Having a medical issue? Ask a doctor or medical professional on Reddit! All flaired medical professionals on this subreddit are verified by the mods.
Physician Responded
Like the title said, last week I went to urgent care before going on vacation. I had a sore throat for 5 days, the week before and a terrible sinus infection that cleared up with no antibiotics. Last week, a more minor sore throat showed up and was nagging me. I looked in my throat and saw the telltale white spots so I hightailed it to UC.
The techs took my vitals and I waited to see the doctor. He looked at me, felt my neck, and said "you're fine have fun on your trip". And I asked that he didn't want to test me for any of the major causes for white spots? He said "nope, it'll be negative" and sent me home.
I felt somewhat relieved that a doc told me this and let me get on a plane. While gone, my throat was uncomfortable, swollen tonsils, white spots remained etc etc. My throat doesn't feel normal but it's not unbearable. It's mostly noticable at night but relieves with Tylenol.
We got home today, it's still bugging me and I decided to look in the throat of my 4 y/o. Guess what? White spots. Neither he nor I have had fevers nor had he complained of a sore throat.
I'm about to go back to UC tomorrow and pay at least another $100 copay and insist on testing.
Do I have any recourse here with the facility?
Can it be strep with no MAJOR symptoms? How much damage may I have caused by waiting to get treated if it's strep?
-
Nervous patient/mom
Sort by:
Best
Open comment sort options
Best
Top
New
Controversial
Old
Q&A
Thank you for your submission. Please note that a response does not constitute a doctor-patient relationship. This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our Terms of Use and understand that all information is taken at your own risk. Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.
I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.
Your doctor was right. Testing is not even recommended without more signs of invasive strep infection, such as fever, headache, abdominal pain, lack of cold symptoms, swollen, red tonsils, and enlarged lymph nodes. The main reason for treating strep in children over 3 years old and adolescents is to prevent rheumatic fever, which is rare in younger and older age groups.
I am not a doctor but going to piggy back on this. I went in today for swollen tonsils, white spots etc. The only reason they tested me was because I have a fever and my partner was diagnosed with strep last week so it likely got to me. The pain is also not just uncomfortable, I feel like I'm swallowing razor blades.
I got it in 2020 and it hurt to breathe.
When I was finally able to get to the doctor, they gave me the biggest pills I’ve ever seen. And I take a lot of medications.
It felt like a cruel joke.
Yup. My sister somehow became a carrier of it when we were kids, so she had it a bunch of times, I had it maybe 3 or 4 times. “Swallowing razor blades” brought back some memories lol. It was always that level of pain, fever, and white spots before we went in to get tested.
Legit 6AM and I'm on my 4th cup of hot tea just to soothe it lmao. Send help.
Gargling warm salt water always helped soothe the pain temporarily for me
What happens if your child, with a history of frequent strep throat, does have a fever and vomiting—his typical symptoms?
This happened in December. Kiddo, age seven, had five strep throats last year, and already four strep throats at that point. He’s never had a sore throat as a symptom, only high fever (between 103-105.3) and vomiting. Took him in and the doctor only tested him for COVID/flu. Even when I reiterated the above, twice. We ended up in the emergency room overnight for scarlet fever. Thankfully we caught it in time before it became rheumatic.
The ER bill is $1,500 that I don’t really have, and I’ve been on a payment plan using credit for the bill. Is there a process where I could ask for some recourse for money? I assumed there wasn’t, but the post made me want to ask. To be clear, I don’t want to sue kiddo’s pediatric clinic. But if there is a standard process that most doctors adhere to, I might pursue that.
I’m also adding that we have seen an ENT, and while he is a great candidate to have his tonsils removed from a strep perspective, his extreme oral sensory issues combined with the allowable recovery foods is too restrictive, so we were advised against it.
Final thing—thank you for what you do here on this sub. This is actually my first comment, but I sincerely appreciate all the advice you and the other doctors give to the people who need it.
Relevant algorithm
Isn't there a significant increased risk of developing peritonsillar abscess if not treated in adults?
The annual incidence of PTA is reported as 10–45/100,000 people (that is, not common). The most probable causative agent of PTA is strep pyogenes (what people typically refer to as “strep throat”). “At aged 25–34 years, the number of patients with RTI [respiratory tract infection] who would need to be prescribed an antibiotic to prevent one PTA case was…1,984 for women”.
So yes it’s possible IF it’s strep, but I don’t think I’d call it “significantly increased”.
Cool, thanks for offering a genuine answer.
Sure! I didn’t include the links but all the data points are from studies post-2020 and easy to find if you want.
Of course people are not statistics and don’t individually adhere to the numbers (that is, someone’s getting struck by lightning even though there’s an annual incidence of less than one in a million), but I do think it’s worth considering things based on statistics just to get a global view of risk.
This is a completely useless anecdote (and not meant to discount the statistics; they actually make me feel quite a bit better after going through the following experience and now knowing it’s unlikely to happen again) but my husband was one of those unlucky people a couple of years ago. I had symptoms that seemed like strep right before going on vacation for Thanksgiving but a rapid test came back negative at my doctor’s office and I was cleared to travel. I had a nasty sore throat on one side for a few days but was otherwise fine. Soon after though my husband got it and was in bed for the entirety of our trip, and our then-6-year-old got an ear infection bad enough to rupture his eardrum (great fun trying to find a clinic open on Thanksgiving day!). Got home and husband’s sore throat had dissipated and returned, this time visibly swollen on one side with potato voice, which I understood as an immediate red flag for an abscess. Urgent care confirmed strep and were shocked he was able to walk and talk. I’m talking like, 3-4 different staff were called in to look into his throat, each with horrified expressions upon examination. He was sent to an ER to confirm the abscess via CT and to determine whether it needed to be drained. Fortunately all he ended up needing was an antibiotic drip—might’ve been a different outcome had we waited one more day, according to the doctor—and a prescription to take home but it was quite the ride.
Oof, sounds like he was the “someone’s getting struck by lightning” guy. Sorry for the hard time, but glad he made it out ok and didn’t need more than IV antibiotics. Anecdotal also, but I had strep, was appropriately treated, and still got a PTA. 🤪
No
But what about now? I've had swollen tonsils all week on top of the white spots and a minor sore throat. Shouldn't it be treated? ETA everything I've read says to not ignore strep.
Rheumatic fever is rare in adults. Strep throat is also rare in adults - from what you describe it’s most likely a viral infection.
I’m currently on antibiotics for strep. Tested positive on Wednesday, I’m 44. My daughter tested positive first, now my son also tested positive this afternoon. I didn’t have a fever, just the sore throat.
Nothing about what you wrote changes the fact that strep throat is rare in adults. It also doesn’t require antibiotics as all they do is quicken the recovery by one day.
The likely difference is that you have a known exposure with a close contacts.
Strep throat is self limiting meaning it will go away on its own with or without antibiotics. Chances are you just have a virus. A minor sore throat and swollen tonsils doesn't sound like strep. Sounds like a typical virus which can also cause white spots. If your kid starts to complain of a sore throat and develops a fever definitely take them to the doctor to be safe but you really don't need to go back for yourself. Rheumatic fever is a rare complication of strep in general but it's even more rare for adults.
NAD, but you can have tonsillitis without strep. The swollen red tonsils + white spots is often seen in tonsillitis too, which typically eventually resolves on its own and can also be viral, hence the dr not prescribing antibiotics
My other suspicion was tonsillitis but read that can also require antibiotics. We do have white on the back of the tongue, as well.
Tonsillitis just means "inflammation of the tonsils" it can be caused by many different organisms, including strep. Like a few docs have mentioned, strep infection in adults is generally only tested for and treated when it shows signs of becoming invasive: severe pain, swollen lymph nodes, being very unwell, fever, abdominal pain, etc. . A mild infection usually doesn't require treatment because the risks associated with taking the antibiotics are worse than the risks associated with letting the infection run it's course.
Many cases of sore throat are viral.. Antibiotics won't do much for them.
For instance, this Wikipedia image of herpangina can be caused by some cocksackie viruses or by echovirus.
https://en.wikipedia.org/wiki/Herpangina#/media/File%3AHerpangina2016.jpg
It doesn't look like this. The white spots are on the tonsils. The back of the tongue also looks white.
So youre not systemically unwell.
NAD
Speaking as someone who gets swollen tonsils / neck lypmh nodes with any kind of upper respiratory congestion, fluid in ears, post nasal drip, etc this becomes my "baseline" for fall cold season. Only thing that works for me is 12 hr Sudafed, ibuprofen & tylenol like clock work during illness. Sometimes I'll get fevers & other times it lingers for weeks. It's gotten worse since moving out of Midwest city & into Midwest farmland.
Also, the last few times it's looked like strep for my daughter they haven't ran a rapid on her since they are gonna perscribe antibiotics anyway for either the clinical exam or ear infections. I feel like the standard of care has changed a lot the past few years either due to COVID, RSV or current local statistics for illnesses. I remember how awful getting a rapid strep was as a kid for both my brother & I. I appreciate the providers thoughtfulness in making things less stressful for my daughter too.
Good luck!
I’ve been in your position before— it’s annoying. Say that it’s high level pain and that it hasn’t gone away for a while, and that you really think you might need antibiotics. If strep A is negative, they can then test for other strains.
I was once refused antibiotics after a negative test despite a clear infection and a lot of pain. Ended up getting so much worse and having to go to urgent care on a Sunday where they immediately gave me antibiotics that helped right away.
I have also tested positive for strep with no fever and with no white spots, just based on the specific painful feeling alone.
Just because they gave you what you want, doesn’t mean that was the necessary treatment.
Just because you came back positive for step doesn’t mean you had severe strep pharyngitis requiring antibiotics.
Strep pharyngitis is a self limited condition that will resolve without antibiotics.
We treat it with antibiotics because it can reduce the risk of rheumatic fever. First-occurrence RF in adults is extraordinarily rare.
A surprisingly high number of people are colonized with strep, and will positive rapid strep tests if tested. If we tested everybody with sore throat with strep swabs, there would loads of "false positives" in people that have viral pharyngitis but are also colonized with group A strep.
You are pretty low risk by modified Centor criteria.
Unnecessary.
"Recourse" implies some wrong was done, which the story here does not suggest at all.
Thank you for your detailed reply. I'm still looping, of course. I haven't gone back to the doctor but my sore throat feels more 'raw' tonight after gargling with salt water. My 4 yo seemed fine and happy. He does have a rash on his inner thighs only, but he has this happen frequently which we believe is contact dermatitis. I gave him a small dose of Benadryl and put him to bed. Doesn't help with my anxiety about the whole thing. I haven't had a sore throat last this long AND white spots AND NOT be on antibiotics.
Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.
The decision to perform or omit a test is complicated. Physicians in the United States go to undergraduate college for 4 years, and work hard, must achieve great grades, high scores on a screening exam (the Medical College Admission Test), many or most do countless hours of volunteer work, medical work or shadowing of doctors, and research and publications. Of those who apply to medical school, only about 1/3 actually ever get in.
Then there is 4 years of medical school. The first two are heavy based in the study of what we call the "basic sciences", which is the underlying knowledge about how the human body develops and operates at every level from the movement of a joint down to the microscopic signaling inside a cell. The second two years are spent in the hospital and in doctors' offices learning the day-to-day language and practice of medicine. Then there is a period of at least three years (but up to seven) where the physician-in-training spends up to 80 hours a week (it is limited to 80 hours, but in real life, many people work more than this) learning to be a specific kind of physician - a surgeon, a primary care physician, an emergency physician. A good proportion of physicians then spend another 1-3 years learning an even more specific branch of their specialty, so that they can be a cardiologist (heart doctor), toxicologist (poisonings), or a colorectal surgeon (focusing on the intestinal tract).
We do all this so that we can know when to order the right test at the right time.
Go ahead. I have no doubt that if you are loud enough, you'll find someone to order a test that you WANT as opposed to a test that you should have. The doctor who spent at least 11 years studying and working to get to this point doesn't want people yelling at them over something like this.
Fair enough. And this guy was a seasoned doctor, if you catch my drift, so I immediately believed him and left.
It's a week later and I still have white spots and a sore throat, though. I will say that it's not (as of now) the extremely unbearable sore throat I've had with strep in the past but it has gotten more sore today after gargling with salt water. I'm afraid of letting something pass that requires treatment.
Can you explain what you mean by this? If something passes on its on without treatment that's a good thing, unless I'm misunderstanding you.
My point is that is doesn't seem to be passing on its own. I did take a deeper look and see a lump in a place where there shouldn't be one where my throat is sore. I made an appointment with the ENT - better safe than sorry. My son seems like he's doing okay so I'm letting that pass but watching him closely.