Why Home Strep Tests Aren’t Reliable

If you suspect your child has strep throat, you may be tempted to buy a home test kit online or in the pharmacy aisle at a local retailer.

But pediatrician Wadie Shabab, MD, says you may want to reconsider. Dr. Shabad explains why the risks involved in testing for strep at home outweigh the potential benefits.

What are at-home strep tests?

Like the strep throat test your child gets when they go to their pediatrician, most home strep tests that you buy over-the-counter (OTC) are rapid antigen detection tests (RADT). These swab-based tests check for the presence of group A strep.

At-home strep tests make sense in theory — but in practice, using one of these kits to diagnose your little one probably isn’t a good idea. Dr. Shabab says you’re better off making sure the testing’s done right.

How do these tests work?

The rapid antigen detection technology used in most strep throat test kits mirrors the kind used in home tests for COVID-19, in that they come with a swab, a reagent and a test strip. But strep tests aren’t as common or user-friendly. And, as Dr. Shabab explains, they tend not to be as reliable.

What to consider before using one

Doing a strep test at home may sound like a great way to avoid dragging your miserable child out of bed. But keep in mind that OTC strep throat tests:

• Aren’t that simple: Even if you follow the directions carefully, it’s possible that a lack of skill or training could affect the test results. “Performing the swab for the strep test requires certain skills that healthcare providers are trained to perform,” Dr. Shabab explains.
• Can get it wrong: “False negatives happen. But when the rapid strep test in your doctor’s office comes back negative, it’s followed up by a 24-hour throat culture,” Dr. Shabab continues. “That way, the pediatrician can be sure they made the correct diagnosis.”
• Don’t treat the infection: Your child’s pediatrician won’t prescribe antibiotics just because a home test comes back positive. They’ll repeat the test in the office to confirm the diagnosis and decide what, if any, treatment is appropriate. An at-home test won’t speed up the process.
• Some children are strep carriers: When your pediatrician assesses your child, they look at the full picture. That’s important because some people can carry group A streptococcus for months or years without getting sick. So, that positive test may not mean what you think it means.
• Delay needed care: A negative strep throat home test could be reassuring enough to keep you from bringing your child to their doctor’s office. But the longer strep goes untreated because of a false negative, the higher the risk of complications.
• Only check for strep: Strep isn’t the only serious issue a trip to the pediatrician can rule out. Dr. Shabab notes that without the tools and training, all red throats tend to look the same. And a DIY approach could mean missing something important, like an abscess around your kid’s tonsils.
• Not all kids can or should be swabbed: Pediatricians don’t usually recommend swabbing children under age 3. It could also be a bad idea for children with certain medical conditions.
• The tests go bad: OTC strep throat tests can expire or become contaminated. They can also be less effective if they’re packaged, stored or administered incorrectly.

“I recommend visiting a doctor’s office rather than attempting the test at home,” Dr. Shabab reiterates. “Pediatricians are interested in your child’s safety. They have the training to make an accurate and timely diagnosis. And you need that diagnosis to find and start the right treatment.”

When to see a doctor

If your child is feeling sick but doesn’t have classic symptoms of a viral infection — like a runny nose or cough — don’t bother running to the store for an at-home rapid strep test. Skip straight to calling your kid’s pediatrician.

Other common signs that your kid is dealing with strep throat include:

• Fever
• Sore throat
• Pain or difficulty swallowing
• White patches on their tonsils or in the back of their throat
• Swollen lymph nodes
• Little red dots (petechiae) on the roof of their mouth
• Stomach symptoms, like nausea and vomiting

If your kid has any of these symptoms and was recently exposed to someone with a confirmed case of strep, that’s all the more reason to reach out to your pediatrician.

Getting your child tested by a trained healthcare provider is crucial because untreated strep can cause serious complications, especially in kids. If strep isn’t discovered and treated in time, Dr. Shabab says that it can lead to:

• Rheumatic fever
• Glomerulonephritis
• Scarlet fever

When it comes to strep infections, Dr. Shabab stresses that it’s better to be safe than sorry. The sooner you bring your little one in, the sooner you’ll know what’s going on and how to get them better.