To wonder why NHS GPs don't use dipstick test to test for strep throat?

[ArgosTheDog]

I get the impression that when you go to your NHS GP with a bad sore throat, they don't typically do a dipstick test for streptococcus ...why not? Wouldn't it make diagnosis (and prescription of ABs) easier and more exact?

Probably isn’t cost effective? Strep throat is fairly visually obvious in my experience. GP took one look at mine (this week) and prescribed antibiotics. Did a swab to send to the lab too, just to confirm.

What sort of a dipstick test?

I've only ever heard my American friends talk about strep throat.

Is it tonsillitis?

I had a swab taken for tonsillitis which took a week to come back. Obviously I was feeling better by then. Maybe they don’t do it because of the time it takes to get the result?

Presence of strep doesnt mean it has caused the sore throat. Most are viral. Too expensive and neither sensitive nor specific enough.

FeverPAIN score should be used to decide whether or not a sore throat would benefit from being treated with an antibiotic or not.
Most sore throats, wether bacterial or not, improved without antibiotics after about a week, so symptoms/signs suggesting systemic illness are needed to guide decision-making.

'Strep throat' is an Americanism and does not say anything about how severe the pain or the illness is. A rapid near-patient test is a. expensive and b. may well actually muddy the waters more, not less.

Are you a doctor ?

Are you American?

I’m in Canada and we have rapid strep tests (results in 15minutes) as well as the 48hour tests. The swab is taken as a matter of course when the patient complains about significant throat ache. Depending on the result, the Dr can then decide if/which ABs are appropriate.

I had strep throat. It was the worse pain (on par with labour) that I have experienced. Not one fucking dose of AB or Penicillin would clear it. 3 weeks I had that. Traumatised to this day.

Doctor DID do a swab, even the it was resistant to the AB's.

As you can see I'm rather bitter

@pigshavecurlytails

Presence of strep doesnt mean it has caused the sore throat. Most are viral. Too expensive and neither sensitive nor specific enough.

This is probably why AB or Penicillin didn't work for me. It was awful

Antibiotics shorten the length of strep throat by a grand old 16 hours on average. Tests cost between £1.28 and £3.46 each depending on brand and none of the ones looked at detected more than 90%.

Is it tonsillitis?

No.

I had strep throats and didn't get antibiotics (my own fault) and ended up with rheumatic fever. I had to have a heart scan. I've gone in to develop M.E. £3 for a test seems small in comparison to how much I've probably cost the NHS

Also agree with PP that it is the most pain and most unwell I have ever felt. Well, until I got necrotising fasciitis, that was pretty shitty too.

£3 for a test seems small in comparison to how much I've probably cost the NHS confused

But you're the extreme. The vast majority of sore throats are self limiting and/or viral. Thousands of people go to their GP about a sore throat every day.

A really important question to ask yourself before doing any test is what you're going to do if it's positive - if it won't change the management (usually give it a few days, if it gets worse/doesn't settle then ring for an antibiotic prescription) then there's no real point in doing it. As long as you give antibiotics within 9 days of symptoms starting, then it's preventing rheumatic fever. That test really won't change most doctors management.

I had Strep throat and Glandular fever at the same time. Now that was rubbish.

I'm not American. I'm not a doctor.

I have just experienced 2 bouts of tonsillitis in the last 12 months (having never had it before). On both occasions the tonsilitis was a strep A infection.

I had gone to a private GP who'd done a swab test there and then. The results were there in 5 mins.

However, from talking to my friends (some of whom have had tonsilitis repeatedly), it sounds like NHS GPs don't do this test. And some just routinely give ABs 'just in case'. Which obviously doesn't sound like a great idea in this day and age of AB resistance.

And yes, as I understand, you shouldn't really leave a streptococcus infection untreated for the reasons that a previous poster mentioned...it leaves you at a higher risk of getting rheumatic fever and possibly heart problems.

They do a fingerprick CRP test here (Finland) as a matter of course for sore throats (or any other infection signs) and a high level usually indicates bacterial infection so antibiotics are prescribed then, if it's viral the CRP shouldn't be raised. Often do a swab too though.

@Welshmaenad I'm so sorry to hear what you've been through! Sounds horrid.

I left my extreme sore throat for several days earlier this year until my mum scared me into going to the dr because she'd heard that one shouldn't leave a bad sore throat unexamined/untreated because of the risk of complications if that sore throat was caused by strep.

PPs who talk about a swab test being sent to the lab are not talking about the same test that I'm talking about.
In the test that I'm talking about the result is there within 5 mins....if it shows 2 lines then it's positive (a bit like a pregnancy test!)

When pp's doctors send swabs off to the lab this may be to test for resistance to ABs.

I suffer from recurrent UTIs and my de is meticulous about getting me to do a sample and sending this off to the lab to see which ABs the bacteria may be resistant to. The results for this do take a few days.

I don’t understand why the NHS at GP level takes such a tech phobic approach, and/or is frightened of going down the copayment route. If a patient presents with a possible bacterial infection, why not ask if they would like to pay £2 for a reasonably accurate diagnostic test? I would happily pay a lot more than a cheap cappuccino to feel better faster if I am unwell. Also if early antibiotic prescription even saves 0.05% of admissions for sepsis, surely the net cost would be close to zero.

I am an extreme case and I'm not suggesting it for everyone who presents with a slight irritation but those who present with clearly severe pain. It would prevent the needless prescribing of antibiotics for one thing. Which was why I didn't go to the doctor when I was first unwell, because I was hyper aware of not being an ABX seeking annoyance. By the time I'd been ill for 9 days I couldn't have got to the surgery, I'd have needed a home visit (and didn't ring for one because I didn't want to waste nhs resources).

Some people carry strep anyway, but that may not be the cause of yhe sore throat. Do people go to GPs with a sore throat?

Wouldn't it make diagnosis (and prescription of ABs) easier and more exact?

even if the infection is bacterial, it doesn't mean it needs antibiotics to treat. our bodies are amazing at fighting infection, bacterial and viral.

Strep has become less aggressive and that is why the incidence of rheumatic fever has gone down, not just because of use of antibiotics.

I don't think that not using this particular technology is 'tech phobic' - CRP sticks would be useful (although viral illness can also give very high CRPs but it gives an indication of systemic involvement of the infection).