Advice Needed: Guttate Strep Test Positive

[TJM718]

Hi Everyone!

If you've been following my posts, I've had a bad outbreak of guttate since Sept. 06. I followed the suggestions of many of you on here and asked my derm to do the blood test. The results came back today and I tested positive. My doctor said he's not going to do antibiotics because we did that back in Sept. with no results. I told him that I had some clearance after that (actually a whole lot) but attributed it to using my home sun lamp. Shortly thereafter I had a major flare up and now the sun lamp makes the guttate angry. He said he'd give me another two weeks of the antibiotic but doesn't think it would do anything. He said even if the strep goes away, the guttate stays. I also asked about being put on MTX short-term to help clear me. He said he doesn't do MTX, just biologics, and wants me to see a doctor in a different hospital. I'm frustrated and his advice seems different from what folks on here have been telling me. I should mention a few more things: (1) I'm trying diet and a homeopath; (2) I stopped Humira two weeks ago; and (3) biologics and UVB worked almost 100% for my plague. Now I'm wondering if I should find a new doctor (despite this guy being one of the cities best and across the street from my office) who is willing to try different treatments without referring me. I'm wondering if I should go back on the Humira with some antibiotics and some MTX to help the clearance. Or maybe just stick with the diet and the homeopath and hope that works. I'm really confused here. I feel the answer is right at my finger-tips. My doctor is a nice guy but honestly, I really feel like he's at a loss as to what to do. And does anyone else know of a big city major hospital derm who only uses one form of treatment? If it's not a biologic, he's not interested. My skin is a big, giant mess. Help, anyone!!!!!

[forestal]

Hi Tom,
a big problem with the streptozyme/aso titer is a lot of stuff can cause false positives and a positive test won't necessarily mean you have latent strep.
any infection (colds, etc) or other stresses may cause flare ups as well

how can you tell a false from true positive test - you cant' - hence why its often not part of the rheum usual blood tests, but can often be looked at if no other explanation.

many antibiotics other than fighting infections also have some anti-inflammatory effects so some improvement may not mean its an infection.

also strep infections that have not been fully treated can cause problems, but the body often kills the strep, but the toxin from strep causes the secondary problems such as scarlet/rheumatic fever/arthritis etc. and antibiotics do not do anything to the toxin, which has to go down on its own,

hence the reason why some docs won't test titer or treat over and over if its positive

hope this helps and wasnt too disjointed, getting ready to leave work and rushing the typing

[twinieten]

Basically, I gather this. The ASO test can only determine if you have had an infection, and not whether or not it's current. I would guess that multiple tests over time would show more accuratly what's going on. An extremly high titer could probably mean there is an active strep infection. Antibiotics to clear up the strep are not going to clear up the p. But, if you have a strep infection, it could prevent any treatment you throw at the p from working. So, IMHO, the antibiotics are a fairly low risk treatment worth trying. If it helped you before, then it could help you again.

I would say, stick with the natural treatment. Again, this is IMHO. I just think it's better. I don't know how bad your p is. I'm sticking with the natural for now simply becuase I'm dealing with the p of a 7 year old who is not effected by it severly. I'd much rather stay away from harsh medications for as long as possible, but it's not something I wouldn't consider for him if necessary. For now, the PUVA with psorolin, 777 oil and steroid ointment are making a difference. Finally, 2 years later, he's almost clear! He's also been on antibiotics and I beleive that they made a difference in his case. I would suspect that with past use of bioligics and diet change, your p is going to get worse before it gets better, though.

[MikeK]

Hi Tom,

I'm sorry to hear that you're still hurting.

Thanks for the update. I suspected that we were dealing with an asymptomatic strep outbreak. From what I understand, a strep induced psoriasis flare won't respond to treatment until the underlying infection is taken care of. I'm not a doctor, but I suspect that this is true for all treatment options. Unfortunately, PJ Leary reports that it can take several months to clear from a strep induced outbreak. (Sigh) (Here's a link to a post where she discusses her experience: http://www.psoriasis.org/forum/showt...ths#post234953.)

Part of me can understand why your derm is reluctant to prescribe multiple courses of antibiotics. He's probably concerned that about you developing drug-resistant strep. (Here's some links to some additional information about drug-resistent strep: http://query.nytimes.com/gst/fullpag...57C0A9649C8B63 and http://www.cdc.gov/drugresistance/community/faqs.htm.) That being said, I think that there's a possibility that you're going to attack the problem by going on more then one course of antibiotics. Maybe you can discuss the problem with your primary care physician? Perhaps he or she will be willing to prescribe a second or a third round of antibiotics. (You should probably be retested after about a month or so. Especially if your psoriasis isn't responding to treatment.)

Turning to your treatment dilemma. My psoriasis is fairly mild, but my derm has already told me she will refer me to someone else if it ever becomes necessary for me to consider going on a biologic or systemic medication. It sounds like your derm has similar feelings about drugs like MTX, Soriatane, and cyclosporine. Since you like him and since he's conveniently located, you might want to consider accepting his offer to refer you to someone else for a short course of MTX. You also might want to start treating your psoriasis very aggressively by sticking with the homeopath, treating the strep, going back on Humira, using topicals and your home UVB unit.

I hope this helps.

I hope you fell better soon.

See you tonight. I'm very much looking forward to meeting you.

Mike

[aikido83]

I have a seemingly mild case of GP, (this 2nd time around)... I got it last year really bad after my first strep infection.... I got tested less than 2 weeks ago with a rapid test, and that gave a positive result... Odd thing was, I went to bed that night feeling ok, with just a little discomfort in my throat, then woke up that day with a really sore throat and went into Urgent Care, they did a quick strep. They gave me a shot of Bissilan... But, back to the odd thing, I had my first eruptions of GP about 2 weeks before that... Admittedly I was sick, but I don't beleive with strep, as I had previous strep tests done with negitive results. My GP is seeming to be managed at this point with Dovanex, fluocinonide, and tanning, (till the light thearapy calls me next week)...But still now, even after treatment, I'm still having some discomfort in my throat, I went back again a few days after the shot, and the quick strep came back neg. I'm just wondering if strep can lay dorm or not get fully suppressed and come back with little or no symptoms, and cause further GP problems?

[RichJ]

hi aikido83,
sorry i can't help much but welcome to the p family. you have meet some of the wonderful people on here and will find alot of great info. welcome and nice to meet you.

try and have a good weekend

richard

[MikeK]

Hi Aikido83,

I don't think that we've met, so let me take this opportunity to welcome you to the Board. Nice to meet you.

You mentioned:

I had my first eruptions of GP about 2 weeks before that... Admittedly I was sick, but I don't beleive with strep, as I had previous strep tests done with negitive results.

You asked:

But still now, even after treatment, I'm still having some discomfort in my throat, I went back again a few days after the shot, and the quick strep came back neg. I'm just wondering if strep can lay dorm or not get fully suppressed and come back with little or no symptoms, and cause further GP problems?

Strep (or some other type of infection) often turns out to be the culprit when someone has a guttate flare. More then a few people have posted here that either their psoriasis or their child's psoriasis was triggered by a case of strep throat. To add insult to injury may of these same people have also posted that the psoriasis outbreak is often the only sign they (or their child) had an infection because they they were asymptomatic for the infection. (I.E., No sore throat or fever in the case of strep.) To further comlicate things, many of these same people also report that the psoriasis won't respond to treatment until the underlying infection is taken care of. Since you tested positive for strep when you had the rapid test at urgent care, you might want to get re-tested. The quick or rapid strep test is often unreliable so you might want to ask for a strep culture. Some people have to get a blood test, called an ASO blood test, to confirm the presence of strep. Here's the links to some previous discussions about psoriasis and infections:

http://www.psoriasis.org/forum/showt...nce+strep+test;

http://www.psoriasis.org/forum/showt...entation+strep;

http://www.psoriasis.org/forum/showt...&highlight=uti; and

http://www.psoriasis.org/forum/showt...&highlight=aso.

I hope this helps.

Feel better.

Good luck. Keep us posted. Let us know if you have any other questions and please don't be a stranger.

Mike