How Sore Throat Without Strep Could Still Be Serious

Sore throat may signal presence of F. necrophorum bacteria

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When a patient has a sore throat but not strep, doctors usually prescribe rest and lots of fluids. However, aching throats may warrant more serious medical attention.

A new study found that a significant number of patients with sore throat symptoms tested positive for F. necrophorum, a bacterial infection distinct from strep that can lead to health problems when untreated.

“These new data are interesting, but do not warrant reconsideration of [sore throat] guidelines,” wrote Jeffrey A. Linder, MD, FACP, of Brigham and Women’s Hospital in Boston, in an editorial about this study.

Dr. Linder suggested that, if a patient is infected with F. necrophorum, doctors should prescribe penicillin, a bacteria-fighting medication.

According to Deborah Gordon, MD, an integrative medicine specialist based in Ashland, Oregon, "Best practices suggest that a lab test to rule out strep is indicated if the person with a sore throat has a fever, swollen glands behind the angle of the jaw and absence of non-strep symptoms such as runny nose, cough or upset stomach. Fever and abdominal pain may be present with strep or other infections.

"Best wisdom reminds us that at our best we are able to heal ourselves from viral as well as strep and F. necrophorum infections. In addition to rest, I suggest patients avoid smoking (always!) and sugar, that they consume nourishing liquids such as bone broth or miso soup, and that they eat colorful fruits and vegetables, raw or cooked, to provide anti-oxidant reserves," said Dr. Gordon, who was not involved in this research.

"Zinc, better as lozenges or as capsules, at 10-50 mg a day will shorten the duration of the illness. Although controversial, extras such as high dose vitamin C, echinacea and supplement anti-oxidants have helped some people," she said. "And don't forget to keep taking extra good care of yourself for three days after you feel well: nothing worse than a relapse after you're back at your normal routine!"

According to the current study, led by Robert M. Centor, MD, of the University of Alabama in Birmingham, F. necrophorum can cause a sore throat, but doctors usually only test for strep when they take throat swab cultures. However, F. necrophorum sometimes causes dangerous inflammation and blood clots in the jugular vein. The jugular is a main blood vessel in the throat.

"Sore throats sometimes seem like the bread and butter of medical practice, with patients worrying, 'Is it strep?' and often hoping there will indeed be a magic bullet pill for their painful symptoms," said Dr. Gordon. "Dr. Centor's study highlights the central role of individual vitality in the natural course of illness. A bacteria of which I've never heard evidently lives in a fair number of our throats, and can become problematic if they grow in increasing numbers."

For this research, Dr. Centor and team studied more than 300 sore throat patients aged 15 to 30 years old. They also looked at nearly 200 patients without sore throats for comparison.

They tested each of the patients for three types of strep, pneumonia and F. necrophorum.

They found that 20 percent of the sore throat patients and 9.4 percent of the patients without symptoms had F. necrophorum bacteria present. The bacteria was more common among all patients than strep or pneumonia.

Dr. Centor and team concluded that F. necrophorum, which has similar symptoms to strep, may be just as common as strep.

However, the presence of the bacteria itself is not necessarily cause for alarm. Dr. Linder wrote in his editorial that F. necrophorum is also naturally present in the body.

Dr. Linder wrote that doctors should further test patients who have a fever, a cough and swollen lymph nodes.

The study and editorial were published Feb. 16 in the Annals of Internal Medicine.

The University of Alabama at Birmingham and the Justin E. Rodgers Foundation funded this research. Dr. Centor and team disclosed no conflicts of interest.

Review Date: 
February 13, 2015
Last Updated:
February 17, 2015