As I wrote yesterday, making the diagnosis of strep is not so easy. There are many viruses that can give a mean sore throat – and some that even look worse than strep.

So, how do I approach a sore throat – especially in the online world?

First, I ask a lot of questions and run through the Centor Score that I mentioned yesterday.

The best-case scenario for making the diagnosis is that they get a high likelihood (50%) on the scoring algorithm AND have had direct contact with someone who has a confirmed case of strep.

If that’s the case, then I think it is reasonable to treat them with antibiotics.

But what if they only have a 25% chance of strep?

Well, I give them 3 options:

1. Treat this like a virus (which it most likely is). Drink a lot of water, get rest, take ibuprofen/acetaminophen as needed for pain/fever, gargle salt water, zinc lozenges, etc. I also think using a nasal saline rinse is pretty helpful at loosening up the mucus that tends to dry out the back of the throat.
2. Go in to the office or urgent care to get swabbed. They’ll be able to test and treat on the spot.
3. Order your own strep test kits online! Yes, you can order these online and have them available at home. Granted, if you aren’t trained or feel comfortable getting a sample, then maybe this isn’t for you. But it’s not a terribly difficult test to do. Then, if you have a positive test, you can call up the online doc (me) and we don’t have to worry about whether you are only 25% likely to have strep… you do have it! So we can treat it.

So, there you have it. Most sore throats are viral, but sometimes they are bacterial (strep), and it’s not always super easy to diagnose… especially without testing.

I hope that was helpful info!