Topic Overview
What is strep throat?
Strep throat is a
bacterial infection in the throat and the
tonsils. The throat gets irritated and
inflamed, causing a sudden, severe sore throat.
What causes strep throat?
Strep throat is caused
by streptococcal (strep) bacteria. There are many different types of strep
bacteria. Some cause more serious illness than others.
Although
some people are quick to think that any painful sore throat is strep, sore
throats are usually caused by a
viral infection and not strep bacteria. A sore throat
caused by a virus can be just as painful as strep throat. But if you have cold
symptoms such as coughing, sneezing, or a runny or stuffy nose, you probably do
not have strep throat.
What are the symptoms?
The most common symptoms of
strep throat are:
- A sudden, severe sore throat.
- Pain when you swallow.
- Fever over
101°F (38.3°C).
- Swollen tonsils and
lymph nodes.
- White or yellow spots on the
back of a bright red throat.
You may also have a headache and belly pain. Less common
symptoms are a
red skin rash, vomiting, not feeling hungry, and body
aches.
Strep throat can be passed from person to person. When a
person who has strep throat breathes, coughs, or sneezes, tiny droplets with
the strep bacteria go into the air. These droplets can be breathed in by other
people. If you come into contact with strep, it will take 2 to 5 days before
you start to have symptoms.
How is strep throat diagnosed?
Your doctor will do a physical exam, ask you about your symptoms and past
health, and do a rapid strep test to diagnose strep throat. Sometimes another
test, called a throat culture, is also needed.
If the rapid strep
test says that you don't have strep (the test is negative) but your symptoms
suggest that you do, your doctor may want to do a throat culture to be sure.
This is because rapid strep tests aren't always accurate. To do a throat
culture, the doctor will swab a sample of cells from the back of your throat.
The sample will go into a special cup (culture) where the strep bacteria can
grow over time. If strep bacteria grow, the doctor knows that you have strep.
If the rapid strep test is positive and says that you do have
strep, there's no need to do the throat culture.
How is it treated?
Doctors usually treat strep throat with
antibiotics. Antibiotics shorten
the time you are able to spread the disease to others (are contagious) and
lower the risk of spreading the infection to other parts of your body. Antibiotics also may help you feel better faster.
You are contagious while you still have symptoms. Most people stop being
contagious 24 hours after they start antibiotics. If you don't take
antibiotics, you may be contagious for 2 to 3 weeks, even if your symptoms go
away.
Your doctor may also advise you to take an over-the-counter
medicine like acetaminophen (such as Tylenol) or ibuprofen (such as Advil or
Motrin) to help with pain and lower your fever. Do not give aspirin to anyone
younger than 20. It has been linked to Reye syndrome, a serious illness.
How do you prevent strep throat?
To avoid getting
strep throat, it is a good idea to avoid contact with anyone who has a strep
infection. If you are around someone who has strep, wash your hands often.
Don't drink from the same glass or use the same eating utensils, and don't
share toothbrushes.
Bacteria can live for a short time on
doorknobs, water faucets, and other objects. It's a good idea to wash your
hands regularly.
If you have a strep infection, there are things
you can do to avoid spreading it to others. Use tissues you can throw away
instead of handkerchiefs, wash your hands often, and do not sneeze or cough on
others. Antibiotics can shorten the time that you are contagious. It is a good
idea to stay home from work or school until 24 hours after you have started
antibiotics.
Frequently Asked Questions
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Cause
Strep throat is
caused by streptococcal (strep) bacteria, most often by group A beta-hemolytic
streptococcus (GABS). Other types of strep that can sometimes infect the throat
are groups C and G strep bacteria.
A strep infection causes the
throat (pharynx) and the
tonsils or adenoids to become irritated,
inflamed, and painful.
Sore throats are
most commonly caused by
viral infections or other irritants such as smoke,
allergies, dry air, or a throat injury, and not by a strep infection.
How the strep infection is spread
Strep throat can
be passed from person to person. When a person infected with strep throat
breathes, coughs, or sneezes, tiny droplets containing the strep bacteria are
released into the air and are breathed in by other people.
Symptoms
Common symptoms of
strep throat in children and adults include:
- Severe and sudden sore throat without coughing,
sneezing, or other cold symptoms.
- Pain or difficulty with
swallowing.
- Fever over
101°F (38.3°C). Lower fevers
may point to a
viral infection and not strep.
- Swollen
lymph nodes in the neck.
- White or yellow
spots or coating on the
throat and tonsils.
- Bright red throat or dark red spots on the roof
of the mouth at the back near the throat.
- Swollen tonsils, although
this symptom may also be caused by a viral infection.
In teenagers,
mononucleosis can cause a severe sore throat that
looks like and has symptoms similar to those of strep throat. For more
information, see the topic
Mononucleosis (Mono).
It is easy to
tell when you have a sore throat or a cold. It is harder to know when you have
strep throat. Typically, sore throats are caused by a
viral infection and not strep bacteria. Strep throat
usually does not occur with cold symptoms such as
coughing, sneezing, or a runny or stuffy nose. The more cold symptoms you have,
the less likely it is that your sore throat is a strep infection.
In some cases of strep infection, a skin rash develops and spreads over
the neck and chest and eventually over the whole body. The rash feels rough
like sandpaper. This condition is called
scarlet fever. Scarlet fever is treated with
antibiotics. This usually leads to a quick recovery. Scarlet fever is not
dangerous if treated.
What Happens
Symptoms of
strep throat usually begin within 2 to 5 days after
you come in contact with someone who has a strep infection. Strep throat usually
goes away in 3 to 7 days with or without antibiotic treatment. In contrast, if
allergies or irritants are the cause of your sore throat, it will usually last
longer unless the cause is eliminated.
If strep throat isn't
treated with antibiotics, you will continue to be contagious for 2 to 3 weeks
even if your symptoms go away. You are much less contagious within 24 hours after you start antibiotics and are less likely to develop complications of the strep
infection.
Complications of strep throat
Complications of strep throat are rare but can occur,
especially if your throat infection isn't properly treated with antibiotics.
Complications can occur when the strep infection spreads to other parts of the
body and causes other infections, such as an ear or sinus infection or an
abscess on the tonsils (peritonsillar abscess). Complications can also result in your
immune system attacking itself and causing serious
conditions such as
rheumatic fever.
Treating strep throat
can greatly reduce your risk of developing rheumatic fever and its
complications. It is not clear whether treating the strep infection with
antibiotics reduces your risk of developing inflammation of the kidneys (acute
glomerulonephritis).
What Increases Your Risk
Your risk of getting
strep throat increases if you come in close contact
with others, especially children, who have a strep infection.
The
size of a child's tonsils isn't a risk factor for throat infections. Children
or adults who have had their tonsils removed can still get strep throat.
When To Call a Doctor
Call 911 or other emergency services immediately if a
severe sore throat (pain being an 8 or 9 on a scale of
1 to 10) occurs along with the following symptoms, especially in a small
child:
- Drooling
- Difficulty breathing
- Head pushed
forward to breathe
Call your doctor today if you have:
- A severe sore throat and fever over
101°F (38.3°C) that lasts
longer than 1 to 2 days.
- A severe sore throat 2 to 5 days after you
know you have been exposed to someone with strep.
- A sore throat
that is not part of a cold that lasts longer than 2 to 3 days despite home
treatment.
- A red rash that feels like sandpaper. This may indicate
scarlet fever.
- Difficulty sleeping because
your throat is blocked by swollen
tonsils or adenoids.
Call a doctor if the following symptoms develop 1 to 2
weeks or longer after a strep throat infection. These symptoms may indicate
rheumatic fever.
- Weakness
- Shortness of
breath
- Joint pain
- Raised red rash or lumps under the
skin
- Uncontrolled, jerking movements of the arms or legs
Watchful waiting
Watchful waiting is appropriate if your
sore throat occurs with symptoms like those of a cold, such as sneezing,
coughing, and a runny or stuffy nose. In general, the more of these symptoms
you have, the less likely it is that your sore throat is caused by a strep
infection. You can try home treatment if your sore throat is not severe and you
have other symptoms of a cold.
Call a doctor if:
- Sore throat is the main symptom and you have
no improvement after 2 to 3 days.
- Signs of strep throat are
present.
Who to see
The following health professionals can evaluate a sore throat, do quick
tests or throat cultures, and prescribe antibiotic treatment if needed:
If surgery to remove chronically enlarged or infected
tonsils or adenoids is suggested, you may be referred to an
otolaryngologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Strep throat is diagnosed from your medical history, a
physical exam of your throat, and a rapid strep test. A throat culture
may sometimes be done to confirm the result of the rapid strep test or when
your doctor suspects the rapid strep test result was inaccurate.
Current
treatment guidelines recommend that your doctor confirm strep throat with a
rapid strep test and not just diagnose strep throat from your symptoms.1 But your doctor may begin treatment for strep throat before
the result of your throat culture is back if you have 3 or 4 of the following
symptoms:2
- A recent fever of
101°F (38.3°C) or
higher
- White or yellow spots or coating on the throat or
tonsils
- Swollen or tender
lymph nodes on the neck
- Absence of signs
of a cold or
upper respiratory infection, such as coughing or
sneezing
One or both of the following tests are used to confirm that
you have strep throat.
- Rapid strep test
analyzes the bacteria in your throat to see if strep is the cause of your sore
throat. The doctor uses a cotton swab to gather cells from the back of your
throat for testing.
- Throat culture is also a test that analyzes cells from the back of your throat.
The cells are gathered with a cotton swab and then placed in a container with
substances that promote the growth of strep bacteria. If the strep bacteria
grow, the culture is positive. If strep bacteria do not grow, the culture is
negative.
If symptoms of strep throat are present, it is important to
be tested for strep infection. Prompt treatment will reduce the spread of strep
throat and may reduce the risk of
complications, such as the infection spreading to
other parts of your body causing ear or sinus infections or an
abscess behind or around your tonsils (peritonsillar abscess).
If you need to be
tested for strep throat, the choice between a rapid strep test and a throat
culture may not be clear. It may help to discuss with your doctor the
advantages and disadvantages of each test. For
instance, results from a rapid strep test are available within 10 to 15
minutes, and results from a throat culture may take 1 to 2 days. A throat
culture is more accurate.
- A negative rapid strep test result can mean
there are no strep bacteria present. But the rapid strep test can give negative
results even when strep bacteria are present (false-negative
test results). If the rapid strep test result is negative but strep throat is
still suspected, your doctor may order a throat culture to verify the results.
- If the rapid strep test result is positive, a throat culture isn't needed. Antibiotic treatment can be started right away. Antibiotics may not
make you well faster. But they shorten the time you are able to spread the
disease to others. Antibiotics also lower the risk of spreading the infection
to other parts of your body.
Testing is not needed:
- After antibiotic treatment, unless you still have symptoms.
Testing may be done if symptoms return or you have had
rheumatic fever and are at risk for it coming back.
- For a person who was exposed to strep but has no symptoms. For
instance, family members of a person who has strep throat do not need to be
tested unless they start to have symptoms.
It is possible for a person to carry the strep bacteria and
not have any symptoms. If a number of infections occur in the same family, or
if there have been severe complications such as rheumatic fever or
toxic shock syndrome, it may be helpful to test
family members to learn whether they are carriers of strep infection. But it is
unusual for a person to catch strep throat from a carrier.3
Treatment Overview
Antibiotics such as
penicillin, cephalexin, or amoxicillin are used to treat
strep throat. Antibiotics work only against
bacterial infections such as strep throat. They will not
help sore throats caused by
allergies or viral infections such as colds.
Antibiotics are commonly used to:
- Kill the bacteria and shorten the time you are
contagious. You are typically no longer contagious 24 hours after you start
antibiotics.
- Prevent rare
complications. Although uncommon, strep bacteria can
spread to other parts of your body, causing
ear or
sinus infections or an
abscess behind or around the tonsils (peritonsillar abscess). Antibiotics may also prevent
the infection from triggering your
immune system to attack itself and cause serious
conditions such as
rheumatic fever.
- Relieve discomfort and
speed healing to some degree.
Antibiotic treatment can begin immediately if a strep
infection is confirmed by a
rapid strep test. But there is no harm in waiting for
the results of a
throat culture to confirm strep throat before starting
antibiotic treatment. In fact, it is better to wait until strep throat has been
confirmed so that antibiotics are not used unnecessarily. Overuse of
antibiotics can make them ineffective.
Although waiting to treat strep throat may prolong
the time you have the illness, delaying treatment for a few days doesn't
increase the risk of rheumatic fever or other complications.3
Your doctor also may recommend
nonprescription medicines such as acetaminophen or
anesthetic throat sprays to help relieve the pain and discomfort caused by
strep throat. Acetaminophen will also reduce fever.
For more information, see:
-
Sore Throat: Should I Take Antibiotics?
Prevention
To avoid getting
strep throat, it is a good idea to avoid contact with
anyone who has a strep infection.
Wash your hands often when you
are around people with colds or
viral or
bacterial illnesses. Do not share toothbrushes or
eating and drinking utensils.
- Bacteria are almost always transmitted by
contact with tiny droplets from an infected person. Strep throat is passed from
one person to another by contact with the tiny droplets of an infected person's
cough, sneeze, or breath.
- Bacteria can also live for a short time
on doorknobs, water faucets, and other objects. If you touch an infected object
and then touch your eyes, nose, or mouth, you can become infected with the
bacteria or virus.
- Bacteria can also be carried on food.
Keep up your body's resistance to infection with a good
diet, plenty of sleep, and regular exercise. Managing
stress can also strengthen your body's ability to
fight off illness, such as strep throat.
Humidify your home
during the dry winter months or year-round if you live in a dry climate.
Moisture in the air (humidity) helps keep your
mucous membranes moist and more resistant to bacteria.
You can use a humidifier in the bedroom while you sleep. But use care if a
person in the home has
asthma or
allergies, because mold or other particles that
collect in the humidifier can make these conditions worse. Clean humidifiers on
a regular basis.
Stop smoking, and avoid breathing others' smoke.
Smoke irritates the throat tissues and may make you more susceptible to
infection.
Home Treatment
Your doctor may have prescribed an
antibiotic for
strep throat. Take all of the antibiotic exactly as
prescribed. This will help prevent the infection from coming back and will
prevent complications of infection that could occur if you do not take the
medicine as prescribed.
There are many ways that you can make
yourself feel better while you are waiting for the strep infection to go
away.
- Drink plenty of fluids and increase humidity (moisture in the air) in your home to help keep your throat
moist. Herbal teas formulated for colds may help relieve
symptoms.
- Take
nonprescription medicines to relieve a painful sore
throat and reduce fever.
- Get plenty of rest. Stay home the first
day of antibiotic treatment. You are still contagious and might pass the
infection to others. Rest in bed if you feel very sick. Bed rest is not
required if you feel fine.
For the first 24 hours after you start taking an
antibiotic, you are still contagious. You can avoid passing the strep throat
infection to others and reinfecting yourself by:
- Avoiding sneezing or coughing on
others.
- Washing your hands often.
- Using tissues you can
throw away, not handkerchiefs.
- Throwing out your toothbrush as soon
as you feel sick. Replace it again when you are well. You can also clean your
toothbrush well before using it again. Bacteria can collect on the bristles and
reinfect you.
Medications
Antibiotics are the treatment of choice
for a confirmed
strep throat infection.
- Antibiotics will reduce the time you are
contagious. You are usually not contagious 24 hours after starting
antibiotics.
- Antibiotic treatment for strep throat can also help
prevent some of the rare
complications related either to the strep infection
itself or to the body's
immune response to the infection. Complications of
strep throat are rare but can occur, especially if strep throat is not properly
treated.
- Antibiotics may shorten the time you are sick by about one
day.4
When antibiotics may be used
Antibiotics may be
used in the following situations:
- You have had a positive rapid strep test or
positive throat culture.
- You have three or more of the following
signs or symptoms:
- A recent fever
- White or
yellow spots or coating on the throat or tonsils
- Swollen or tender
lymph nodes on the neck
- Absence of signs of a cold or other upper
respiratory illness, such as coughing or sneezing
- You have recently had
rheumatic fever and have been exposed to strep.
Preventive antibiotics may be given in some cases.
- Several family
members are having repeated strep infections as confirmed by positive throat
cultures.
It is possible for you to carry the strep bacteria in the
throat and not have any symptoms. Antibiotics for the carrier state are usually
not needed unless you have a history of rheumatic fever or frequent infections
or infections are occurring frequently in the family.
For more information, see:
-
Sore Throat: Should I Take Antibiotics?
Medication choices
Antibiotics such as penicillin, cephalexin, or
amoxicillin are used to treat strep throat infection.
What to think about
Immediate treatment with an
antibiotic after a positive rapid strep test may not make you well faster. But
it will shorten the time you are able to spread the disease to others.
Antibiotics also lower the risk of the infection spreading to other parts of
your body. But there is no harm in delaying medicine treatment 1 to 2 days to
wait for the results of a throat culture. Antibiotics will prevent rheumatic
fever even if it is started up to 9 days after symptoms begin.3
Surgery
If
strep throat continues to recur, you and your doctor
may decide that you need surgery to remove the tonsils (tonsillectomy). Surgery is
considered when you:
- Have recurring episodes of strep throat or
tonsillitis in a single year despite antibiotic
treatment.
- Have
abscesses around the tonsils that do not respond to
drainage, or if an abscess is present in addition to other signs that you may need tonsillectomy.
- Have persistent bad odor or taste in the mouth,
which is caused by tonsillitis that does not respond to
antibiotics.
- Need a
biopsy to evaluate a suspected tumor of the
tonsil.
Large tonsils are not an indication for tonsillectomy
unless they are causing one of the above problems or they are blocking the
upper airway, which can cause
sleep apnea or problems with eating.
Surgery choices
Tonsillectomy may be done in some
cases of strep throat.
An
abscess around the tonsils (peritonsillar abscess) may be treated with a simple procedure in which a small
incision is made to drain the abscess, although removing the tonsils is
appropriate in some of these cases.
What to think about
Tonsillectomy is no longer
routine for children who have frequent sore throats. Surgery has been shown to
reduce the number of throat infections for 2 years. But over time many children
who did not have surgery also had fewer throat infections.5
When you are trying to decide whether to have
your or your child's tonsils removed, consider:
- How much time you or your child is missing
from work or school because of throat infections.
- How much stress
and inconvenience the illness places on the family.
The risks of surgery must also be weighed against the
risks of leaving the tonsils in. In some cases of persistent strep throat
infections, especially if there are other complications, surgery may be the
best choice.
Other Treatment
There is no other treatment
for
strep throat at this time.
Other Places To Get Help
Organizations
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Centers for Disease Control and Prevention
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| |
| 1600 Clifton Road |
| Atlanta, GA 30333 |
| USA |
| |
| Phone: |
1-800-CDC-INFO (1-800-232-4636)
|
| TDD: |
1-888-232-6348 |
| Email: |
cdcinfo@cdc.gov |
| Web Address: |
www.cdc.gov/getsmart |
| |
|
The Get Smart Web site at the Centers for Disease Control and Prevention (CDC) provides information for both consumers and health professionals on the appropriate use of antibiotics. The Web site explains the dangers of inappropriate use of antibiotics and gives tips on actions people can take to feel better if they have an infection that cannot be helped by antibiotics. Some materials are available in English and in Spanish.
|
|
|
American Academy of Otolaryngology—Head and Neck Surgery
(AAO-HNS)
|
| 1650 Diagonal Road |
| Alexandria, VA 22314-2857 |
| Phone: |
(703) 836-4444 |
| Web Address: |
www.entnet.org |
| |
|
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.
|
|
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Centers for Disease Control and Prevention
(CDC)
|
| 1600 Clifton Road |
| Atlanta, GA 30333 |
| Phone: |
1-800-CDC-INFO (1-800-232-4636) |
| TDD: |
1-888-232-6348 |
| Email: |
cdcinfo@cdc.gov |
| Web Address: |
www.cdc.gov |
| |
|
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.
|
|
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KidsHealth for Parents, Children, and
Teens
|
| 10140 Centurion Parkway North |
| Jacksonville, FL 32256 |
| Phone: |
(904) 697-4100 |
| Fax: |
(904) 697-4220 |
| Web Address: |
www.kidshealth.org |
| |
|
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
|
|
|
National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health
|
| NIAID Office of Communications and Government Relations |
| 6610 Rockledge Drive, MSC 6612 |
| Bethesda, MD 20892-6612 |
| Phone: |
1-866-284-4107 toll-free |
| Phone: |
(301) 496-5717 |
| Fax: |
(301) 402-3573 |
| TDD: |
1-800-877-8339 |
| Web Address: |
www.niaid.nih.gov |
| |
|
The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
immune-system-related diseases.
|
|
References
Citations
- Bisno AL, et al. (2002). Practice guidelines for the
diagnosis and management of group A streptococcal pharyngitis. Clinical Infectious Diseases, 35(2): 113'125.
- McIsaac WJ, et al. (2004). Empirical validation of
guidelines for the management of pharyngitis in children and adults.
JAMA, 291(13): 1587'1595.
- American Academy of Pediatrics (2009). Group A
streptococcal infections. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp.
616'628. Elk Grove Village, IL: American Academy of Pediatrics.
- Mar CB, et al. (2006). Antibiotics for sore throat.
Cochrane Database of Systematic Reviews (4). Oxford:
Update Software.
- Paradise JL, et al. (2002). Tonsillectomy and
adenotonsillectomy for recurrent throat infection in moderately affected
children. Pediatrics, 110(1): 7'15.
Other Works Consulted
- American Heart Association (2009). 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 the Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics. Circulation, 119(11): 1541'1551.
- American Public Health Association (2008). Streptococcal diseases caused by group A (beta hemolytic)
streptococci. In DL Heymann, ed., Control of Communicable Diseases Manual, 19th ed., pp. 577'587. Washington, DC: American
Public Health Association.
- Kenealy T (2008). Sore throat. Online version of
BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
- Low DE (2012). Nonpneumococcal streptococcal infections, rheumatic fever. In L
Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed.,
pp. 1823'1829. Philadelphia: Saunders.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
|
Sarah Marshall, MD - Family Medicine |
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Specialist Medical Reviewer
|
Donald R. Mintz, MD - Otolaryngology |
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Last Revised
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April 17, 2012 |
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