Tunde could barely swallow his own saliva. His tonsils were white and his temperature was 39.4 °C. Unlike most sore throats, this one had a bacterial cause — and Mascot Healthcare confirmed it with a rapid strep test and treated it correctly.
First-year university student, Akoka. Presented with 3-day history of severely painful throat, difficulty swallowing, high fever (39.4 °C), and markedly swollen tonsils with white exudate. No cough. Rapid strep test positive.
Acute Streptococcal PharyngotonsillitisTunde had had sore throats before — usually mild, clearing in 3–4 days. This was different from the first day: excruciating, with fever that made his sheets damp. By day 3 his roommates could see the white on his tonsils from across the room.
He came to Mascot Healthcare at 8 am. The nurse took his temperature — 39.4 °C. The doctor examined his throat and applied the Centor criteria: exudate (yes), tender anterior lymph nodes (yes), fever (yes), no cough (yes) — Centor score 4/4. Rapid strep test: positive within 5 minutes.
"This is bacterial streptococcal tonsillitis," the doctor said. "This is the sore throat that actually needs an antibiotic. And you need 10 days of the right one."
Group A Streptococcus (GAS) pharyngotonsillitis is one of the few sore throats that actually needs antibiotics — and the only reliable way to distinguish it from a viral sore throat is testing (Centor criteria + rapid strep test).
Pain so severe that swallowing saliva was difficult — disrupting sleep and eating.
Both tonsils enlarged to grade 3, with white patches of exudate — a Centor criterion.
Significant fever — above the level typical of viral pharyngitis.
Absence of cough is a Centor criterion pointing toward bacterial rather than viral cause.
Tender, swollen lymph nodes in the front of the neck — Centor criterion.
Paracetamol 1 g QDS — appropriate; insufficient for the degree of pain.
Throat lozenges (benzocaine) — partial topical relief; no antibacterial effect.
Increased water and juice — appropriate hydration.
Considered stopping the course at day 5 if "feeling better" — counselled against this.
A 10-day course of the recommended first-line medication for strep tonsillitis. The doctor explained the specific medicine was chosen carefully to avoid a rash that can occur if the illness turns out to be glandular fever rather than strep.
A painkiller for the first few days for the throat pain. A single anti-inflammatory injection was given at the clinic for the severe difficulty swallowing — shown to reduce pain and time to return to a normal diet.
Tunde was told emphatically: complete the full course even after he feels well. Completing it prevents relapse and protects against rheumatic fever.
Acute Streptococcal Pharyngotonsillitis — Group A Streptococcus (Centor score 4/4; rapid strep test positive)
A 10-day course of the recommended medication; a painkiller for the first few days; a single anti-inflammatory injection; adequate fluids; complete the full course
At 48 hours: fever resolved; swallowing significantly improved. Completed 10-day course. No complications.
Full resolution within 5 days of starting treatment. Completed the full course as instructed. No relapse. ASO titre at 4 weeks: normal — no post-streptococcal immune reaction.
Most sore throats are viral and don't need antibiotics. But Group A Strep tonsillitis does — and failing to treat it fully (a complete course of treatment) risks rheumatic fever, a preventable cause of heart valve disease in young people.
The Centor score and a rapid strep test distinguish bacterial from viral tonsillitis reliably. This is how we target antibiotics appropriately — not by giving them to every sore throat.
Most sore throats are viral. But a white-exudate, high-fever tonsillitis with a positive strep test needs a full course of treatment — never stop early.
Walk in to Mascot Healthcare, Akoka — same-day consultation, transparent pricing, 4.9★ rated.