immune-supportive supplements, and lifestyle modifications. This approach aims to address the underlying factors contributing to recurrent strep throat and enhance the body's natural defense mechanisms for long-term prevention and management.

The Importance of Immune System Support For Recurrent Strep Throat

As discussed above, a weakened immune system can contribute to recurrent strep. Therefore, focusing on building a robust immune response is an important factor in warding off future infections. Through a functional medicine lens, nutrition, sleep, stress, and your microbiome play important roles in supporting your immune system. 

Nutrition For Immune System Support

Nutrition plays a significant role in boosting the immune system and supporting a healthy gut microbiome. An optimal diet is anti-inflammatory, nutrient-dense, and high in fiber, exemplified by the Mediterranean Diet. This diet comprises mainly plant-based foods like fruits, vegetables, herbs, legumes, beans, and whole grains, with moderate amounts of poultry, seafood, eggs, and dairy. A key focus is on high-fiber plant foods and healthy fats, primarily olive oil. This eating style promotes a robust immune system by reducing inflammation and stimulating immune cells. Certain nutrients, including vitamins C and D, zinc, selenium, iron, and protein, are integral in preparing the body against microbial attacks and inflammation. These nutrients can be found in a low-processed, high-fiber, plant-rich, and prebiotic/probiotic-rich diet. Probiotic foods also help maintain a balanced microbiome, and options include kefir, yogurt, fermented vegetables, and kombucha tea. 

Supplements and Herbs For Immune System Support

For patients interested in supplements and herbs, there are various evidence-based solutions that may help improve immune response.

Vitamin D For Immune System Support

Vitamin D plays a pivotal role in supporting our immune system. Its deficiency can increase susceptibility to infections and autoimmunity. Supplementing with vitamin D, particularly in deficient individuals, may provide significant immune benefits.

Dose: 1,000-5,000 IU (as D3) per day, 20,000-40,000 IU per week

Duration: As deficiency continues

Probiotics For Immune System Support

Probiotics support the restoration and balance of the microbiome, reducing inflammation and boosting immune function by stimulating the production of specific immune cells (12). 

Dose: 10-20 billion CFUs per day for adults

Duration: Ongoing

Supplements And Herbs With Potential Antimicrobial Properties

Some supplements and herbs with potential antimicrobial properties include:

Garlic

Garlic is an herb commonly used for cooking, but it also has antimicrobial properties. It contains allicin, which has been shown to have antibacterial, antiviral, and antifungal properties (24). 

Turmeric 

Turmeric is a spice commonly used in Indian cuisine. It contains curcumin, which has been shown to have antimicrobial properties against a variety of bacteria, viruses, and fungi (24).  

Ginger 

Ginger has been reported to have weak fungicidal and strong antibacterial properties (12,24). 

Cinnamon

Cinnamon is a spice that has been shown to have antimicrobial properties against a variety of bacteria, viruses, and fungi. It contains cinnamaldehyde, which has been shown to have antibacterial and antifungal properties (24).

Stress Management And Sleep Hygiene For Immune Support

Sleep, our body's natural restorative mechanism, has a significant influence on our immune functions. During nocturnal sleep, there's a spike in certain immune parameters, such as the numbers of undifferentiated naïve T cells and the production of pro-inflammatory cytokines. Conversely, during periods of daytime wakefulness, circulating numbers of immune cells with immediate effector functions, like cytotoxic natural killer cells, and anti-inflammatory cytokine activity peak. In addition, sleep also plays a critical role in forming immunological memory, which enhances our body's defenses. Maintaining a regular bedtime and decreasing blue light from electronics at least 1 hour before bedtime can help ensure a restful night's sleep (31).

On the other hand, stress can adversely impact our immune system, with chronic stress suppressing our immunity. Chronic stress can reduce the number of vital immune cells in our body, leading to potential health issues. Evidence shows that slow breathing, where the exhale is extended, can prompt a relaxation response, effectively lowering stress. 

Therefore, managing stress and ensuring good sleep hygiene are essential for optimal immune support.

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Summary

To sum it up, recurring strep throat is a bacterial infection that primarily affects your throat and tonsils, instigated by group A Streptococcus bacteria. Though it can cause serious complications, prompt medical attention can usually solve the problem. However, for some people, recurrent strep throat becomes an issue. Integrative treatment focuses on combining conventional treatments with changes in lifestyle and diet, focusing on supporting the immune system to prevent further recurrence.