A sore, scratchy throat is often the first sign that you're getting sick. Most sore throats are caused by viral infections and usually go away on their own in a few days.

Only a small portion of sore throats are the result of strep throat. But it's important to identify this bacterial throat infection for a number of reasons. Unlike other causes of sore throat, strep throat is treatable. The bacteria that cause strep throat respond quickly to antibiotics, and treatment stops the infection from spreading to other people. If not treated, strep throat infections can sometimes result in more serious complications.

Signs and symptoms

In general, signs and symptoms of strep throat include:

Throat pain
Difficulty swallowing
Red and swollen tonsils, sometimes with white patches or streaks
Swollen, tender lymph glands in the neck
Fever
Headache
Rash
Stomachache and sometimes vomiting, especially in younger children

It's possible to have many of these signs and symptoms but not have strep throat. The cause of these signs and symptoms could be a virus, tonsillitis or other illnesses. That's why your doctor may test specifically for strep throat.

It's also possible to have streptococcal bacteria in the throat without a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria don't make them sick.

Causes

The cause of strep throat is bacteria known as Streptococcus pyogenes, or group A beta-hemolytic streptococcus. These bacteria are highly contagious. They can spread through airborne droplets when someone with the infection coughs or sneezes. Children can also pick up the bacteria from a doorknob or other surface and transfer them to their noses or mouths. Kitchen utensils and bathroom objects are other common sources of infection transmission.

Risk factors

Strep throat occurs most commonly in children between the ages of 5 and 15. The infection tends to circulate in late fall, winter and early spring, but strep throat peaks in the fall and spring, while viruses peak in the winter. Strep bacteria flourish wherever groups of people are in close contact. That's why they spread easily among family members, in schools and in child-care settings.

When to seek medical advice

Call your doctor if you or your child has any of these signs and symptoms:

A sore throat without a cold or runny nose
A sore throat accompanied by tender, swollen lymph glands
A sore throat that lasts longer than 48 hours
A fever higher than 103 F in older children, or any fever lasting longer than 48 hours
Rash
Severe headache
Joint pain
Problems breathing or difficulty swallowing anything, including saliva

Sometimes symptoms can occur even after your child has finished treatment for strep throat. Call your doctor if your child develops a fever — or has pain or swelling in the joints, shortness of breath or a rash — after a strep infection. These can be indicators of rheumatic fever.

Screening and diagnosis

Doctors usually diagnose the cause of a sore throat on the basis of a physical exam and lab tests. During the exam, your doctor will look for signs and symptoms of strep throat, such as fever and enlarged lymph nodes, and will probably also use a tongue depressor to get a clear look at the throat and tonsils. He or she will check for redness, swelling and white streaks or pus on the tonsils. There also may be tiny red spots on the soft palate — the area at the back of the roof of the mouth. Although these signs indicate an infection, there's no way to tell by looking whether it's viral or bacterial. In fact, some viral throat infections look worse than infections caused by streptococcal bacteria.

For that reason, your doctor is likely to use one or more of the following tests to check for the presence of bacteria, including streptococcal bacteria:

Throat culture. This simple test can check for the presence of bacteria, such as streptococcal bacteria. For this test, a sterile swab is rubbed over the back of the throat and tonsils to get a sample of the secretions. It's not a painful procedure, but it may cause brief gagging. The sample is then cultured in a laboratory, but results may take as long as two days.
Rapid antigen test. Because of the waiting period for a throat culture, your doctor may also order a rapid antigen test on the swab sample. This test can detect strep bacteria in minutes by looking for foreign substances (antigens) in the throat. If you or your child tests positive for strep bacteria, antibiotic treatment can be started right away. But rapid strep tests have a downside. They may miss as many as 20 percent of strep throat infections. For this reason, many doctors still use throat cultures, especially if results of the rapid test are negative.
Rapid DNA test. Newer rapid tests use DNA technology to detect strep throat in a few hours. These tests may be more sensitive than other rapid tests, eliminating the need for multiple tests.

Complications

Although strep throat in itself isn't dangerous, it may lead to serious complications if left untreated. These complications include other infections, such as:

Tonsillitis or a collection of pus around the tonsils caused by infection
Sinusitis
Ear infections
Scarlet fever, an illness characterized by a rash

Strep throat may also lead to inflammation of the kidney and rheumatic fever.

However, the risk of developing severe complications from strep throat is low.

Treatment

If diagnosed with strep throat, your doctor will likely prescribe an oral antibiotic. These antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to classmates or family members.

Once treatment begins, your child should start feeling better in just a day or two. If children on antibiotic therapy feel well and don't have a fever, they often can return to school or child care when they're no longer contagious — usually 24 hours after beginning treatment. But be sure to finish the entire course of medicine. Stopping medication early may lead to recurrences and serious complications, such as rheumatic fever.

In addition to antibiotics, your pediatrician may suggest giving your child acetaminophen (Tylenol, others) to relieve throat pain and reduce fever. Because of the risk of Reye's syndrome, a potentially life-threatening illness, don't give aspirin to young children. Be careful with acetaminophen, too. Taken in large doses, it can cause serious problems. Talk to your doctor or pharmacist if you have questions.

Prevention

Proper hand cleaning is the best way to prevent all kinds of infections. That's why it's important to clean your own hands regularly and to teach your children how to clean their hands properly, using soap and water or an alcohol-based hand sanitizer.

In addition, teach your children to cover their mouths when they cough or sneeze. And if your child does have strep throat, be sure no one else uses his or her drinking glass and eating utensils. Wash those items carefully in hot, soapy water or in a dishwasher.

Self-care

In most cases, antibiotics will quickly wipe out the bacteria behind the infection. In the meantime, try these tips to relieve symptoms of strep throat:

Get plenty of rest. Sleep helps the body fight infection. Keep your child at home until there's no sign of fever and he or she feels better.
Drink plenty of water. Keeping a sore throat lubricated and moist eases swallowing. Drinking plenty of water also helps prevent dehydration.
Eat soothing foods. Foods that are easy on a sore throat include broths, soups, applesauce, cooked cereal, mashed potatoes, soft fruits, yogurt and soft-cooked eggs. You may even want to puree foods in the blender to make them easier to swallow. Very cold foods such as sherbet, frozen yogurt or frozen fruit pops may also be soothing. Don't give your child spicy foods or acidic foods such as orange juice.
Gargle with warm salt water. For older children and adults, gargling several times a day can help relieve throat pain. Mix 1/2 to 1 teaspoon of table salt in 8 ounces of warm water. Be sure to tell your child to spit out the liquid after gargling.
Use a humidifier. Adding moisture to the air can help ease discomfort. Moisture keeps mucous membranes in the throat from becoming dry and even more irritated. Choose a cool-mist humidifier and clean it daily, because bacteria and molds can flourish in some humidifiers. Saline nasal sprays also help to keep mucous membranes moist.
Stay away from irritants. Cigarette smoke can irritate a sore throat and increase the likelihood of infections such as tonsillitis. In addition, don't expose your child to fumes from paint or cleaning products, which can be irritating to the throat and lungs.
Plan low-key activities for a sick child. If your child tests positive for strep throat, he or she should take antibiotics for at least 24 hours before returning to school or child care. When staying home with your child, plan some low-key activities that you both will enjoy. These can be things you don't normally have time to do, such as reading a favorite book aloud.

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Childhood illnesses

Fifth Disease

Does Your Child Have a Cold or the Flu

Is it a Cold or Allergies

Strep Throat