Strep throat

Strep throat is a throat infection caused by streptococcus bacteria and is characterized by a sore throat, fever, and enlarged lymph nodes in the neck

Strep throat with typical tonsillar exudate

Pathophysiology

Group A streptococci live in the nose and throat and can easily spread to other people. It is important to know that all infected people do not have symptoms or seem sick. People who are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.

Key facts

• Strep throat is an infection in the throat and tonsils caused by group A Streptococcus bacteria (called “group A strep”). However, viruses — not bacteria — cause most sore throats.
• Group A strep bacteria spread through contact with droplets from an infected person’s cough or sneeze. If you touch your mouth, nose, or eyes after touching something that has these droplets on it, you may become ill.
• No one, not even a doctor, can diagnose strep throat just by looking at your throat. Doctors can swab your throat to see if you have strep throat.
• People with strep throat should stay home from work, school, or daycare until they no longer have a fever and have taken antibiotics for at least 24 hours.
• Antibiotics taken for strep throat reduce your symptoms and the length of time you’re sick, prevent long-term health problems, and help prevent spreading the infection to friends and family members.

Strep throat

Transmission

People can get sick if they:

• Breathe in those droplets
• Touch something with droplets on it and then touch their mouth or nose
• Drink from the same glass or eat from the same plate as a sick person
• Touch sores on the skin caused by group A strep (impetigo)
• Rarely, people can spread group A strep through food that is not handled properly (visit CDC’s food safety page).
• Experts do not believe pets or household items, like toys, spread these bacteria.

Signs and symptoms

• Pain and Fever without a Cough Are Common Signs and Symptoms
• 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
• Tiny, red spots (petechiae — pronounced pi-TEE-kee-eye) on the roof of the mouth (the soft or hard palate)
• 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 known as scarlet fever (also called scarlatina).
• A sore throat that starts quickly, pain with swallowing, and fever are some of the common signs and symptoms of strep throat.

A throat infected with group A streptococcus

Risk factors

Children and Certain Adults Are at Increased Risk Anyone can get strep throat, but there are some factors that can increase the risk of getting this common infection.

Demographics

• Strep throat is more common in children than adults. It is most common in children 5 through 15 years old. It is 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
• Close contact with another person with strep throat is the most common risk factor for illness. For example, if someone has strep throat, it often spreads to other people in their household.

Streptococcus pyogenes (Lancefield Group A)

Community spread

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

• Schools
• Daycare centers
• Military training facilities

Strep throat in children

• Strep Throat: More Common in Children
• 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

A case of strep throat, culture positive.

Diagnosis - Rapid strep test

Only a rapid strep test or throat culture can determine if group A strep is the cause.

Treatment

Antibiotics such as penicillin or amoxicillin are recommended as a first choice for people who are not allergic to penicillin. Other antibiotics can also be used to treat strep throat in people who are allergic to penicillin.

Benefits of antibiotics include:

• Decreasing how long someone is sick
• Decreasing symptoms
• Preventing the bacteria from spreading to others
• Preventing serious complications like rheumatic fever

Asymptomatic carriers

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.

Complications

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 around the tonsils
• Swollen lymph nodes in the neck
• Sinus infections
• Ear infections
• Rheumatic fever
• Post-streptococcal glomerulonephritis

Strep throat Resources
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