Strep throat

Overview

Strep throat is an infection of the throat and tonsils caused by group A Streptococcus bacteria (often called group A strep). Most sore throats come from viruses, not strep. Because strep needs antibiotics and a virus doesn't, a test is the only way to know for sure.

Strep throat often starts quickly, with a painful throat and fever, and usually without a cough or runny nose. It's very contagious and often spreads to others in the same home. With antibiotics, most people feel better in a day or two.

Symptoms

Symptoms usually start 2 to 5 days after you're around someone with strep. A cough, runny nose, hoarse voice, or pink eye point more toward a virus than strep.

• Sore throat that starts quickly
• Pain when swallowing
• Fever
• Red, swollen tonsils, sometimes with white patches or streaks of pus
• Tiny red spots on the roof of the mouth
• Swollen, tender glands in the front of the neck

Less common

• Headache
• Stomach pain, nausea, or vomiting, especially in children
• A red, rough rash that feels like sandpaper (scarlet fever)

How it usually goes

• Days 1–2: Throat pain and fever start quickly. See a healthcare professional for a strep test.
• Day 1 of antibiotics: After 12 to 24 hours of antibiotics and no fever, you usually can't spread it anymore.
• Days 2–3 of antibiotics: Most people feel much better. Keep taking every dose until the antibiotic is gone.

When to get medical care

Causes

Strep throat is caused by group A Streptococcus bacteria. The same bacteria can also cause scarlet fever and skin infections like impetigo.

Strep spreads through drops when someone with it coughs, sneezes, or talks. You can also catch it by sharing cups, forks, or food with someone who's sick, or by touching something with the bacteria on it and then your mouth or nose. Some people carry strep in their throat without getting sick; they're much less likely to spread it.

Does it spread or run in families?

• Yes, it can spread from person to person.
• How it spreads: coughs, sneezes, or touch.
• Washing hands often and staying home when sick help protect others.

Who is more likely to get it

• Children ages 5 to 15, who get strep throat most often
• Parents of school-age children, and adults who are often around children
• Close contact with someone who has strep, the most common risk, especially in the same home
• Crowded places, like schools, daycare centers, and military training

Possible complications

• Scarlet fever: A sandpaper-like rash with strep throat
• Abscess near the tonsils: Severe one-sided throat pain and trouble opening the mouth
• Ear infection: Ear pain or fever
• Sinus infection: Face pain and congestion
• Rheumatic fever: Rare; can affect the heart, joints, brain, and skin weeks later
• Kidney inflammation: Rare; dark urine or swelling 1 to 3 weeks later

Diagnosis

A healthcare professional will ask about your symptoms and look in your throat. You can't tell strep from a viral sore throat just by looking, so if strep is possible, they'll swab your throat to test for it.

Questions you may be asked

• When the sore throat started, and how fast it came on
• Whether you have a fever, cough, or runny nose
• Whether anyone around you has had strep throat
• Whether you've had strep throat before, and how often
• Whether you're allergic to penicillin or other antibiotics

The exam

They'll look at your throat and tonsils for redness, swelling, white patches, or tiny red spots on the roof of the mouth. They'll gently feel the glands in the front of your neck and check your temperature.

Tests

A throat swab is the test for strep. It takes just a few seconds and may make you gag briefly:

• Rapid strep test: Results in minutes. If it's positive, you have strep and can start antibiotics.
• Throat culture: If a child or teen's rapid test is negative, a second swab may be sent to a lab. Results take a day or two. It catches cases the rapid test can miss.

Treatment

Strep throat is treated with antibiotics. They help you feel better faster, stop you from spreading it, and prevent rare but serious problems like rheumatic fever. If your test is negative, antibiotics won't help, because the sore throat is likely from a virus.

Self-care

• Take every dose of the antibiotic, even after you feel better
• Drink fluids and eat soft foods, like soup, yogurt, or applesauce
• Warm salt-water gargles, throat lozenges, or ice pops for throat pain (no lozenges for children under 4)
• Treat pain and fever with acetaminophen or ibuprofen at the right ages
• Stay home until you have no fever and have taken antibiotics for at least 12 to 24 hours
• Get a new toothbrush once you've been on antibiotics for a day or two

Medicines

Antibiotics need a prescription. Over-the-counter medicines can ease pain and fever while the antibiotic works. Ask a pharmacist if you take other medicines.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

Call your healthcare professional if you don't feel better within 2 days of starting antibiotics, if you get a rash, or if you can't keep the medicine down. If strep keeps coming back many times a year, they may talk with you about other options, including taking out the tonsils.

How it compares

Prevention

There's no vaccine for strep throat. These steps lower the chance of catching it or spreading it:

• Wash your hands often with soap and water
• Don't share cups, forks, spoons, or food with someone who's sick
• Wash dishes and utensils in hot, soapy water or a dishwasher after a sick person uses them
• Cover coughs and sneezes
• Stay home until you've had no fever and have taken antibiotics for at least 12 to 24 hours

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to an ENT doctor (ear, nose, and throat doctor).

Back to school, work, or sports

• Children and adults can go back to school or work after taking antibiotics for at least 12 hours and having no fever.

Children, pregnancy, and older adults

• Children: Strep throat is most common from ages 5 to 15 and rare under 3. Children may have a stomachache or vomiting instead of complaining about their throat. Most schools and daycares ask that children stay home until they've had antibiotics for at least 12 to 24 hours and have no fever.
• Pregnancy: Strep throat can be treated during pregnancy. Penicillin and amoxicillin are commonly used. Tell your healthcare professional you're pregnant.
• Adults: Strep is less common in adults, and rheumatic fever after strep is very rare in adults. A sore throat in an adult is more often from a virus.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

With antibiotics, most people feel better within 1 to 2 days and recover fully. Taking every dose helps prevent the infection from coming back and lowers the chance of rare problems like rheumatic fever.

Myths and facts

Getting ready for your visit

A strep test only takes a few minutes. A little preparation helps you get the most from the visit.

What to bring

• When the sore throat started, and your highest temperature
• Any antibiotic allergies, and what happened
• All medicines you take, including over-the-counter medicines
• Whether anyone at home, school, or daycare has strep

Questions to ask

• Is this strep or a virus? Do I need a throat culture if the quick test is negative?
• When can my child go back to school or daycare?
• Should anyone else at home be tested?
• What should I do if I don't feel better in 2 days?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Strep throat