EAR, NOSE, THROAT, AND DENTAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 210

appears beefy red and exudates, which are similar to the pus found in boils or infected
wounds, can be seen as white or pale yellow points or patches scattered over the throat,
particularly on the tonsils. The lymph nodes in the neck and under the jaw usually are en-
larged and tender.
Fever, exudates, enlarged lymph nodes, and general malaise without a cough serve to
differentiate strep throat from other forms of pharyngitis. However, malaise may not be
marked, lymph node enlargement may not be prominent, and fever may not be very high.
Any sore throat should be regarded with suspicion. In a remote area, if three of the four
signs and symptoms listed are present, antibiotic therapy should be instituted.
Treatment for streptococcal pharyngitis consists of the oral administration of penicillin.
Amoxicillin/clavulanate (Augmentin®) is also effective. Individuals allergic to penicillin
canbegivencephalexinorazithromycin.Symptomsandsignsofthediseaseusuallydisap-
pear completely within twenty-four to forty-eight hours with or without antibiotics. Non-
etheless, therapy must be continued for ten days to ensure complete eradication of the in-
fection and the prevention of complications, particularly rheumatic fever.
DISORDERS OF THE MOUTH
Canker Sores
Canker sores are small painful ulcers that appear inside the mouth without apparent
cause. They first appear as small blisters that soon rupture, leaving small, white ulcers sur-
rounded by an area of inflammation. Such sores may be caused by Herpes simplex infec-
tion.
No therapy is effective for these ulcers, but they disappear in a few days without treat-
ment. A mouthwash consisting of a teaspoon (4 ml) of sodium bicarbonate (baking soda)
in a glass of water is soothing. A mouthwash of half water and half 3 percent hydrogen
peroxide solution helps prevent secondary infection.
Herpes
Herpes (also known as cold sores or fever blisters) is a viral infection ( Herpes simplex )
thatproducessmall,painfulblisters,mostcommonlyonthelipsandskinaroundthemouth.
The viruses persist in the tissues so blisters recur in the same location. Herpes sores com-
monly are exacerbated by sunburn of the lips or face, and avoiding sunburn helps prevent
them.Herpessoresmayaccompanysevereinfectionssuchaspneumoniaormeningitis,but
most commonly cannot be associated with any disorder.
An initial small, painful swelling rapidly develops into one or more small blisters con-
taining a clear fluid and surrounded by a thin margin of inflamed skin. The blisters may
rupture, particularly if they are traumatized, resulting in bleeding and crusting. Fever or
other symptoms are rarely experienced.