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Question About Strep Carrier

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I just got off the phone with my son's doctor and he had the labs back for our family's strep tests. Everyone's came back normal except one daughter: ASO 281, anti-DNase 960. He said this meant she was a strep carrier. He said my son (the one being treated for PANDAS) is a strep carrier as well (ASO originally 240 (now back to normal), anti-DNase 315 and rose to 340 and now 680 while on antibiotics).


From what I have read on the internet, I thought a strep carrier was someone who has no typical strep symptoms but has strep in the back of their throat all the time. Therefore if you do a rapid throat test on a carrier it will come back positive. My son had no typical strep symptoms and his rapid throat test for strep came up negative. But his ASO and anti-DNase were high. So he had asymptomatic strep, but he wouldn't be a carrier since his throat test was negative. Is that right?


Also was wondering. Is it safe for my daughter to take the nursery at church if she's a strep carrier?

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You are correct. Buster does a great job of explaining it and many docs get it wrong! Carriers swab positive (so the bacteria is continuously hanging out on the surface tissue), but never develop infections (maybe it's called colonization?) as indicated by a rise in ASO/anti DNAse B.....the OPPOSITE of what is going on with your kids.


Maybe Buster pinned something up top or you could search carriers on the board; it has been discussed several times.

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if I remember correctly...dh (Buster) had a conversation with Ed Kaplan (WHO strep expert). Dr. Kaplan said it is unknown whether strep carriers get elevated ASO/anti-dnase b titers.


As far as your dd having high titers (but I assume neg. throat culture?)some possible explanations:

1) titers are still elevated from a past strep infection (maybe she is one of the kids that gets very high titers that drop very slowly)

2) she currently has strep hiding out somewhere else in her body (sinuses? vaginal? )

3) I don't know if exposure to strep can cause elevated titers??


I agree with you and Jag10...I think of a strep carrier as someone that cultures positive without any symptoms.

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I guess I'm a little confused, and wondering if it might not always be one thing or another: carrier tests positive, versus carrier being asymptomatic but able to "spread" strep to others despite negative swab tests.


I can only go on our own experience. My DS14 has always been entirely asymptomatic for strep: never had a sore throat or a fever, and never had a positive culture. However, within 7 to 10 days of a note coming home from his elementary school that some kid in his class had been identified with strep, either DH or I would come down with a classic, painful case of it, though DS never showed any signs, and he was our only obvious point of exposure. As best we can identify, he "carried" the strep home to us and contracted it in his own way (asymptomatically), but it took years for the psychological signs of it to manifest definitively.


His titers, however, have tested off the charts the two times we've had them measured.

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Hi MomwithOCDson,


it is my understanding that carriers can transmit strep to others, but it is just less likely (vs. someone with symptomatic pharygitis).


My dd's (we find out later were both culture positive) did give strep to some family friends that slept over (this was a few weeks b-4 my PANDAS dd was hospitalized for anorexia).


I read an old study (gee I wish I could find it) that did show that the longer someone spent with a carrier, the more likely the carrier was to transmit strep to that person...so sleepovers/living with someone would be more of a problem than just casually meeting someone for a couple of hours at a party.

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So lets see if I have this straight:

A carrier has strep living on the surface, but does not exhibit an immune reaction?


So, are they able to self infect? I think this is what happens when my child gets dental work or even just bites her tongue.

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I think I'm starting to respond to posts a little too early this morning and my coffee hasn't kicked in, but I'll post anyway. If your child has a rise in titers, it does not necessarily mean they are a carrier, but it also does not mean they are not a carrier. It means they have strep somewhere. So, you want to treat it. Even if your child was a carrier, you should still treat carriers as well. Never leave strep untreated. Some docs are still old school and find this as a loop hole not to treat. If yours is one, find a different doctor.


Now,if a person is asymptomatic (no symptoms), tests positive on a strep swab, it still does not mean they are a carrier. I say my kids are a perfect example of this since they are asymptomatic, test + on a rapid or culture, but will clear on 10 days of amox. Carriers are hard to clear and take stronger antibiotics for a longer amount of time. This is why it is important to retest people weeks after finishing antibiotics.


Long story short, still treat your child for strep.

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