If you suspect your child has strep throat, and you’re considering trying a home test kit, you may want to reconsider. Yes, these strep home test kits are modestly priced and convenient, but there are risks involved with attempting to test for strep at home.
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The test checks for group A streptococcal infection in the throat, and these infections can result in serious complications in kids more than adults.
If strep is not discovered and treated in time, these post-strep infections may include (and are not limited to):
- Rheumatic fever, which may affect the heart and the joints
- Glomerulonephritis, which may injure the kidneys
- Scarlet fever, which involves a high fever and rash
I recommend visiting a doctor’s office rather than attempting the test at home. As pediatricians, we are interested in making an accurate and timely diagnosis so we can start the appropriate treatment promptly.
Also, performing the swab for the strep test requires certain skill sets; our clinical caregivers in the office are trained to do these tests. Their quality and safety are observed and maintained.
If the rapid strep test in your doctor’s office comes back negative, we will follow that with a culture that will take 24 hours to confirm the diagnosis. This way, we are sure not miss a false negative test.
On the other hand, even if parents follow directions carefully, it’s possible that a lack of skill or training in swabbing the throat could affect the test’s results.
A home strep test could potentially:
- Give a false negative result
- Ignore other related signs and symptoms
- Create bias in the person giving the test to see it as negative; as a result, a child may not come to the office for necessary antibiotics
- May result in overuse of antibiotics if a test reading is a false positive
- Miss an abscess around the tonsils; to the untrained eye, all red throat might look the same
For a variety of reasons, it’s best to be safe and seek a diagnosis in your pediatrician’s office.
— Pediatrician Wadie Shabab, MD
Home Strep Tests: Are They Worth It?
When your child has a sore throat, it’s important to rule out a strep infection. According to the Centers for Disease Control and Prevention (CDC), between 2 and 3 out of every 10 children with a sore throat have strep throat. (1) Caused by bacteria called group A Streptococcus, or group A strep for short, strep throat is a typically mild infection that can occasionally have more severe consequences.
Fortunately, strep throat is easily treated with readily available antibiotics. But early diagnosis is important to protect your child’s health. Getting your child tested for strep throat usually requires a doctor’s visit, which means taking time off work and taking your child out of school — an inconvenience that adds to what researchers estimate is a total U.S economic cost per year of up to $539 million for childhood strep.
That trip to the pediatrician could potentially be avoided with the use of a home strep test, according to a study published in March 2017 in the Journal of Participatory Medicine.
Researchers in the Pediatrics Service of the Massachusetts Institute of Technology medical department (MIT Medical), invited parents of patients aged 5 to 16 who had either a sore throat or upper respiratory infection to perform a home strep test on their children.
The test involved taking a throat swab to collect mucus and then exposing the swab to a chemical that reacts in the presence of group A strep. Out of 76 parents who attempted to perform the test, 71 did so successfully. Fifty-four of those tests turned out to be negative and 17 were positive. All the swabs were sent to the lab for bacterial culture, and only one of them returned back positive. The study reports that the child whose throat swab was positive for strep was prescribed antibiotics.
Most parents also reported feeling “confident” or “somewhat confident” about taking the swabs and performing the test.
The researchers concluded that home testing could save parents and pediatricians a lot of time and ease a major burden on the healthcare system — not to mention saving the United States economy a lot of money.
The Holdup With Bring At-Home Strep Tests to Market
If you’re making a mental note to stop by the pharmacy the next time your child has a sore throat, unfortunately it’s not that simple. While you can buy tests for group A strep from various online retailers, the United States Food and Drug Administration (FDA) has not approved any of these tests for home use. Don’t be fooled by the marketing copy, which in most cases says that the devices are FDA-approved. This is technically true, but it’s misleading in that the tests are only approved for use by clinicians. But that doesn’t mean you’re out of luck.
“It’s possible for parents to ‘hack’ this issue, so to speak,” says David Diamond, MD, the associate medical director of MIT Medical and an author of the study. You can buy the test online if your pediatrician agrees it will be helpful.
Dr. Diamond notes that this home testing for strep is only worth pursuing if your pediatrician is on the same page. “It’s outside of the norm of practice, so they might not be receptive,” he says. “One of our reasons for doing this study was to help get this out there so it’s more readily available.”
Andrew Fine, MD, MPH, an associate physician at Boston Children’s Hospital and assistant professor at Harvard Medical School, describes the study’s approach to reducing hospital visits for strep testing as “a great strategy,” but says that home testing has some limitations.
Dr. Fine says that some people may be carriers of strep, which means they will test positive for strep even if that is not the cause of their sore throat, runny nose, cough, and conjunctivitis. But if an at-home test turns up positive, a doctor may feel obligated to treat them. “And that leads to more antibiotic waste and more antibiotic resistance,” Fine says. You want to reduce the number of people with strep throat, but you don’t want to raise antibiotic resistance.”
Fine also notes that the test may be easier to perform under clinical supervision than at home.
“It’s not always so easy to swab a child — with some you say ‘Open up and say ahh,’ and it’s great, and with others, not so much. That could result in some false negatives, the kid doesn’t cooperate, and so you don’t really swab the tonsils.”
In spite of these limitations, Fine says that home testing for group A strep is “definitely worthy of further study.”
Diamond recommends that parents who would like to see home strep tests in stores call their pediatricians and ask about them.
“Tell your physician that you heard home strep testing is safe and effective,” he says. “We would love to see a groundswell of interest in this, such that the relevant regulatory agencies make this available wherever home pregnancy tests and so on are sold.”
Home tests for strep throat– are they worth it?
For less than two dollars you can buy a home test kit for strep throat, and save yourself the trouble of going to urgent care or your pediatrician. But how accurate are home step throat tests? Is it worth it?
The Medchoice Strep A Rapid Test Kit by BTNX sells on Amazon for about $40 for a box of 25 tests. The company claims their test is very accurate, with a sensitivity of 97% and a specificity of 95%. This means there is a low false negative rate and a low false positive rate. The test has been cleared by the FDA and results are ready within 5 minutes. So what’s a parent got to lose? Why go to the doctor if your child has a sore throat?
Children are at higher risk than adults for serious health consequences from group A streptococcal infections, including rheumatic heart disease and a kidney disease called glomerulonephritis. Hence, in pediatrics we are more careful not to miss the diagnosis due to a false negative rapid strep test. We don’t have a better or fancier test in our office or hospital than the ones you can buy online– we actually do two different tests.
In pediatrics, when we test for strep in an office or hospital we actually run two different tests– a rapid strep test (which is the test described above) and a culture test. For the culture test, the specimen swab is rubbed on a petri dish of agar (bacteria food) and put in an incubator to grow. If group A streptococcal bacteria grow on the agar, we say the culture is positive. The culture test is the most accurate test for strep throat. Every negative rapid step test is “backed up” with a culture test so that we don’t miss the diagnosis.
Home strep testing can still save a tired parent time and grief. If the test is positive, you’ve got an answer for why your child is sick. You need to contact your doctor and get a prescription for antibiotics. Early treatment of strep throat with antibiotics prevents the serious complications of strep and helps your child feel better quickly. Sometimes a home strep test can help you decide if you should go to the pediatrician today or wait until tomorrow to see if they are worse. It can help you decide if you need to keep your child home tomorrow and allow you to rearrange your family plans, find childcare, etc.
The problem is what to do when a home rapid strep test is negative. Your child really should be seen by your doctor anyway to get a back-up culture test. If you just wait a few days to see if your child gets worse, it may be too late to prevent the rare but serious consequences of group A streptococcal infection.
If the rapid strep test is negative, we still need to figure out what is wrong with your child. Is it the flu? We can test for that in the office, too. You can buy a home flu test online, but they are expensive, about $200 for 15 test kits. Influenza can be treated, but the antiviral medicine is most effective if started within 24 hours of the onset of symptoms. So if you wait too long to get tested, treatment is unlikely to be effective.
I get it– going to the doctor, paying your copay and waiting to be seen is no fun for any busy family, especially when your kids are sick. But whether your home strep test is positive or negative, your child still needs to be seen by their pediatrician.
Most children who visit a doctor because they have a sore throat are tested for Streptococcus (“strep throat”), a contagious condition that can cause serious complications if not treated. A new study led by MIT and Beth Israel Deaconess Medical Center researchers suggests that the time spent on these visits could be saved by having parents test their children at home.
The study, performed at MIT Medical, shows that most parents who tried were able to successfully perform the test on their children. If this approach were implemented on a large scale, it could save time for parents, who would avoid a trip to the doctor’s office, and for doctors, who could devote their time to treating other conditions. It could also help patients get treatment more quickly.
“The results supported our hypothesis, which is that parents can probably do this test at home, and with this added information, care could be delivered in a way that is more efficient for everyone,” says David V. Diamond, associate medical director of MIT Medical and an author of the study, which appears in the Journal of Participatory Medicine.
Other authors of the paper are Stan Finkelstein, a senior research scientist in MIT’s Institute for Data, Systems, and Society; Gary Horowitz, an associate professor of pathology at Harvard Medical School and Beth Israel Deaconess Medical Center; Pat Bartels, a registered nurse at MIT Medical; Jocelyn Joseph, chief of pediatrics at MIT Medical; Lester Hartman, medical home director at Westwood-Mansfield Pediatric Associates; Jeffrey Blander, chief innovation officer at the U.S. State Department; and Warner Slack, professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.
Hartman, who practices in a large pediatric clinic based in Westwood, Massachusetts, began offering home strep tests to parents in 2008. His practice now distributes about 5,000 of the tests every year to parents of children ages 5 to 9 — the age group that comes down with the most cases of strep throat.
To perform the test, parents swab their child’s throat, then deposit the swab into a tube and add some chemical reagents. A test strip is then dipped into the tube and reveals a positive or negative result in about 10 minutes.
For the new study, MIT Medical doctors and nurses recruited parents of children between the ages of 5 and 16 who were brought in with sore throats. Of 120 parents invited to participate, 76 agreed and 71 successfully performed the test after watching a three-minute instructional video.
Of these parents, 57 said they were confident and 14 said they were somewhat confident about performing the test. Fifty-four of the tests were negative and 17 were positive. The negative samples were sent to the lab for bacterial culture to confirm the results, and one of those returned positive, representing a false negative rate of 1.9 percent. That is similar to the rate when the test is done in the clinic by medical assistants.
The researchers envision that parents could perform the test on their own at home, then communicate with their health care provider, who could prescribe antibiotics without the need for an office visit. If the home test was negative but the child was still not feeling well in a few days, the parent could bring the child to the doctor’s office for further evaluation and, if necessary, another test.
In Hartman’s practice, giving parents the opportunity to test at home has contributed to a significant decline in strep throat office visits, which Hartman says was the number one reason for office visits in 2008 but has since dropped to number four. That has allowed doctors in the practice to spend more time helping children with chronic conditions such as asthma, obesity, and behavioral problems.
“One of the reasons we started this is we need to focus more on the ever-rising population of kids with chronic diseases,” Hartman says.
Danny Sands, an assistant clinical professor of medicine at Harvard Medical School, agrees that this approach could help to free up health care professionals to treat other patients.
“What they have shown is that we can teach parents how to do a self-diagnosis test at home with their kids,” says Sands, who was not involved in the study. “If that could be applied appropriately and that information can be given to health care professionals so the appropriate antibiotic can be prescribed, that’s an important step toward a time when we can use fewer clinical resources for strep throat.”
The researchers hope that their results will help build support for the idea of parents performing this test and other simple diagnostics on their own.
“The ultimate goal for parents is to self-manage their kids in their home and not have to leave the home and go to a doctor unless the kid is really, really sick,” Hartman says.
This type of home testing approach would likely be most appealing for health care centers that do not rely on fee-for-service income, the researchers say. For parents, doing a strep test at home would save money as well as time because the kits cost only a few dollars, less than a typical copayment for a doctor’s visit.
“It would seem to be a positive thing for families, and depending on how your system is set up, it’s a positive thing for the health care system,” Diamond says.
Rapid Strep Test
If you suspect you or your child have strep throat, don’t put off seeing your doctor. Your doctor will look at the inside of your or your child’s throat using a tongue depressor and flashlight. Physical signs of strep throat include redness, as well as white or yellow spots on the tonsils. If you have strep throat, you also may have swollen glands in your neck. Your doctor will place his hands around your neck to feel for swelling. Your doctor will check your temperature (a fever of 101 degrees or more is typical with the strep infection). He or she will ask you if you have experienced chills, headache, loss of appetite, nausea, a rash, or an overall feeling of illness, as these are also common symptoms.
Test confirmation: After reviewing your physical signs and symptoms of strep throat, your doctor may perform a rapid strep test (also called a rapid antigen test). A rapid strep test is done in the doctor’s office during your visit. It involves sampling the bacteria from the back of your throat and tonsils. The doctor will insert a long, sterile cotton swab in your mouth and rub the back of your throat and tonsils to collect a bacteria sample. Swabbing is quick and painless. However, the procedure can make you gag. If your child is being swabbed for strep throat, encourage him or her to relax and sit still to make the procedure go smoothly. Most people react with little more than a cough after the procedure. The sample then undergoes rapid testing in the office while you wait for the results. The wait may take 7 to 15 minutes to find out if you test positive or negative for the strep infection. If the test is negative for strep bacteria, your doctor will give you tips on how to ease the pain of a sore throat (see treatment). If the results are negative, but all physical signs and symptoms point to an infection, your doctor may send the sample to an outside lab for additional testing. It could take up to two days to get the results. If the test is positive for the strep infection, your doctor will prescribe an antibiotic to kill the bacteria.