Our tendency to hide indoors together in the winter probably explains the increased number of cases we see during this season. Luckily, sore throats rarely kill people. Most go away without treatment. In large parts of the developing world, however, this type of infection may lead to long-term disability and early death. This is because even minor or asymptomatic streptococcal infections, for reasons we do not really understand, sometimes lead to rheumatic fever, which in turn often leads to slow but relentless rheumatic heart disease and, occasionally, kidney disease.
Rheumatic fever occurs most often in the setting of poverty and crowding.
Occurrences of this disease have declined dramatically in the developed world over the course of this century, probably because of improving socioeconomic conditions. In the 1960's and 1970's, the disease almost disappeared from North America, perhaps because of the widespread use of antibiotics to treat streptococcal infections. In the 1980's, several American communities saw a resurgence of rheumatic fever. These appear to have been isolated outbreaks, and, in recent years, the number of cases appears to be declining again. In most cases, the antibiotic actually does little to improve the sore throat itself.