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Strep throat

Strep throat is a disease that causes a sore throat (pharyngitis). It is an infection with a germ called Group A Streptococcus bacteria.

Throat anatomy

Alternative Names

Pharyngitis - streptococcal; Streptococcal pharyngitis; Tonsillitis-strep

Causes

Strep throat is most common in children between ages 5 and 15, although anyone can get it.

Strep throat is spread by person-to-person contact with fluids from the nose or saliva. It commonly spreads among family or household members.

Symptoms

Symptoms appear about 2 to 5 days after coming in contact with the strep germ. They may be mild or severe.

Common symptoms include:

  • Fever that may begin suddenly and is often the highest on the second day
  • Chills
  • Red, sore throat that may have white patches
  • Pain when swallowing
  • Swollen, tender neck glands
Strep throat

Other symptoms may include:

  • General ill feeling
  • A loss of appetite and abnormal sense of taste
  • Headache
  • Nausea

Some strains of strep throat can lead to a scarlet fever-like rash . The rash first appears on the neck and chest. It may then spreads over the body. The rash may feel rough like sandpaper.

The same germ that causes strep throat may also cause symptoms of a sinus infection or an ear infection

Exams and Tests

Many other causes of sore throat may have the same symptoms. Your health care provider must do a test to diagnose strep throat and decide whether to prescribe antibiotics.

A rapid strep test can be done in most health care provider offices. However, the test may be negative, even if strep is present.

If the rapid strep test is negative and your health care provider still suspects that the strep virus is causing the sore throat, a throat swab can be tested (cultured) to see if strep grows from it. Results will take 1 to 2 days.

Treatment

Most sore throats are caused by viruses, not bacteria.

Sore throats should be treated with antibiotics only if the strep test is positive. Antibiotics are taken to prevent rare but more serious health problems, such as rheumatic fever.

Penicillin or amoxicillin are most often the first drugs tried. Antibiotics should be taken for 10 days, even though symptoms are often gone within a few days.

The following tips may help your sore throat feel better:

  • Drink warm liquids, such as lemon tea or tea with honey.
  • Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
  • Drink cold liquids or suck on fruit-flavored ice pops.
  • Suck on hard candies or throat lozenges. Young children should not be given these products because they can choke on them.
  • A cool-mist vaporizer or humidifier can moisten and soothe a dry and painful throat.
  • Try over-the-counter pain medications, such as acetaminophen.

Outlook (Prognosis)

Symptoms of strep throat usually get better in about 1 week. Untreated, strep can lead to serious complications.

Possible Complications

In rare cases, strep throat can lead to rheumatic fever if it is not treated. Strep throat may also cause a rare kidney complication called post-streptococcal glomerulonephritis .

Other complications may include:

When to Contact a Medical Professional

Call if you or your child develops the symptoms of strep throat. Also, call if symptoms do not get better within 24 - 48 hours of starting treatment.

Prevention

Most people with strep can spread the infection to others until they have been on antibiotics for 24 - 48 hours. They should stay home from school, daycare, or work until they have been on antibiotics for at least a day.

Get a new toothbrush after two or three days, but before finishing the antibiotics. Otherwise, the bacteria can live on the toothbrush and re-infect you when the antibiotics are done. Also, keep your family's toothbrushes and utensils separate, unless they have been washed.

If repeated cases of strep still occur in a family, you might check to see if someone is a strep carrier. Carriers have strep in their throats, but the bacteria do not make them sick. Sometimes, treating them can prevent others from getting strep throat.

References

van Driel ML, De Sutter AIM, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2013;4:CD004406. DOI: 10.1002/14651858.CD004406.pub3.

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.

Wessels MR. Streptococcal pharyngitis. N Engl J Med. 2011;364:648-655.

Frye R, Bailey J, Blevins AE. Clinical inquiries. Which treatments provide the most relief for pharyngitis pain? J Fam Pract. 2011;60(5):293-294.

Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102.

Updated: 2/4/2014

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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