Overview

Strep throat is a bacterial infection of the throat and tonsils caused by group A Streptococcus (also called Streptococcus pyogenes). It spreads easily through respiratory droplets and often presents with symptoms such as a sudden sore throat, fever, and difficulty swallowing. While commonly seen in children ages 5–15, it can affect people of all ages.

Prompt diagnosis and treatment with antibiotics can reduce symptoms, prevent complications, and lower the risk of transmission. Without treatment, strep throat can lead to serious health issues like rheumatic fever or kidney inflammation.

Common Symptoms

Symptoms of strep throat usually appear 2 to 5 days after exposure to the bacteria. They often come on suddenly and can range from mild to severe.

Key symptoms include:

  • Sore throat

  • Pain when swallowing

  • Red, swollen tonsils (sometimes with white patches or streaks of pus)

  • Swollen lymph nodes in the neck

  • Fever (often above 38°C or 100.4°F)

  • Red spots (petechiae) on the roof of the mouth

  • Headache

  • Fatigue

  • Loss of appetite

  • Swelling of the uvula

Some individuals may also experience stomach pain, nausea, or vomiting, particularly in children.

Symptoms in Children

Children are more likely to experience strep throat than adults. Signs in children include:

  • Sudden sore throat

  • Headache

  • Fever

  • Stomach pain or cramps

  • Nausea and vomiting

  • Fatigue and irritability

Children between 5 and 15 years are most commonly affected. It’s rare for children under 3 years old to develop strep throat, but they can still carry the bacteria and transmit it to others.

Less Common Signs

Although most strep infections are limited to the throat, some strains can lead to more severe conditions. These include:

Scarlet Fever

This condition results from a toxin produced by group A strep. Symptoms include:

  • Red rash that feels like sandpaper

  • Bright red tongue ("strawberry tongue")

  • Flushed face with pale areas around the mouth

  • Red lines around the underarms, elbows, or groin

Scarlet fever primarily affects children and usually develops 1–2 days after strep throat symptoms appear.

Complications

If not properly treated, strep throat can lead to a variety of complications. Though uncommon, they may be serious or life-threatening.

Common Complications

  • Peritonsillar abscess (pus-filled pockets near the tonsils)

  • Otitis media (ear infections)

  • Sinus infections

Post-Streptococcal Complications

  • Rheumatic fever: Causes inflammation of the heart, joints, and nervous system

  • Post-streptococcal glomerulonephritis: Kidney inflammation

  • Post-streptococcal reactive arthritis: Joint pain and swelling

Severe Complications (Rare)

  • Bacteremia: Bacteria in the bloodstream

  • Toxic shock syndrome: A rapid-onset, life-threatening illness

  • Meningitis: Infection of the membranes around the brain and spinal cord

When to See a Doctor

Consult a healthcare provider if you or your child experience:

  • Persistent or severe sore throat

  • High fever

  • Difficulty swallowing

  • White patches on the tonsils

  • Enlarged lymph nodes

Seek immediate medical help if you notice:

  • Trouble breathing

  • Drooling due to inability to swallow

  • Rash

  • Swollen tongue or neck

  • Severe headache or stiff neck

Also, contact your doctor if symptoms don’t improve within 3 days after starting antibiotics, or if they worsen.

Diagnosis Methods

Doctors diagnose strep throat based on symptoms, physical examination, and laboratory testing. Common diagnostic methods include:

  • Rapid antigen detection test (RADT): Quick test using a throat swab; results in minutes.

  • Throat culture: More accurate but takes 1–2 days for results.

In some cases, especially if RADT is negative but symptoms are consistent with strep, a throat culture is performed for confirmation.

Treatment Options

Strep throat is treated effectively with antibiotics, which:

  • Reduce the severity and duration of symptoms

  • Lower the risk of complications

  • Limit transmission to others

Common antibiotics include:

  • Penicillin or amoxicillin (first-line treatment)

  • Cephalexin, azithromycin, or clarithromycin (for penicillin-allergic individuals)

Most people begin to feel better within 24–48 hours after starting antibiotics. It’s important to complete the full course even if symptoms improve.

Supportive care tips:

  • Drink plenty of fluids

  • Use lozenges or warm saltwater gargles

  • Take pain relievers (acetaminophen or ibuprofen)

  • Rest and avoid exertion

Patients are usually no longer contagious 24 hours after starting antibiotics.

Prevention Tips

Since strep throat is highly contagious, preventive measures can reduce the risk of infection and transmission:

  • Wash hands regularly with soap and water

  • Avoid sharing utensils, cups, and towels

  • Cover your mouth and nose when sneezing or coughing

  • Disinfect frequently touched surfaces like doorknobs and toys

  • Stay home from school or work until 24 hours after starting antibiotics

There is currently no vaccine for strep throat, so hygiene remains the most effective method of prevention.

Living With or Recovering From Strep

With proper treatment, most cases of strep throat resolve within 7 to 10 days. Recovery can be faster with rest, hydration, and following your prescribed antibiotic course.

Children can typically return to school after 24 hours on antibiotics and when they are fever-free. Adults can resume work under similar conditions.

If you experience strep throat multiple times a year, your provider may investigate further or consider a tonsillectomy (surgical removal of the tonsils).