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Perianal Strep: Diagnosis, Prevention, Treatment, & PANDAS - Overview of Perianal Strep

strep under a microscrope

Sometimes, medical conditions are embarrassing, yet, they are all the more necessary to treat. Perianal strep is a contagious infection around the anus and rectum, typically only found in children under the age of 10. This article will shed light on everything you need to know about Perianal Strep and Perianal Strep treatment.

Your physician will likely prescribe antibiotics and encourage frequent handwashing after a perianal strep diagnosis. And if you’re looking for more detailed health information on this topic, you came to the right place.

If you have any children, it is important to understand the precautions you need to take to prevent the spread of perianal strep.

Overview of Perianal Strep

Perianal (pronounced “pair-ee-AY-nal”) strep is a bacterial infection of the skin around the anus and rectum — the “perianal” area. The red rash will surround the infected area and will be more red and moist than a diaper rash.

Perianal Strep is also known as perianal streptococcal dermatitis or perianal streptococcal cellulitis. The infection often affects the anus area, but it can also spread to the vulva or penis.

Perianal strep is caused by group A Streptococcus bacteria, which also causes strep throat.

Like strep throat, perianal strep is very contagious. Many cases of perianal strep are from children scratching or wiping the vulnerable area with unwashed hands that harbor group A streptococci from another existing infection.

Because of this, perianal strep usually occurs in children with strep throat, streptococcal pharyngitis, or impetigo (a strep infection of the skin). 6% of children with streptococcal pharyngitis have perianal strep as well. However, sometimes, perianal strep can be an isolated finding without any other obvious Strep infection.

Make sure not to touch the infected area if you don’t have to. If you or your child does touch the area, wash your hands very well.

Symptoms of Perianal Strep

  • Moist red perianal rash
  • Painful defecation¹
  • Itching (called pruritus)
  • Swelling, inflammation (significant swelling should be seen by your physician right away as it could be cellulitis which may require more aggressive treatment or hospitalization)
parent touching their child's feet

Risk Factors for Perianal Strep

  • Boys are more likely to get perianal strep than girls.²
  • Perianal strep typically affects children aged 6 months to 10 years old.
  • Having any strep infection increases the risk it will spread to other areas.

Complications of Perianal Strep

In uncommon cases, complications may arise during or after a perianal strep infection.³ Your pediatrician should work with you on how to prevent these complications of perianal Strep:

  • Kidney disease (post-streptococcal glomerulonephritis)
  • Anal scarring
  • Severe infection of skin and/or soft tissue (necrotizing fasciitis)
  • Other strep infections, such as strep throat

PANDAS (“Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus”)

How Perianal Strep Is Diagnosed

Make sure to get your child diagnosed before treatment can begin.

Diagnosis might include:

  • A rapid strep test
  • A skin swab culture from the infected area
  • A throat culture (to test for other strep infections that could have led to perianal strep)

NOTE: physicians should always do a physical examination on your child for this disorder since it is based mostly on physical exam findings and only confirmed by lab testing.

Doctors may also have to rule out other “differential diagnoses,” meaning conditions that share symptoms and shouldn’t be confused for one another. Perianal strep has several differential diagnoses to look out for:

  • Psoriasis
  • Seborrheic dermatitis
  • Atopic dermatitis
  • Candidiasis
  • Inflammatory bowel disease (IBD)
  • Pinworms
  • Sexual abuse

A proper diagnosis is critical since antibiotics are probably in the future. You don’t want to give your children antibiotics unless it is certain they have a bacterial infection. Otherwise, they can develop antibiotic resistance or an imbalance of good bacteria in their gut.

thermometer and liquid medicine

Prevention of Infection & Perianal Strep Treatment

Once properly diagnosed with perianal dermatitis, your child will likely be prescribed antibiotics. But those aren’t the only treatments or preventative measures you can take against perianal strep:

  • Antibiotic treatment is the most common and most effective treatment option. Although penicillin is the most popular antibiotic prescribed, amoxicillin might be better tolerated among children.⁴ Erythromycin is another antibiotic used if penicillin is less than effective. Make sure your child remains on antibiotics for the prescribed time, even if he or she starts to feel better. On the flip side, don’t use antibiotics unless a strep infection has been officially diagnosed. Needlessly overusing antibiotics can be harmful.⁵
  • Cream or ointment should not be the sole treatment prescribed. But it may very well be given alongside antibiotics. Topical creams or ointments, such as mupirocin, can ease pain or help stop the spread of infection. Many prescribed creams or ointments are antifungal or antiseptic.
  • Always wash your hands with soap and water, especially after bowel movements. Make sure hands are washed for at least 20 seconds with high quality soap.
  • Do not share towels or washcloths. Bacteria can spread easily with towel sharing.

Follow-up appointments are important to make sure your child is fully better. Your doctor may make sure the full course of antibiotics was taken, or check if the strep infection spread.

ginger root and a bowl of honey

At Home Remedies

If your child has a diagnosed strep infection, antibiotics are the best measure to take.

However, if you’re waiting for a doctor’s visit or worried about antibiotic resistance, here are some at-home remedies you can consider:

  • Handwashing prevents the spread of strep bacteria to others as well as other parts of the body.
  • Sitting in shallow warm water after a bowel movement and cleaning can ease some of your child’s pain from defecating.
  • Probiotics will prevent the imbalance of good bacteria in your child’s gut after antibiotic treatment. Probiotics can be found in supplement form, or in fermented foods.
  • Natural anti-inflammatories can reduce swelling in perianal strep. This is only treating the symptom, but it might provide a little relief. All-natural anti-inflammatories include tomatoes, olive oil, leafy greens, fatty fish, curcumin (found in turmeric), walnuts, and zinc. Do not begin any medications or supplements without checking with your doctor first.

As an added bonus, here are six all-natural antibiotics that you can supplement or add to meals:

  1. Honey⁶
  2. Garlic⁷
  3. Ginger
  4. Echinacea⁸
  5. Clove⁹
  6. Oregano

Again – always consult a doctor before starting any new dietary supplements, especially in children.

Strep & PANDAS

PANDAS is an autoimmune response to a group A beta-hemolytic strep infection, such as perianal strep. The strep bacteria tricks your immune system into attacking the brain, triggering OCD symptoms.¹⁰

Note: PANS is a similar condition. It displays the same symptoms but does not come from a Strep infection.

Research confirms that a perianal infection can lead to PANDAS.¹¹ Here are some common PANDAS symptoms you can look out for to determine if your child has PANDAS from his or her perianal strep:

  • OCD (obsessive compulsive disorder)
  • Eating disorder
  • Bedwetting
  • Insomnia
  • Aggressive behavior
  • Sudden mood changes
  • Deterioration of handwriting or drawing skills

If you suspect your child might have PANDAS or PANS, you can book an appointment by clicking here, or please call us at (317) 989-8463, Monday-Thursday, from 8AM – 5PM Eastern time.

The Center for Fully Functional® Health is located in Carmel, Indiana, but we often see out-of-town patients. As recognized experts in the diagnosis and treatment of PANS/PANDAS patients — we have even helped our own daughter to recover from PANS a few years back.

We provide the best treatment in Indiana and beyond when looking for a PANDAS or PANS doctor.


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