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If you are a strep "carrier" do you have symptoms?


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I think my daughter was a carrier. She had symptoms when she was younger, but was never tested for strep at that time. By the time she was tested for strep (years after symptoms went away), she was symptom free and did not have elevated titers. But she consistently had positive throat swabs 3-5days after finishing a course of abx for @ 2 years. Once on prophylactic abx we did not test as often- but when she had a bad, bad flare- then I'd bring her in and she'd test positive. I was always so sure that we were done w/ strep once we'd gone prophyl that I only tested when I'd bring her in for other things- like injuries sustained while raging! In hindsight, I should have realized!

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In our office, we routinely test all family members for strep who have not been tested yet.

have found one mom with positive strep in the throat, no symptoms.

one dad with high aso, no symptoms.

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Our DS is/was a carrier. For years, he would bring letters home from school announcing that another child in his class had been identified with strep, and that we should keep an eye out for sore throat and/or fever.

 

DS, however, never got either a sore throat or a fever. But within 7 to 10 days, either DH or I would come down with classic strep throat.

 

We had DS swabbed a couple of times, trying to tie his OCD to strep exposure, but the cultures always came back negative, and since he didn't show any other physical signs of having contracted it, we couldn't get the pediatrician to treat him. It wasn't until after reading "Saving Sammy" that I pushed for ASO and AntiDnase B blood tests. By the time we got to that point, NONE of us in the family had had any active strep infections for more than a year, but DS's titers were five times the high end of the lab's normal range.

 

So, yes, I do think carriers CAN have elevated titers, but I don't know if they necessarily do, especially during the period in which they are contagious in the classic sense.

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None of our family ever had classic strep throat symptoms or a positive throat culture, but all of us had elevated ASO. Interestingly, after abx treatment (augmentin XR for PANDAS ds, clindamycin for the rest of us), all of our ASO levels came down. So - to a layman - that seems to indicate that we indeed had active strep infections despite no standard symptoms / immune response.

 

Unfortunately, many docs don't agree. Our youngest's ASO came down from 597 to 254 after a month of clindamycin, has now spiked back up to 499 after confirmed cases of strep at daycare. Our family doc decided he can no longer prescribe abx for this because a local infectious disease specialist (who declined to see any of us as patients) told him that "it's a mistake to chase the titers." So they told us to bring our youngest in if he complains of a sore throat and they'll do a culture; otherwise, no abx.

 

So I'd say a lot of ID docs still believe that high titers or a "carrier state" are benign in the absence of classic strep throat symptoms, even for a PANDAS family. Argh....

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Try not to feel overwhelmed. Just start with the most basic testing..a rapid and culture. Some say skip the rapid, I say do it since if that's positive, you get antibiotics faster. My kids don't get symptoms of strep,yet they have tested positive of rapids and cultures before. But my kids are not carriers, they clear on a regular 10 day script and do not continuously test positive.

 

Rapids do have a high failure rate so don't let anyone tell you it's reliable, even for the adults. My husband has had false negative rapids before.

 

I was told today that it would be wise to get everyone who lives here swabbed, cultured, and titers pulled on all.

Ugghhh, I am so overwhelmed right now.

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We recently had some of our extended family members tested because my children consistently react when around them. Everyone cultured negative and but several family members had extremely high ASO titers in the 700 and 800 range. They are completely asymptomatic. We showed the results to two doctors - 1 neurologist and 1 immunologist who both felt that they are either strep carriers or have a chronic strep infection that has not been cleared.

Edited by Debbie1
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Way before this whole thing began with my son, I was the one who always got strep - evry 3-4 months for about a year and a half. (Had strep prior times, but not as often/recurrent) Got amoxcil each time I cultured positive and was good for a few more months. Then an ENT told me I had allergies causing a post nasal drip, tonsils infecting, and gave me Levaquin for 10 days. After that, strep stopped but my next infection many months later was a sinus infection. I've since had some of those, maybe strep again (?) but not nearly as often anymore.

 

Not sure what my bloods are, but would be curious to have them drawn.

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