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Strep throat: All you need to know.

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Centers for Disease Control and Prevention

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Worried your sore throat may be strep throat? Doctors can do a quick test to see if a sore throat is strep throat. Antibiotics can help people with strep throat feel better faster and prevent spreading it to others.

Bacteria cause strep throat

Viruses cause most sore throats. However, strep throat is an infection in the throat and tonsils caused by bacteria called group A Streptococcus (group A strep).

How you get strep throat

Group A strep bacteria are very contagious. Generally, people spread the bacteria to others through

Respiratory droplets

Direct contact

Rarely, people can spread group A strep bacteria through food that is not handled properly (visit CDC's food safety page).

It usually takes two to five days for someone exposed to group A strep bacteria to become ill with strep throat.

Respiratory droplets

Group A strep bacteria often live in the nose and throat. People who are infected spread the bacteria by talking, coughing, or sneezing, which creates respiratory droplets that contain the bacteria.

People can get sick if they:

Breathe in respiratory droplets that contain the bacteria

Touch something with those droplets on it and then touch their mouth or nose

Drink from the same glass or eat from the same plate as a person infected with group A strep bacteria

Direct contact

People can also spread group A strep bacteria from infected sores on their skin. Other people can get sick if they:

Touch sores on the skin caused by group A strep bacteria (impetigo) or come into contact with fluid from the sores

It is important to know that some infected people do not have symptoms or seem sick. People sick with strep throat are much more contagious than those who do not have symptoms.

Pain, fever, but no cough is common

In general, strep throat is a mild infection, but it can be very painful. The most common symptoms of strep throat include:

Sore throat that can start very quickly

Pain when swallowing

Fever

Red and swollen tonsils, sometimes with white patches or streaks of pus

Petechiae - pronounced pi-TEE-kee-eye - on the soft or hard palate (tiny, red spots on the roof of the mouth)

Swollen lymph nodes in the front of the neck

Other symptoms may include a headache, stomach pain, nausea, or vomiting - especially in children. Someone with strep throat may also have a rash; it is known as scarlet fever.

Some symptoms suggest a viral cause rather than group A strep

The following symptoms suggest a virus is the cause of the illness instead of strep throat:

Cough

Runny nose

Hoarseness (changes in your voice that make it sound breathy, raspy, or strained)

Conjunctivitis (pink eye)

Up to 3 in 10 children with a sore throat have strep throat

About 1 in 10 adults with a sore throat has strep throat

Some people are at increased risk

Anyone can get strep throat, but there are some factors that can increase the risk of getting this common infection.

Age

Strep throat is more common in children than adults. It is most common in children 5 through 15 years old. It is very rare in children younger than 3 years old.

Adults who are at increased risk for strep throat include:

Parents of school-aged children

Adults who are often in contact with children

Group settings

Close contact with another person with strep throat is the most common risk factor for illness. For example, if someone has strep throat, the bacteria often spread to other people in their household.

Infectious illnesses tend to spread wherever large groups of people gather. Crowded settings can increase the risk of getting a group A strep infection. These settings include:

Schools

Daycare centers

Military training facilities

A simple test gives fast results

A doctor will determine what type of illness you have by asking about symptoms and doing a physical exam. If they think you might have strep throat, they will swab your throat to test for strep throat. There are two types of tests for strep throat: a rapid strep test and throat culture.

Rapid strep test

A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep bacteria are causing the illness.

If the test is positive, doctors can prescribe antibiotics.

If the test is negative, but a doctor still suspects strep throat, then the doctor can take a throat culture swab.

Throat culture

A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses.

Culture is important to use in children and teens since they can get rheumatic fever from an untreated strep throat infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following a strep throat infection.

Antibiotics get you well fast

Doctors treat strep throat with antibiotics. Benefits of antibiotics include:

Decreasing how long someone is sick

Decreasing symptoms (feeling better)

Preventing the bacteria from spreading to others

Preventing serious complications like rheumatic fever

Someone with strep throat should start feeling better in just a day or two after starting antibiotics. Call the doctor if you or your child are not feeling better after taking antibiotics for 48 hours.

When to return to work, school after illness

People with strep throat should stay home from work, school, or daycare until they:

AND

Have taken antibiotics for at least 12 hours

Antibiotic dos and don'ts

1. Do take the prescription exactly as the doctor says to.

2. Don't stop taking the medicine, even if you or your child feels better, unless the doctor says to stop.

You can find more guidance on taking antibiotics on CDC's Antibiotic Do's & Don'ts Page.

Not everyone needs antibiotics

Someone who tests positive for strep throat but has no symptoms (called a "carrier") usually does not need antibiotics. They are less likely to spread the bacteria to others and very unlikely to get complications.

If a carrier gets a sore throat illness caused by a virus, the rapid strep test can be positive. In these cases, it can be hard to know what is causing the sore throat.

If someone keeps getting a sore throat after taking the right antibiotics, they may be a strep carrier and have a viral throat infection. Talk to a doctor if you think you or your child may be a strep carrier.

Serious complications are not common

Complications can occur after a strep throat infection. This can happen if the bacteria spread to other parts of the body. Complications can include:

Abscesses (pockets of pus) around the tonsils or in the neck

Swollen lymph nodes in the neck

Sinus infections

Ear infections

Rheumatic fever (a disease that can affect the heart, joints, brain, and skin)

Post-streptococcal glomerulonephritis (a kidney disease)

Protect yourself and others

People can get strep throat more than once. Having strep throat does not protect someone from getting it again in the future. While there is no vaccine to prevent strep throat, there are things people can do to protect themselves and others.

Good hygiene

The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating.

To prevent group A strep infections, you should:

Cover your mouth and nose with a tissue when you cough or sneeze.

Put your used tissue in the waste basket.

Cough or sneeze into your upper sleeve or elbow, not your hands, if you don't have a tissue.

Wash your hands often with soap and water for at least 20 seconds.

Use an alcohol-based hand rub if soap and water are not available.

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

Antibiotics

Antibiotics help prevent someone with strep throat from spreading the bacteria to others.

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Worried your sore throat may be strep throat? Doctors can do a quick test to see if a sore throat is strep throat. Antibiotics can help people with strep throat feel better faster and prevent spreading it to others. Viruses cause most sore throats.

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Strep throat is a bacterial infection that can make your throat feel sore and scratchy. Strep throat accounts for only a small portion of sore throats.

If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage.

Strep throat is most common in children, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt testing and treatment.

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Overview

Strep throat is a bacterial infection that can make your throat feel sore and scratchy. Strep throat accounts for only a small portion of sore throats.

If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage.

Strep throat is most common in children, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt testing and treatment.

Symptoms

Signs and symptoms of strep throat can include:

Throat pain that usually comes on quickly

Painful swallowing

Red and swollen tonsils, sometimes with white patches or streaks of pus

Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate)

Swollen, tender lymph nodes in your neck

Fever

Headache

Rash

Nausea or vomiting, especially in younger children

Body aches

It's possible for you or your child to have many of these signs and symptoms but not have strep throat. The cause of these signs and symptoms could be a viral infection or some other illness. That's why your doctor generally tests specifically for strep throat.

It's also possible for you to be exposed to a person who carries strep but shows no symptoms.

When to see a doctor

Call your doctor if you or your child has any of these signs and symptoms:

A sore throat accompanied by tender, swollen lymph glands

A sore throat that lasts longer than 48 hours

A fever

A sore throat accompanied by a rash

Problems breathing or swallowing

If strep has been diagnosed, a lack of improvement after taking antibiotics for 48 hours

Causes

The cause of strep throat is bacteria known as Streptococcus pyogenes, also known as group A streptococcus.

Streptococcal bacteria are highly contagious. They can spread through airborne droplets when someone with the infection coughs or sneezes, or through shared food or drinks. You can also pick up the bacteria from a doorknob or other surface and transfer them to your nose, mouth or eyes.

Risk factors

Several factors can increase your risk of strep throat infection:

Young age. Strep throat occurs most commonly in children.

Time of year. Although strep throat can occur anytime, it tends to circulate in winter and early spring. Strep bacteria flourish wherever groups of people are in close contact.

Complications

Although strep throat isn't dangerous, it can lead to serious complications. Antibiotic treatment reduces the risk.

Spread of infection

Strep bacteria may spread, causing infection in:

Inflammatory reactions

Strep infection may lead to inflammatory illnesses, including:

Scarlet fever, a streptococcal infection characterized by a prominent rash

Inflammation of the kidney (poststreptococcal glomerulonephritis)

Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin

Poststreptococcal reactive arthritis, a condition that causes inflammation of the joints

A possible relationship has been suggested between strep infection and a rare condition called pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS). PANDAS is a term used to describe certain children whose symptoms of neuropsychiatric conditions, such as obsessive-compulsive disorder or tic disorders, are worsened by strep infection. This relationship currently remains unproved and controversial.

Prevention

To prevent strep infection:

Clean your hands. Proper hand cleaning is the best way to prevent all kinds of infections. That's why it's important to clean your own hands regularly and to teach your children how to clean their hands properly using soap and water or an alcohol-based hand sanitizer.

Cover your mouth. Teach your children to cover their mouths when they cough or sneeze.

Don't share personal items. Don't share drinking glasses or eating utensils. Wash dishes in hot, soapy water or in a dishwasher.

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Strep throat is a bacterial infection that can make your throat feel sore and scratchy. Strep throat accounts for only a small portion of sore throats. If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage.

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Strep throat is an infection of the throat and tonsils caused by a bacteria called group A streptococcus, which is also known as Streptococcus pyogenes. This bacteria lives in the nose and throat. You can get the infection from someone who is carrying strep A bacteria or is sick from it.

Anyone can get strep throat, but it's most common in children and teens.

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Kids often come down with sore, scratchy throats. Colds and other viruses are usually to blame. Irritants such as smoke in the air can also make you feel raw.

Strep throat is different -- it's caused by bacteria. You need to know whether you or your child has strep or another illness so you can get the right treatment.

How Do I Catch It?

Strep throat is an infection of the throat and tonsils. Bacteria called group A streptococcus, also known as Streptococcus pyogenes. cause it. They live in the nose and throat. You can get the infection from someone who is sick with strep A bacteria or is a carrier of it.

Like other infections, it spreads through close contact. When people who are sick cough or sneeze, they release droplets into the air that hold the bacteria.

You can infect yourself if you touch something a person with strep has coughed or sneezed upon and then brush your eyes, mouth, or nose with your hand. You can also get sick if you share a glass or other personal item with someone who has strep.

Strep is most common in children and teens. Adults can sometimes get it, too.

Symptoms

A sore throat is the main sign your child has strep. Colds and other viruses can also cause a sore throat. One way to tell the difference is that a virus will often cause a runny nose, too.

With strep, the sore throat comes on quickly. Your throat feels raw, and it hurts to swallow.

Strep is also more likely to cause these other symptoms as well:

Call your doctor if you or a child in your care has these symptoms.

How Is It Diagnosed?

Your doctor will ask about your child's symptoms. The only sure way to tell strep from viruses that cause a sore throat is with a test. There are two kinds:

Continued

Rapid strep test: It can identify a case in just a few minutes. The doctor will gently hold down your child's tongue with a depressor. Then, she will use a cotton swab to take a sample from the back of the throat.

You'll get the results in 20 minutes or less. If the test is positive, which means strep is there, the doctor will prescribe antibiotics to treat it.

If the test is negative, which means the strep bacteria could not be found, the doctor might send the sample to a lab for a follow-up that takes longer.

Throat culture: She will rub a swab over the throat and tonsils to be sent to the lab. If your child has strep throat, streptococci bacteria will grow in it.

It usually takes about 2 days to get results from a throat culture. It can confirm whether your child has strep throat or not.

Treatments

Your doctor will prescribe antibiotics to kill the bacteria that cause the infection. Most treatments last for about 10 days. The medicine can make your child's symptoms go away faster and help prevent complications.

Make sure your child takes all of the doses. Stopping the medicine too early can leave some bacteria alive. These can make your child sick again. Be sure to tell the doctor if your young one is allergic to any types of antibiotics.

If the strep test is negative, a virus likely caused the sore throat. Your child doesn't need antibiotics because these medications don't work on viruses.

Self-Care Tips

Try these home treatments to ease symptoms:

Gargle with a mixture of a quarter-teaspoon of salt and 8 ounces of warm water.

Take ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to bring down a fever and ease pain. Don't give aspirin to children or teens. It can cause a rare but dangerous condition called Reye's syndrome.

Suck on a throat lozenge or piece of hard candy. Don't give small pieces of candy to children younger than 4.

Drink warm liquids such as tea and broth. Or, suck on something cold such as an ice pop.

Pass on orange juice and other drinks that have a lot of acid. They'll sting.

Get lots of rest.

Continued

How to Keep It From Spreading

Have your child stay home from school or daycare until the fever is gone and he has been on an antibiotic for at least 24 hours. Same for you and the workplace. Other tips:

Don't share cups, dishes, forks, or other personal items with someone who's sick.

Ask children to cover their mouths with a tissue or sleeve whenever they cough or sneeze.

Have everyone in the house wash their hands or use an alcohol-based hand sanitizer many times daily.

Possible Complications

Strep complications are rare today, thanks to better diagnosis and treatment. Yet untreated strep can cause serious diseases, such as:

Abscess around the tonsils or behind the throat; an abcess is a collection of pus that can be extremely painful.

Rheumatic fever, which can damage the heart, brain, and joints

A kidney disease called glomerulonephritis

Quick treatment with antibiotics can help prevent these problems.

Sources

SOURCES:

American Academy of Family Physicians: "Strep Throat Diagnosis & Tests."

American Academy of Pediatrics: "Choking Prevention."

American Association for Clinical Chemistry: "Strep Throat Test."

CDC: "Is It Strep Throat?"

Cleveland Clinic: "Strep Throat."

Nemours Foundation: "Strep Throat."

PubMed Health: "Strep Throat," "Strep Throat: Treatments."

Seattle Children's Hospital: "Strep Throat."

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Strep Throat: Symptoms, Causes, Diagnosis, and Treatment

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Kids often come down with sore, scratchy throats. Colds and other viruses are usually to blame. Irritants such as smoke in the air can also make you feel raw. Strep throat is different -- it's caused by bacteria. You need to know whether you or your child has strep or another illness so you can get the right treatment.

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5. Three signs and symptoms of Strep Throat

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5. Three signs and symptoms of Strep Throat

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Three common symptoms of Strep Throat is high fever, sore throat, and swollen tonsils.

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A few main treatments for strep throat are antibiotics and pain relievers such as Ibuprofen.

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Conclusion: The scores proposed in the implemented guideline seem inappropriate to lower antibiotic prescriptions for sore throat, but better adherence of practitioners to negative RADTs should lead to fewer prescriptions.

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Randomized Controlled Trial

doi: 10.1186/s12875-023-01987-w.

Affiliations

¹ Institute of General Practice, Kiel University, Michaelisstr. 5, 24105, Kiel, Germany.

² Institute of General Practice, Kiel University, Michaelisstr. 5, 24105, Kiel, Germany. hk@allgemeinmedizin.uni-kiel.de.

³ Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus V40, 24105, Kiel, Germany.

⁴ IT Services Applications, Science & Laboratory, MHH Information Technology, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

⁵ Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany.

Randomized Controlled Trial

doi: 10.1186/s12875-023-01987-w.

Affiliations

¹ Institute of General Practice, Kiel University, Michaelisstr. 5, 24105, Kiel, Germany.

² Institute of General Practice, Kiel University, Michaelisstr. 5, 24105, Kiel, Germany. hk@allgemeinmedizin.uni-kiel.de.

³ Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus V40, 24105, Kiel, Germany.

⁴ IT Services Applications, Science & Laboratory, MHH Information Technology, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

⁵ Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany.

Abstract

Background: Pharyngitis due to Group A beta-hemolytic streptococci (GAS) is seen as the main indication for antibiotics for sore throat. In primary care settings prescription rates are much higher than the prevalence of GAS. Recommendations in international guidelines differ considerably. A German guideline suggested to consider antibiotics for patients with Centor or McIsaac scores ≥ 3, first choice being penicillin V for 7 days, and recommended analgesics for all. We investigated, if the implementation of this guideline lowers the antibiotic prescription rate, and if a rapid antigen detection strep-test (RADT) in patients with scores ≥ 3 lowers the rate further.

Methods: HALS was an open pragmatic parallel group three-arm cluster-randomized controlled trial. Primary care practices in Northern Germany were randomized into three groups: Guideline (GL-group), modified guideline with a RADT for scores ≥ 3 (GL-RADT-group) or usual care (UC-group). All practices were visited and instructed by the study team (outreach visits) and supplied with material according to their group. The practices were asked to recruit 11 consecutive patients ≥ 2 years with an acute sore throat and being at least moderately impaired. A study throat swab for GAS was taken in every patient. The antibiotic prescription rate at the first consultation was the primary outcome.

Results: From October 2010 to March 2012, 68 general practitioners in 61 practices recruited 520 patients, 516 could be analyzed for the primary endpoint. Antibiotic prescription rates did not differ between groups (p = 0.162) and were about three times higher than the GAS rate: GL-group 97/187 patients (52%; GAS = 16%), GL-RADT-group 74/172 (43%; GAS = 16%) and UC-group 68/157 (43%; GAS = 14%). In the GL-RADT-group 55% of patients had scores ≥ 3 compared to 35% in GL-group (p < 0.001). After adjustment, in the GL-RADT-group the OR was 0.23 for getting an antibiotic compared to the GL-group (p = 0.010), even though 35 of 90 patients with a negative Strep-test got an antibiotic in the GL-RADT-group. The prescription rates per practice covered the full range from 0 to 100% in all groups.

Conclusion: The scores proposed in the implemented guideline seem inappropriate to lower antibiotic prescriptions for sore throat, but better adherence of practitioners to negative RADTs should lead to fewer prescriptions.

Trial registration: DRKS00013018, retrospectively registered 28.11.2017.

Keywords: Antibiotics; Group A beta-hemolytic streptococci; Guideline; Pharyngitis; Point-of-care test; Primary care; Rapid antigen detection test; Rapid strep test; Sore throat.

PubMed Disclaimer

Conflict of interest statement

HW was author of the DEGAM-guideline 2009. The other authors declare that they have no competing interests.

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streptococcal infections* / drug therapy

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national center for biotechnology information

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Influence of a guideline or an additional rapid strep test on antibiotic prescriptions for sore throat: the cluster randomized controlled trial of HALS (Hals und Antibiotika Leitlinien Strategien) - PubMed

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She has put more emphasis on what families should know about Strep throat and how parents can help their kids at home.

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Dr. Whitney Hardy received her undergraduate degree from Xavier University of Louisiana and medical degree from Louisiana State University School of Medicine. Following this, she completed her internship and residency at Lake Charles Memorial Hospital.

Dr. Hardy's expertise is in family medicine. In her spare time, she enjoys Tae Kwon Do, writing her science fiction novel, and meditation.

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Whitney Hardy, MD, specializes in Family Medicine at Ochsner Health in Gretna, LA and Belle Chasse, LA

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Strep Throat: How It Spreads and How to Treat It