Recurrent Strep Throat: What To Do When Strep Comes Back

There’s a specific dread that comes with swallowing and feeling that familiar razor blade sensation for the third time in four months. For most, strep throat is a one-and-done annoyance. For others, it becomes a relentless cycle.

At Advanced ENT & Allergy in Newport News, VA, Timothy Queen, MD, and Erica Cherry, FNP-BC, see many patients who struggle to evade strep throat for more than a few weeks.

Here’s what they tell patients who suffer from this familiar scenario.

Recognizing the signs of a strep infection

Strep throat is caused by a bacterium called Group A Streptococcus. When these bacteria invade the lining of your throat and tonsils, they cause significant inflammation.

Common symptoms include:

• Sudden and severe throat pain
• Pain when swallowing
• Fever higher than 101 degrees Fahrenheit
• Red and swollen tonsils, sometimes with white patches or streaks of pus
• Tiny red spots on the roof of the mouth
• Swollen lymph nodes in the front of the neck

Children and teenagers are the most likely groups to catch strep. It’s most common in kids ages 5 to 15. However, parents of school-aged children and adults who work in crowded settings, such as schools or daycare centers, are also at higher risk.

Why strep throat keeps coming back

When strep throat is recurrent, it means you have had several confirmed infections within a single year. There are a few reasons why this happens:

The initial round of antibiotics didn’t fully clear the bacteria

This can happen if a patient stops taking the medication too early because they feel better.

Re-exposure

The most common reason isn't a failure of the medicine, but the environment. If a family member, classmate, or close contact is an asymptomatic carrier, they can pass the bacteria back to you as soon as you finish your antibiotics. Approximately 15% to 20% of school-aged children are asymptomatic carriers, meaning they host the bacteria without ever feeling sick. 

Genetic or immune susceptibility

Some people are simply pre-programmed to be more susceptible to strep.

• Smaller germinal centers: Some children have smaller "germinal centers" in their tonsils—the areas where the immune system trains B-cells to fight specific invaders.
• Antibody deficiency: These individuals may produce fewer antibodies against SpeA (a toxin produced by strep), meaning their bodies don't "learn" to fight it off effectively, leading to repeat infections.
• Deep tonsil crypts: Tonsils aren't smooth; they have nooks and crannies called crypts. In some people, these crypts are deep enough to serve as hiding places for bacteria.

If you find yourself or your child taking antibiotics multiple times a year, it’s time to look at long-term solutions.

Solutions for chronic throat infections

We start by confirming that the infections are actually strep through a rapid test or a throat culture.

One often overlooked factor is allergies. Chronic nasal congestion and post-nasal drip from allergies can irritate the throat, making it easier for bacteria to take hold. We may recommend allergy testing to determine whether environmental triggers are making your throat more susceptible to infection.

When medical management and lifestyle changes aren’t enough, we might advise a tonsillectomy, a surgical procedure to remove the tonsils. 

We take a personalized approach to every patient. We want to make sure we are treating the root cause of your discomfort rather than just the symptoms.

To book a consultation at Advanced ENT & Allergy in Newport News, VA, call our practice or request an appointment online.