Strep Throat: Signs, Symptoms, & Treatment

What Is Strep Throat

Strep throat is a bacterial infection that causes sudden, intense sore throat, characterized by pain upon swallowing and red or white spots on the back of the roof of the mouth. Strep often occurs with a fever of 101° F or higher. If your sore throat comes on gradually, or is accompanied by congestion, a cough, or red and watery eyes, this is more likely due to a virus or allergy rather than strep.

Strep Throat Symptoms

It can be tricky to distinguish strep from other causes of sore throat. Strep does have some characteristic symptoms, which can include:

• Throat pain that comes on quickly

• Pain upon swallowing

• Red, swollen tonsils

• Small red spots on the back of the roof of the mouth

• Tender, swollen lymph nodes, and glands

• Fever of 101° F or higher

• Headache

• Rash

• Nausea or vomiting, especially in younger children

• Body aches

However, it's possible to experience these symptoms and not have strep throat. Viral infection or other illness may cause similar symptoms, which is why if strep is suspected your doctor will usually perform a test to determine what you have.

Causes of Strep Throat

Strep throat is caused by the bacteria Streptococcus pyogenes, also known as group A streptococcus. Streptococcal bacteria are extremely contagious and can spread by coughing, sneezing, sharing food and drinks, handshakes, hugs, and so on. You can also become infected with the bacteria by touching a surface like a doorknob, handle, or towel, and then touching a mucous membrane like your nose, mouth or eyes.

Strep Throat Risk Factors

Several factors can increase your risk of strep throat infection. They are:

• Age: Adults can get it too, but strep throat most often occurs in children between the ages of 5 and 15.

• Season: Late fall and early spring are the most common times of year to become infected with strep, but you can get it at any time you come in contact with the bacteria.

Diagnosing Strep Throat

If your doctor suspects you have strep throat, he/she will conduct a physical exam looking into your mouth and throat, and feeling your glands. She will also likely perform a rapid antigen test, in which she’ll swab the back of your throat with a cotton-tipped stick and test it for strep. Within minutes you should have your result. If the test is negative or inconclusive and strep is still suspected, your doctor may perform a throat culture. This involves swabbing the back of the throat and tonsils and sending the samples to a lab. It may take longer for these results to come in, from a few hours to a few days.

Strep Throat Treatment

While some sore throats due to a virus or common cold can improve on their own, strep throat needs to be treated with medicine. Oral antibiotics are the most common and effective treatment for strep. When taken within 48 hours of strep onset, antibiotics can reduce the duration and severity of symptoms, and limit contagion to others. Antibiotics are also important to prevent some of the complications associated with untreated strep throat. Often patients experience relief of symptoms within 24 – 48 hours of beginning antibiotics. If you don’t feel better after 48 hours of taking the antibiotics, let your doctor know.

You can relieve throat pain and reduce fever while waiting for diagnosis or treatment with over-the-counter pain medications like acetaminophen (Tylenol) and NSAIDs (Ibuprofen, Advil, Motrin, and others). 

Other general tips to help you while fighting an infection:

• Sleep: It will help your body fight infection.

• Hydrate: Keeping your throat moist can ease pain and can help prevent dehydration due to a fever.

• Eat comforting foods: Soups, popsicles, applesauce, mashed potatoes, and other soft foods can help keep your throat lubricated, which may temporarily reduce pain. Both hot and cold foods and liquids are effective.

• Gargle: Gargling with warm salt water a few times daily can help relieve pain.

• Humidify your space: Ensuring a humid environment can ease pain by helping to keep mucous membranes in the nose and throat moist.

• Avoid smoking: Even if you are a smoker, try to limit the number of cigarettes you smoke while you have strep throat. You should also avoid second-hand smoke

Complications of Untreated Strep

One of the reasons diagnosing and treating strep with antibiotics right away is so important, is that untreated strep can cause serious complications in two main ways: by spread of infection, or by impaired immune system functioning.

Infection can spread to:

• The middle ear: Known as otitis media, this can cause fever, ear pain, and trouble hearing. In young children, this can also cause fussiness and loss of appetite.

• The sinuse: Called sinusitis, this causes congestion, fever, facial pain or pressure, and difficulty smelling.

• The lining of the brain and spinal cord: Called meningitis, causing fever, headache, and stiff neck. While this complication from Strep is very rare, meningitis is a medical emergency and must be treated immediately.

Untreated strep can affect the immune system and can cause more serious conditions. These include:

• Kidney problems: Post-streptococcal glomerulonephritis (PSGN) is an inflammatory problem of the kidneys following an infection with strep. Symptoms can include high blood pressure, swelling in the face, hands, and feed, dark reddish-brown urine, fatigue, decreased urination frequency, and amount. While anyone can develop PSGN following a strep infection, children under seven years old are at the highest risk. It typically doesn’t damage the kidneys long-term, and resolves within a few weeks.

• Rheumatic fever: When strep is untreated or only partially treated, bacteria can linger in the tonsils, causing a generalized and constant immune response throughout the body. This can lead to the body attacking its own organs, particularly at risk are joints (causing inflammation and arthritis) and heart valves (damaging heart muscle and structures). Symptoms include fever, joint pain, cardiac inflammation, hard nodules under the skin, rapid, jerky movements, and in about 5 percent of cases, a skin rash. Children ages five to fifteen years old are most at risk of developing rheumatic fever from a strep infection. Rheumatic fever can be effectively treated with medicine like antibiotics, but any tissue or organ damage sustained while infected may be permanent.

• Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS): Also associated with strep, PANDAS describes the intensification or onset of Obsessive compulsive disorder (OCD) or a tic disorder such as Tourette's syndrome following strep. It is thought that lingering group A strep can cause the immune system to attack itself, causing OCD, tics, joint pain, hyperactivity, inattention, or fidgeting as in attention-deficit/hyperactivity disorder (ADHD), insomnia and bed-wetting, mood changes and emotional lability, and changes in motor skills or handwriting. PANDAS is most common in children under twelve years old, and can be treated with antibiotics.

Strep Throat Prevention

To prevent strep infection:

• Wash your hands: The most important thing to do to prevent many kinds of infections, including strep, is to wash your hands frequently throughout the day. Especially during strep season (late fall and early spring) and especially when in public places like schools, public transportation, or any crowded place where germs can be shared. You can carry an alcohol-based hand sanitizer with you for when it’s not possible to clean your hands using soap and warm water.

• Cover your cough or sneeze: To prevent the spread of bacteria, cover your mouth when you cough or sneeze, and encourage children and others to do the same.

• Avoid sharing personal items: You can eliminate some risk of contracting strep and other contagious illnesses by avoiding sharing food, drink, eating utensils, towels, and other personal items that come into contact with saliva.

When to See a Doctor

If you experience the following, call your doctor:

• Sore throat and tender, swollen glands

• Sore throat lasting > 48 hours

• Fever

Seek immediate help if you experience:

• Sudden sore throat with a rash

• Difficulty breathing or swallowing

• Fever > 100.4° F for an infant 12 weeks old or younger

• Fever > 104° F in any child or adult

• Diagnosed case of strep that doesn’t respond to antibiotics in 48 hours