Strep throat, or streptococcal pharyngitis, is a throat infection caused by group A Streptococcus bacteria. It is most common in children aged 5 to 15. Unlike most sore throats, which are caused by viruses and get better on their own, strep throat is treated with antibiotics. Proper treatment matters because untreated strep can lead to rheumatic fever and permanent heart valve damage, which remains a problem in many African countries.
Key facts
- Most sore throats are viral. Only about 1 in 3 sore throats in children, and fewer in adults, is caused by strep.
- Strep throat usually starts suddenly with fever and a painful throat, without cough or runny nose.
- A rapid test or throat swab confirms it.
- A full course of penicillin or amoxicillin is the usual treatment.
- Treating strep throat prevents rheumatic fever and rheumatic heart disease.
How it spreads
Strep bacteria spread through droplets from coughs and sneezes, and through sharing cups, utensils or food with an infected person. It spreads easily in schools, homes and crowded places. Symptoms usually begin 2 to 5 days after exposure.
Symptoms
- Sudden sore throat and pain when swallowing
- Fever
- Red, swollen tonsils, sometimes with white patches or streaks of pus
- Tiny red spots on the roof of the mouth
- Swollen, tender lymph nodes in the front of the neck
- Headache, stomach ache, nausea or vomiting, especially in children
- Sometimes a fine, sandpaper-like rash (scarlet fever)
Cough, runny nose, hoarse voice and red eyes suggest a viral infection instead.
Diagnosis
Symptoms alone cannot reliably tell strep from a viral sore throat. A health worker may use:
- A rapid antigen test from a throat swab, with results in minutes
- A throat culture, which takes one or two days but is more accurate
Where testing is not available, health workers use scoring systems based on symptoms to decide who needs antibiotics.
Treatment
- Antibiotics: penicillin V or amoxicillin, usually for 10 days. People allergic to penicillin can take alternatives. An injection of benzathine penicillin is another option.
- Finish the full course, even when you feel better after a day or two. Stopping early increases the risk of rheumatic fever.
- Pain and fever relief: paracetamol or ibuprofen.
- Comfort: drink fluids, eat soft foods, gargle with warm salt water (adults and older children).
- People are usually no longer contagious 12 to 24 hours after starting antibiotics. Stay home from school or work until then.
Complications
- Rheumatic fever: an immune reaction 2 to 4 weeks after untreated strep, causing joint pain, fever, and inflammation of the heart. Repeated attacks can permanently damage heart valves (rheumatic heart disease).
- Kidney inflammation (post-streptococcal glomerulonephritis), causing dark urine and swelling
- Peritonsillar abscess, a collection of pus beside the tonsil
- Scarlet fever
- Rarely, invasive group A strep infections
- Guttate psoriasis in some people
Prevention
- Wash hands often.
- Cover coughs and sneezes.
- Do not share cups, cutlery or toothbrushes.
- Replace your toothbrush after starting treatment.
- People who have had rheumatic fever may need regular antibiotic injections to prevent further attacks. Follow your doctor’s advice.
When to see a doctor
See a health worker for a sore throat with fever and no cough, a sore throat lasting more than a week, or swollen neck glands. Seek urgent care for difficulty breathing or swallowing saliva, drooling, being unable to open the mouth fully, a muffled voice, or a stiff neck.
Frequently asked questions
Do all sore throats need antibiotics?
No. Most are viral and get better within a week. Antibiotics only help when bacteria such as strep are the cause.
Can adults get strep throat?
Yes, though it is less common than in children. Parents of school-aged children are more often affected.
