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View Full Version : Why aren't rapid strep tests avail OTC?


PunditLisa
02-10-2006, 10:39 AM
So I've had a sore throat for a few days. No fever. No rash. I assume I have a virus, but realize that there's a chance it could be strep. Now I could make an appointment with the doctor and have the test taken, but frankly it's a pain in the ass. It costs $25 to walk in the door and more often than not, after a strep test, I'm told "It's probably allergies" and sent along my way. So I'm reticent to call, esp since I have no other symptoms.

Which begs the question: Why aren't rapid tests avail OTC? After all, diabetics are entrusted to monitor their own blood sugar and dose themselves with the appropriate amount of insulin so they don't die. Why in the world don't doctors entrust me to swab the back of my throat, or my kids' throats, so that I know whether I need an antibiotic? If it came back positive, I could call the doctor and make an appt so that she can write me a scrip. Or better yet, I could produce a positive test to the pharmacist and have the doctor's office PHONE in a prescription.

Shagnasty
02-10-2006, 10:48 AM
Because there is a whole lot more to medicine that simply doing rapid tests and then reading a color code on the back of the box. There is presumably something seriously wrong so the patient would need to see the doctor anyway and the doctor can evaluate the health of the whole patient, not just test for one possible thing. Plus, the test could be inaccurate and the doctors clinical knowledge could catch the mistake. Maybe it is something even worse.

Strep can be serious. If it is there, the doctor needs to know about it to tell the patient what to do and possible coerce them into treatment. Doctors are authority figures and this effect is often beneficial to patients. OTC tests don't have that authority.

Diabetic get to do some of their won procedures A) because they have to do it often and it wouldn't be practical to have to go to a clinic all the time B) They do it so often that they get good at it and become experts on their body and the disease themselves.

One off home lab tests don't have those traits.

PunditLisa
02-10-2006, 11:25 AM
Because there is a whole lot more to medicine that simply doing rapid tests and then reading a color code on the back of the box.

I agree. However, there is not a whole lot more to doing a rapid strep test than swabbing your tonsils and applying it to a strip. Once again, there are some things I am admittedly qualified to perform and others that I am not. If I'm willing and able to do it, then I should be empowered to do it.

Strep can be serious. If it is there, the doctor needs to know about it to tell the patient what to do and possible coerce them into treatment. Doctors are authority figures and this effect is often beneficial to patients. OTC tests don't have that authority.

Yes, strep is serious. Why is it that some people end up with scarlet fever/rheumatic fever in a day and age where a simple diagnostic tool and antiobiotics to treat it are widely available? My theory is that more people end up with repercussions because it's a pain in the ass to go to the doctor every time you have a sore throat.

To me, it's no different than having complimentary blood pressure machines. If you KNOW you have high blood pressure, you are much more willing to SEEK medical attention. To me, a sore throat is a judgment call: should I go and see the doctor or wait it out? But a positive Strep A test is NOT a judgment call. I NEED to see the doctor. So why not allow me to take more control of my health and do the simple diagnostic test on my own?

Shagnasty
02-10-2006, 11:32 AM
I think the biggest problem it isn't strep but something else that is serious. People will take the negative strep test to mean that they are in the clear for the serious things when they may not be.

A OTC test presumes that people are qualified to narrow down their condition on their own, seek out a test for that condition, and then decide what to do based on the results. Those actions are firmly in the realm of professional medicine.

Other problems include borderline results as well as false negatives that aren't caught by professional judgement.

Available OTC tests don't make those same assumptions. The conditions are fundamentally different and don't involve the complexities of microbiology.

Smeghead
02-10-2006, 12:46 PM
Also, swabbing someone's throat does require a certain amount of technique. You can't really train the general public in sterile sample handling requirements on the back of a box. At least not reliably.

cowboy0812
03-14-2013, 02:12 PM
I so Agree with your complaint about an OTC strep test not being available for two reasons:

1. The reasons other site as a reason for not allowing them is, "that people wont get themselves a complete exam which could catch other illness" so how would people waiting longer to get examined helped this? By human nature, the more inconvenient it is to get an examination the longer a person will wait and most, especially the poor with out insurance will not go at all. CVS charges 89.00 plus 27.00 for the test, I can tell you I don't have 116.00 plus tax to basically swab my throat. You seem to forget the cost factor is always weighted, even for those not poor.

2. The second larger society wide issue is that antibiotics are prescribed at an alarming rate by these very same doctors you claim to be the experts in the field. Why is this? They can't deal with nor want to deal with saying no confidently and the result is that people get sent on their way with an antibiotic for a disease (a bacterial one) that doesn't exist. I have lived in PA, FL, CT, NJ, CA, MN x 2, have in each place very quickly found a doc that will simply do what I want. He will call in whatever script I need and not even see me. If I can find this in all of these new states, what do you think the chances are that a person will find this if they grew up and live in the same state for their entire life. There is also cheap online antibiotics and if I did not have the money for an exam and test, I just might play it safe and selfishly take one (in case) .

The result, super-bugs (antibiotic resistant bacteria) are developing and these tests would lessen the demand for an antibiotic that is not needed.

One final point is that this all comes down to money. Doctors want to be seen now and paid now simply to write prescriptions. Thank god I live in one of the few states with medical insurance (MN), as I do not have it through an employers. I would have to pay 375.00 a month plus the cost of the prescriptions every month for him to write me an ADHD and a antidepressant medication I have been on for over 10 years. Why, I know I need it every month, he does not examine or interview me, he doesn't look for other conditions, he just writes a script. CVS or other docs charging 80-100 bucks for a cash appointment plus testing is part of the scheme of the medical system that is about syphoning every last dollar they can from the public!

That's the bottom!



So I've had a sore throat for a few days. No fever. No rash. I assume I have a virus, but realize that there's a chance it could be strep. Now I could make an appointment with the doctor and have the test taken, but frankly it's a pain in the ass. It costs $25 to walk in the door and more often than not, after a strep test, I'm told "It's probably allergies" and sent along my way. So I'm reticent to call, esp since I have no other symptoms.

Which begs the question: Why aren't rapid tests avail OTC? After all, diabetics are entrusted to monitor their own blood sugar and dose themselves with the appropriate amount of insulin so they don't die. Why in the world don't doctors entrust me to swab the back of my throat, or my kids' throats, so that I know whether I need an antibiotic? If it came back positive, I could call the doctor and make an appt so that she can write me a scrip. Or better yet, I could produce a positive test to the pharmacist and have the doctor's office PHONE in a prescription.

Nametag
03-14-2013, 03:10 PM
http://amazon.com/Rapid-Response-Strep-A-STR-15S25-Strips/dp/B001DD04SQ

However, they don't trust you to swab the back of the throat because it's hard to swab the throat and the tonsils without touching the tongue or the uvula.

Leaper
03-14-2013, 03:49 PM
So, PunditLisa, was it strep? Or do you not remember anymore? :D

BigT
03-14-2013, 04:51 PM
My guess: you have to go to the doctor anyway to get the antibiotic. The idea is that, if you don't know it's strep, you'll be more likely to go to the doctor, which can cover other bacterial infections. They don't want you figuring out it isn't strep but then not going in and getting the antibiotics you need.

Though now that they are doing their best to not give out antibiotics unless absolutely necessary, I'm not sure that logic would hold up. But doctors are oddly conservative for a group of people who are constantly discovering new treatments.

DSeid
03-16-2013, 04:35 PM
Old thread but still ...

As noted, getting a good swab is not something most can do on themselves or on their kids. My own WAG is that a large number of false negatives are a result of poor swab technique even in the hands of professionals who do many of them. And only a few of the Rapid Strep products have good enough sensitivity to believe a negative in the context of a story and exam more consistent with strep than viral sore throat (and if the story and exam are much more consistent with a viral sore throat it is wiser to not swab at all; false positives happen too). Without knowing the test is one of those products a negative in a clinically suspicious circumstance should be backed up with a culture.

Yes, sometimes a sore throat is more than strep. A few times a year someone comes in for sore throat and actually has what is called a peritonsillar abcess. Sometimes those can be treated, if diagnosed early enough, with a stronger/different by mouth antibiotic but often they need to get to an Ear/Nose/Throat surgeon and have it drained.

Another concern is that some patients want antibiotics for a variety of not so very good clinical reasons. Trusting a phone call of a test the doctor did not do, even if something purported to be the patients test strip was handed to a pharmacist, would be an opportunity for some to get medicine inappropriately.

EverwonderWhy
03-16-2013, 04:49 PM
So I've had a sore throat for a few days. No fever. No rash. I assume I have a virus, but realize that there's a chance it could be strep. Now I could make an appointment with the doctor and have the test taken, but frankly it's a pain in the ass. It costs $25 to walk in the door and more often than not, after a strep test, I'm told "It's probably allergies" and sent along my way. So I'm reticent to call, esp since I have no other symptoms.

Which begs the question: Why aren't rapid tests avail OTC? After all, diabetics are entrusted to monitor their own blood sugar and dose themselves with the appropriate amount of insulin so they don't die. Why in the world don't doctors entrust me to swab the back of my throat, or my kids' throats, so that I know whether I need an antibiotic? If it came back positive, I could call the doctor and make an appt so that she can write me a scrip. Or better yet, I could produce a positive test to the pharmacist and have the doctor's office PHONE in a prescription.

Hah, I have thought this about UTI's! Just give me a pee test I can take to the pharmacist for a perscription.

septimus
03-16-2013, 05:07 PM
I've told the following anecdote before but may as well tack it on to this zombie thread....

I've had quite a few sore throats over the decades and am always able to tell whether it is strep or not -- the pain sensation (at least for me) of strep is quite distinctive. I didn't take a strep test for each and every sore throat, but when I did there was perfect correlation between the peculiar pain sensation and the strep diagnosis. The pain is high but by "peculiar" I mean more than that; I can't explain the distinctive pain in words but, although I last had strep in the 1990's, I assume I'd recognize it if I got it again.

The time in the 1990's when I had strep, I knew I had it. (Not only did I have the peculiar pain, but I'd just moved into a house whose residents had only just gotten over it. :smack: ) It was in the U.S., so of course the only possible first step was to consult a physician for a strep culture. He took one look at my tonsils and said "Bright red. I can save you the $25 test; you have strep." (Thanks. I already knew it; wish I could have saved the $45 for you to spend 30 seconds looking at my tonsils.)

I don't know the moral of the story, but it does seem interesting that at least some patients have information (e.g. details of pain sensation) which cannot be easily communicated, at least believably, to physician. As another example, during my brief playboy-like fling in the early 1980's I frequently got gonorrhea or NSU -- I'd eventually know which since I always submitted to the test -- and soon reached a point where I predicted, from the pain sensation, with 100% success whether it was gonorrhea or NSU! :cool: (Yes, I did change modus operandi when AIDS appeared on the scene.)

jm900
09-08-2014, 08:14 AM
There are clearly issues with the accuracy of swabbing the right area and the test itself is only 95% accurate. That said, it's very important to allow people access to their own strep test kits. The results have to be read with all the other symptoms defined for strep as well. If there is a false negative, some of the other symptoms should be present 24 hours later. If there's a false positive, the other symptoms should not be present in theory.
A safe, affordable, rapid test that has some accuracy especially combined with other symptom analysis should be available. Those arguing that everyone should wait to see a doctor don't understand access to and affordability of medical care for many citizens at all.

bump
09-08-2014, 10:38 AM
I know it's a zombie thread, but I think I know the answer.

The reason they let you have diabetic glucometers and blood pressure machines at home is because they're not something you're going to use to diagnose yourself. More often than not, it's the other way around- you've been diagnosed and it's a matter of monitoring. AFAIK, diabetics who have home glucose meters tend to keep a log of their blood sugar for the doctor, so they can track whether the medication/insulin/whatever are working. Same for BP monitoring- I take my pill each morning, but if my doctor tweaks the dosage, he wants me to log it for a few weeks, so at the followup he has an idea of how the tweak affected it.

A home rapid strep test doesn't serve that monitoring function- it's directly a diagnostic test, and likely 99/100 doctors wouldn't actually trust something so sketchy as a home rapid strep test to make their diagnosis; they'd likely give you one of their own and make their diagnosis off that. About the only advantage is if you're a cheapskate about going to the doctor if you think you have strep throat, it might make you go in before it becomes a real problem.

GrumpyBunny
09-08-2014, 11:11 AM
I know of several clinical situations where a sore throat wasn't strep or allergies.

It was an STD.

:eek:



Note: not my situations. I worked in a county ER.

PunditLisa
09-09-2014, 05:45 PM
So, PunditLisa, was it strep? Or do you not remember anymore? :D

Hell, I can't remember what I had for lunch, let alone whether I had strep throat 8 1/2 years ago!

P.S. I still think they should allow you to do a rapid strep test at home. :)

Sattua
09-09-2014, 05:51 PM
I have never had a strep test. Every time I've had a sore throat bad enough to talk to a doctor about it, they just give me the antibiotics anyway.

PS: that only happened once.

DSeid
09-09-2014, 08:39 PM
Question to those who think strep tests should be available otc -

Should people be able to order their own X-rays? Blood tests like CBCs or PSAs (collecting the sample themselves even)?

The fact that there is a technique required to obtaining a throat swab that the average patient family member (and if you think you can swab yourself ....) is unlikely to have mastered has already been mentioned. That's the issue of false negatives. The concern of other causes of painful throat other than strep that require other intervention (one is peritonsillar abscess) has also been mentioned, but it likely a smallish number.

The other factor though is not smallish - it is the issue of false positives and frankly this issue is poorly appreciated even by health care professionals. If clinically the circumstance is a priori unlikely to be strep (cough and cold symptoms along with sore throat, no high fever, no headache, no nausea, throat not too ugly) then a positive swab result is likely to be a false positive. See the medical example of Bayes Theorem here (http://math.ucla.edu/~lensm003/3cf11/extraBayes.pdf) for why that is.

Part of the role of the health care professional is to only perform a test when there is adequate indication to do so; the random person performing the test for inadequate cause is unlikely to have strep even with a positive result.

GrumpyBunny
09-09-2014, 09:00 PM
You can buy rapid strep tests on Amazon. (http://amazon.com/s/ref=nb_sb_ss_c_0_5?url=search-alias%3Dhpc&field-keywords=strep%20test&sprefix=strep%2Caps%2C437)

The catch is that they come with several tests -- like 25+. I guess for a family it might work...

But honestly, how hard is it to go to a walk-in clinic and see a real medical professional? I can sew, but I don't want to suture my own injuries!

Leaffan
09-09-2014, 09:18 PM
I know this is an old thread, but I was under the belief that strep needed to be verified by growth in a Pitre dish, which takes a couple of days.

Maybe WhyNot or someone trained in medicine can confirm this.

RivkahChaya
09-09-2014, 09:22 PM
Also, swabbing someone's throat does require a certain amount of technique. You can't really train the general public in sterile sample handling requirements on the back of a box. At least not reliably.

You can buy rapid strep tests on Amazon. (http://amazon.com/s/ref=nb_sb_ss_c_0_5?url=search-alias%3Dhpc&field-keywords=strep%20test&sprefix=strep%2Caps%2C437)

The catch is that they come with several tests -- like 25+. I guess for a family it might work...

But honestly, how hard is it to go to a walk-in clinic and see a real medical professional? I can sew, but I don't want to suture my own injuries!I wouldn't trust myself to correctly swab my throat, and I don't have tonsils, so I have to have the back of my throat swabbed, which made me puke a little once, contaminating the swab, and causing the NP to have to start over (I warn them to stand to the side now).

But, I have a school-aged child. Sometimes when all three of us are sick (child, husband and me), the doctor will get a positive test from one of us, and give antibiotics all around, which may even be cheaper then three home tests.

I think the most salient point, though, is people using them every time they have the sniffles, and, along with incorrect swabbing, getting false positives.

With home pregnancy tests, false positives are pretty rare, because women who take them are usually experiencing some other symptom, and may also be deliberately trying to get pregnant. However, if you had a random cross-sample of people take them one month, including men, women who were not sexually active, and women who were infertile due to having tubes tied, you would get a much higher percentage of false positives.

Having doctors identify people actually at risk for strep, as opposed to anyone with a scratchy throat, or a cough and temp, take one, you get fewer false positives.

GusNSpot
09-09-2014, 09:48 PM
30 years ago, I would agree, go to the doc.

Today, not so much.
Contrary to what I have been told, I can go to the doc I trust, I just have to pay 100% of the costs ......... Ah, never mind, this crowd thinks all or even most doctors are really concerned about individuals instead of $$$

DSeid
09-09-2014, 11:03 PM
I know this is an old thread, but I was under the belief that strep needed to be verified by growth in a Pitre dish, which takes a couple of days.

Maybe WhyNot or someone trained in medicine can confirm this.

Not true.

Some (and it varies some based on the product they use as well) would back up a negative rapid result with a 48 hour culture (especially if the clinical suspicion was high), but no one would back up a positive one.

RivkahChaya
09-09-2014, 11:23 PM
Not true.

Some (and it varies some based on the product they use as well) would back up a negative rapid result with a 48 hour culture (especially if the clinical suspicion was high), but no one would back up a positive one.It depends on the patient too. I am allergic to a lot of antibiotics. Right now, there is only one cheap one I can take that works well for strep, and the doctor does not like to use it much in case I should become allergic to it as well. If I have a rapid test+, my doctor gives me the antibiotic, or if I have very definitive symptoms, and my son or husband has a positive test, my doctor will give me drugs without testing me, because for some reason I catch it very easily, and it puts me on my back; I also used to get some of the paranoid and OCD/ADD symptoms as a child that had not yet been ID'd as a rare but definite pediatric syndrome that sometimes goes with a strep infection-- my doctor now hesitates to diagnose me with it after the fact, but she has seen my childhood doctor's notes where he has pages of being puzzled over what he thought were repeated unusual reactions to antibiotics, or antibiotics plus codeine cough medicine.

Anyway, my point is, in my particular case, it's important to get strep diagnoses right. If I'm the only one in the family with symptoms, and it really looks like strep, but the rapid comes back negative, my doctor always does a full culture, and then phones in an Rx for me if it's positive.

I know what the poster who said strep feels a certain way meant. I almost always call it right when I have strep, but I have been wrong a couple of times, particularly when my son has had it first, and all I have so far is a tickling in my ears-- the full disease hasn't set in.

It happens I also get bacterial sinus infections that don't go away without antibiotics, though, so if that's what I have, I need to know that as well, which is another good reason to go to the doctor.

WhyNot
09-09-2014, 11:25 PM
Yeah, rapid tests are just that - rapid. The only time I really see cultures done are when the doctor thinks the strep may be antibiotic resistant, and orders a culture and sensitivity test to figure out what kills it, or if the clinical picture is just screaming strep and the rapid test is negative.

I personally think the rapid tests should be OTC. But not for prescription purposes. I'm just very into patient autonomy. I would very much like to take my own throat swab to help me decide if I should go to the doctor for a professionally done test, and then the treatment based on that. I suspect more strep goes undiagnosed and untreated because people don't go to the doctor then would be ignored because of false negatives. That is, I think if we made a screening convenient and cheap, we'd see more strep appropriately diagnosed and treated by a doctor. And just like every cough syrup ever made, it should instruct people to contact their doctor if their pain persists, negative result or no.

When I thought I was pregnant, I took a home test that let me know I should go to the doctor. Who did a pregnancy test. She wasn't going to suggest the treatment or schedule the delivery based on the fact that I told her my test was positive. When I think I have a UTI, I can get a dipstick test to take at home, and it lets me know if I should see the doctor, but he's going to run his own test before he gives me a prescription for Bactrim.

I don't see why a strep test would be any different. Except that it's ucky to swab your own throat.

PunditLisa
09-10-2014, 03:08 AM
Question to those who think strep tests should be available otc -

Should people be able to order their own X-rays? Blood tests like CBCs or PSAs (collecting the sample themselves even)?

I don't know anyone who's ever gotten an x-ray who couldn't have ordered that test on their own. In fact, I know at least two people who delayed getting one because they didn't want to be arsed with going to the doctor first. But since prolonged x-ray exposure can be dangerous, a doctor should regulate that.

I honestly wouldn't care if patients could order a CBC/PSA screening without a doc's prescription once a year, if the patient believes it is indicated. Empower the patient and all that. As far as collecting the sample themselves, it'd depend on the difficulty. Obviously, peeing in a cup and swabbing your throat are on the easier end of the spectrum. Prostate sample? Not so much.

BTW, if you've ever had the misfortune of caring for someone who required long term care, you'd be amazed at what the medical profession entrusts us lay people with, with just a few minutes of training. Cleaning wounds, changing IV fluids, collecting urine samples, coordinating a multitude of prescriptions...it's all in a day's work for many non-medical caregivers.

DSeid
09-10-2014, 11:21 PM
While I think getting a good throat swab on an adult (let alone on a child or even moreso on yourself*) is harder than you may think (and harder than cleaning wounds or changing IV fluids which frankly are very straightforward things to do) the point is being missed.

You believe that x-rays (which are often way over ordered by even many trained healthcare professionals) can be appropriately ordered by the layperson but should be restricted because of the potential harm of the test. You however have a narrow and incomplete understanding of the harms of inappropriate testing.

"Empower the patient" is a nice motto but in real life actually it would, in many cases, mean significantly poorer care that could result in real harms. Healthcare is not a business in which the customer is always right. Blasphemy I know. As arrogant and obnoxious as this may sound, as much as I believe in educating my patients and helping to guide them through a variety of healthcare options, the patient does not always know what is best or when is best to test and when to give it a rest.


*I have personally done by now many many thousands of throat swabs, including on many scared children, and I do not believe I could swab myself adequately. Pee in a cup yeah. Swab myself? I don't think so. Hell even swabbing my own kid was tougher than swabbing a patient.

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