Strep Throat

What is strep throat?

Strep throat is a bacterial infection of the throat and tonsils caused by group A Streptococcus. It spreads through respiratory droplets and close contact. Children 5 to 15 years old are most commonly affected, but anyone can get it.

Symptoms of strep throat

Common symptoms include:

• Sore throat that starts suddenly
• Pain with swallowing
• Fever
• Red, swollen tonsils that may have white patches
• Swollen, tender glands in the front of the neck
• Tiny red spots on the roof of the mouth (petechiae)

Children may also have headache, nausea, vomiting or stomach pain. A sandpaper-like rash can occur with strep throat and is called scarlet fever. Cough, runny nose, hoarseness, mouth sores or pink eye point more to a viral sore throat than strep.

What causes strep throat?

Strep throat is caused by group A strep bacteria. It spreads easily in households, schools, daycare and other crowded settings through droplets from coughing or sneezing, or by sharing utensils.

How is strep throat diagnosed?

Your doctor will examine your throat and may do one or both of these tests:

• Rapid strep test (RADT): a throat swab that gives results in minutes.
• Throat culture: a lab test that can detect infections a rapid test may miss.

If a child or teen has strep symptoms and a negative rapid test, a throat culture should be done. Adults usually do not need a culture after a negative rapid test. Testing is not needed when clear viral symptoms are present.

Can strep throat be prevented or avoided?

You can lower your risk and protect others by:

• Washing hands often
• Covering coughs and sneezes
• Not sharing cups or utensils
• Staying home from work, school or daycare until fever is gone and after at least 12–24 hours of appropriate antibiotics, per current guidance.

Strep throat treatment

If a rapid test or culture confirms strep throat, antibiotics are recommended. They help you feel better faster, reduce spread to others and prevent rare complications like rheumatic fever or certain kidney problems. Penicillin or amoxicillin are first-line choices; your doctor will choose another antibiotic if you are allergic. Resistance to penicillin has not been reported in group A strep, but macrolide resistance (for example, azithromycin) can vary by region. Always take the full course as prescribed.

What can make my sore throat feel better?

• Acetaminophen or ibuprofen for pain and fever (do not give aspirin to children or teens)
• Warm salt-water gargles
• Throat lozenges or ice chips for older children and adults
• Rest and plenty of fluids
  (Avoid spicy or acidic foods if they worsen pain.)

Note on aspirin: because of the risk of Reye syndrome, use acetaminophen or ibuprofen for children and teens unless your doctor specifically recommends aspirin for another condition. (General pediatric guidance.)

Living with strep throat

Most people start to feel better within 24–48 hours of starting antibiotics. You are generally less contagious after 12–24 hours of appropriate antibiotics and when your fever has resolved. If symptoms are not improving after 48 hours on antibiotics, call your doctor. Recurrent strep can happen; sometimes a household member may carry the bacteria without symptoms.

When should I seek care or urgent help?

Call your doctor or seek urgent care if you have:

• Trouble breathing, drooling, severe difficulty swallowing or a muffled “hot potato” voice
• Severe neck swelling or worsening one-sided throat pain (possible abscess)
• A rash plus sore throat and fever
• Signs of dehydration or your child seems very ill