Why Does My Strep Throat Keep Coming Back?

Strep throat is a common infection caused by group A Streptococcus (GAS) bacteria. It is a very contagious illness that causes a severe sore throat and a fever. Some people, especially kids, can get recurring strep throat infections.

This article explains why recurring strep throat occurs and treatment options.

Reasons for Recurring Strep Throat

Researchers have examined why some people are more prone to recurring strep throat infections. In one study, researchers examined why some people experience reinfection while others resist it. They examined tonsil samples from two groups and found those with recurring infections had:

• Smaller germinal centers (structure in lymph nodes that produce long-lived B cells)
• Reduced antibacterial antibodies (proteins made by the immune system to fight infection)
• An inefficient immune response to GAS

In addition, some people are carriers of GAS, also called colonization. Carriers are people who are asymptomatic but test positive for strep bacteria on a throat culture.

Treating Recurring Strep Throat

Treating recurring strep throat requires that a healthcare provider determine whether a person has an actual recurring infection or whether they are a GAS carrier. While both turn up a positive strep test, that is often where the similarities end.

True Recurrent Strep

A true recurrent strep infection has the following characteristics:

• Classic strep symptoms (sore throat, fever, tonsils that are red and swollen, swollen lymph nodes)
• Symptoms improve within one to two days of starting antibiotics
• A throat culture is negative when asymptomatic

In this case, antibiotics (penicillin or amoxicillin) are the standard course of treatment. However, sometimes a tonsillectomy (surgery to remove the tonsils) may be an option.

GAS Colonization

With GAS colonization, symptoms are atypical of strep throat and might include cough and congestion. In addition, symptoms don't improve with antibiotics, and the throat culture remains positive even in the absence of symptoms.

Often, when antibiotics are ineffective, it may indicate a viral infection rather than GAS reinfection. In that case, the illness generally runs its course. Carriers are less contagious than people with an active infection, although how contagious they are depends on the strain in which they are colonized.

Preventing Recurring Strep Throat

Preventing recurring infections is the same as how to prevent strep throat initially. Mainly that involves good hygiene practices, including:

• Washing your hands often for at least 20 seconds
• Covering your mouth and nose with a tissue or elbow when you cough or sneeze
• Using hand sanitizer when hand washing isn't possible
• Avoiding sharing cups and utensils

Recurring episodes most often occur in school-age children. Fortunately, they rarely occur over multiple years, probably because children develop some immunity and improve their hygiene as they get older, which decreases their likelihood of getting sick.

Summary

Recurring strep throat is when you get reinfected multiple times in one respiratory season (fall and winter). Some people tend to be more prone to developing frequent infections. Researchers have identified that those who get recurrent infections tend to have fewer antibodies and a less robust immune response to infection. Recurring strep throat infections are treated the same way as a primary infection. Antibiotics are the first-line treatment for strep throat. It is also possible for someone to be a GAS carrier and not be ill or symptomatic, which is not the same as recurring strep throat.

A Word From Verywell

If you're worried that recurring strep throat means you're doomed to have your tonsils removed, there's good news. Tonsillectomy is no longer standard practice for recurring infections—even as many as six infections in a year. Instead, watchful waiting is recommended. Of course, every situation is unique, so discuss the best options with a healthcare provider.