Sore throat in Puerto Rico: strep care and online treatment

The viruses that cause colds and flu are the most common cause of a sore throat (pharyngitis). Other causes include group A strep bacteria, allergies and smoke. In teens and young adults, a sore throat with deep tiredness and swollen glands in the neck can be mononucleosis.

These signs point to a virus rather than strep: cough, runny nose, hoarseness and pink eye. Strep throat is most common in children aged 5 to 15, but anyone can get it, and it tends to start suddenly.

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A sore throat is handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note after your visit is included at no extra charge.

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Strep tends to start suddenly and cause:

• A sore throat that hurts to swallow
• Fever that starts suddenly
• Red, swollen tonsils, sometimes with white patches or pus
• Swollen, tender glands in the neck
• Headache, nausea or feeling generally unwell
• Sometimes a rough, sandpaper-like rash (scarlet fever)

Many causes of a sore throat look alike, so strep is confirmed with a rapid test using a throat swab, or a throat culture. If the doctor suspects strep (sudden fever, pus on the tonsils, swollen glands, no cough or runny nose), we give you a lab order for a rapid strep test at a lab near you and go over the result with you.

If the test confirms strep, it is treated with an antibiotic taken for the full course; if appropriate, the doctor prescribes it and we send your prescription to your pharmacy. If your symptoms clearly point to a virus (cough, runny nose, hoarseness), Infectious Diseases Society of America (IDSA) guidelines say testing is usually not needed and an antibiotic would not help.

Most sore throats get better on their own within a week. In the meantime:

• Suck on ice chips or ice pops, or sip warm drinks such as tea with honey.
• Gargle with warm salt water several times a day (half a teaspoon of salt in a cup of water).
• Use a cool-mist humidifier.
• Take acetaminophen or ibuprofen as the label or your doctor directs. Do not give aspirin to children or teens.
• Do not give honey to babies under 1, or lozenges to young children, who can choke on them.

According to the CDC, strep throat is most common in children 5 to 15 years old and rare before age 3. In children it usually brings fever, pain when swallowing, red and swollen tonsils and tiny red spots on the roof of the mouth, usually without a cough; a cough, runny nose and hoarseness point more to a virus.

In babies, toddlers and preschoolers, a sore throat is most often caused by a virus. Strep is rare before age 3, and IDSA guidelines say children under 3 are not routinely tested for strep.

The doctor evaluates your child by video with you on camera. For children over 3 with strep symptoms, we give you an order for a rapid strep test at a lab near you; if it is negative in a child or teen, a throat culture is recommended to confirm, and we give you that order too. A child with strep can go back to school or daycare once they have no fever and have taken the antibiotic for at least 12 to 24 hours. Patients under 21 need a parent or legal guardian on camera with ID. See our online doctor for kids.

For safety: a baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the emergency room right away. At any age, go to the ER if your child has trouble breathing or swallowing, or is drooling a lot and cannot swallow. For patients under 21, a parent with patria potestad or a legal guardian stays on camera for the whole visit. A sore throat with fever can also be part of the flu.

For your safety, go to the emergency room or call 911 if you have these signs. See when to go to the ER.

• Trouble breathing
• Can’t swallow your own saliva, or a child is drooling
• Blood in your saliva or phlegm
• Signs of dehydration: very little urine, dry mouth, dizziness
• A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher