Strep throat also called the streptococcal sore throat, is a highly contagious infection caused by a type of bacteria called Group A Streptococcus bacteria (group A strep). It infects the throat and the tonsils.
Although there are many types of bacteria that can cause throat infections, Streptococcus or strep is the most common cause of bacterial sore throat.
While both viruses and bacteria can cause a sore throat, with strep, the sore throat is usually more severe, and it often begins suddenly. In addition, strep throat, unlike a common cold or flu sore throat, doesn’t have accompanying symptoms like a cough and runny nose.
Strep throat is known as a childhood disease but anyone can get it. It accounts for 20–30 % of sore throats in children and 5–15% in adults. Children and teens between ages 5 and 15 are the most susceptible to get strep throat.
How does it spread?
Strep bacteria are spread through direct contact with mucus from the nose or throat of infected people. It can also be transmitted through the air by sneezing or coughing.
Although symptoms can be different, strep is spread much the same way as colds, flu, and other respiratory infections, through droplets expelled by sneezing or coughing. If a person comes in contact with those droplets, there is a big chance they might pick up the bug.
Due to it being highly contagious, people with strep throat should stay home from work or school. If left untreated, strep can spread quickly from person to person. A person can still be contagious for up to 24 hours of starting antibiotics.
How is it diagnosed?
No one, not even a doctor, can diagnose strep throat just by looking at the throat. Together with a physical examination of the symptoms, tests will also be conducted.
A rapid strep test can be done by taking a quick swab sample from the throat. These can diagnose strep throat within minutes. If the result comes out negative but the doctor still suspects strep throat, he can do a throat culture.
A throat culture is done by quickly rubbing a sterile swab at the back of the throat to check for the presence of the streptococcus bacteria. It will be then sent to a laboratory for further examination. It usually takes 24 to 48 hours for throat culture results to come in.
What are the symptoms?
There is a myriad of symptoms that physicians have been traditionally trained to look for that are more indicative of strep throat. These symptoms help differentiate it from other similar diseases.
Symptoms of strep throat develop one to four days after exposure to the bacteria via airborne droplets or by direct contact with an infected person. The symptoms of strep throat are as follows:
1. Fever and chills
Fever is a sign that the body is fighting off an infection. The streptococcal bacteria cause inflammation in the throat and tonsils which prompts the body to raise its temperature to deal with the infection. The immune system raises the body’s temperature to make it harder for the bacteria to survive.
A normal person’s temperature ranges between 36°C-37°C or 98°F-100°F. Strep throat results in a fever that could go as high as 102°F. It can begin suddenly and is often the highest on the second day.
Also, the presence of a fever can help to differentiate strep from a sore throat caused by a cold, which usually doesn’t cause an elevated temperature.
Chills is described as the shaking, shivering and cold feeling that often accompanies fever. When a person has a fever, the body’s temperature is higher than that of its environment. As a result, muscles rapidly contract and relax in an effort to produce body heat. As the body temperature goes up, the person may feel cold until it levels off and stops rising.
2. Sore throat
There is often confusion when it comes to a painful sore throat. Many people have a hard time telling whether it is due to colds or if it is strep throat.
A majority of sore throats are caused by viruses, most commonly the cold and flu viruses. They tend to get better by themselves, usually in a day or two and have a very low chance of complications. Other symptoms like cough, runny nose or congestion follow this type of sore throat.
A sore throat due to strep, on the other hand, has a higher chance of complication and requires more attention. It is more painful than a regular sore throat brought about by common colds or the flu. The throat also feels raw and swallowing becomes very painful. It is the hallmark symptom of strep throat, and it is often one of the earliest symptoms
The pain starts quickly unlike other kinds of sore throat that are felt gradually. Throat pain typically starts suddenly one to five days after exposure to the bacteria. Not only is the pain more severe, but it also persists for several days.
3. Difficulty in breathing
Bacterial infection may result in the infection and inflammation of structures around the throat area. An example of such a structure is the epiglottis.
The epiglottis is a flap of tissue at the base of the tongue. When a person swallows, the epiglottis stops solid food and liquids from going down through the voice box and windpipe to the lungs.
Difficulty in breathing can occur if the epiglottis gets infected or inflamed. In severe cases, the inflamed epiglottis, or epiglottitis, can obstruct or close off the windpipe which may turn fatal unless promptly treated.
A headache, also known by its medical term cephalgia, is a common symptom of strep throat. While headaches are common and usually nothing to worry about, a trip to the doctor would be best especially if the headache is accompanied by fever. Headaches and fever are a sign of an infection happening in the body.
In strep throat, the bacteria can also affect the ears. This can create a buildup of liquid inside the middle ear. This buildup causes pressure and pain in and around the ear and produces a headache.
Headaches caused by an infection doesn’t easily get better with over-the-counter pain medicines.
5. Loss of appetite
People with strep throat could lose their appetite and find it difficult to eat regular meals. They may also experience an abnormal sense of taste.
Throat pain especially when swallowing can discourage anyone who is sick with strep throat from eating. Adding to that, other accompanying strep throat symptoms, like fever, can also cause a loss in appetite.
When a bacterial infection is trying to get hold within the body, the immune system sends hormones to the brain to trigger responses that could help fight the infection. One of these responses is a loss of appetite.
Losing appetite is the body’s way of starving the bacteria because it can live off from the glucose that comes from food.
6. Nausea and vomiting
Nausea is a feeling of unease in the stomach that is usually followed by vomiting or the forcible removal of the stomach’s contents. These symptoms may occur separately or together. Both nausea and vomiting are very common symptoms for many diseases and can be caused by a wide range of factors.
For people who are sick with strep throat, nausea and vomiting are not usually common but they do happen especially in younger children.
Nausea and vomiting can happen due to other symptoms of strep throat like a high fever or headache. The strep bacteria can also affect the stomach and cause a stomach ache in children which then leads to nausea and/or vomiting. It can also lead to an imbalance in the system-senses, like in the ears, that could make a person feel nauseous and have the urge to vomit.
7. Ear pain
Ear pain may include dull or sharp stabbing pain in one or both ears. There could also be muffled hearing or a feeling of fullness.
Strep throat is an infection caused by bacteria that can sometimes travel into the eustachian tubes (a pair of narrow tubes that connect the middle ear to the throat area) and middle ear, causing an ear infection. Middle ear infections, also called acute otitis media, affect the space behind the eardrum.
There is usually swelling, fluid buildup and irritation inside the ear which can cause pain. Ear pain is felt the most when swallowing.
8. Small, red spots on the roof of the mouth
Tiny, red spots called petechiae seen are caused by any number of fungal, viral and bacterial infections. But for those people with strep throat, these rashes often appear toward the back of the roof of the mouth. It is one of the most common symptoms of strep throat.
Petechiae is a sign that blood is leaking from the small capillaries found under the skin. Capillaries are tiny blood vessels that connect arteries to veins. They also help move oxygen and nutrients from the bloodstream to the various organs and tissues. These leaks are caused by an illness, infection or some medication. The bleeding causes the petechiae to appear red, brown or purple.
By itself, petechiae is not a serious condition. In bacterial infections, it can be dealt with antibiotic but it can be also a sign of something more serious. That is why it is very important to be checked by a doctor to determine the cause and be given prompt and proper medical treatment.
9. White patches on the tonsils and throat
These white patches are pus pockets. They may appear only on the tonsils or it may appear around the tonsils and throughout the mouth. It may look like streaks in the back of the throat or blotches on or around the tonsils.
Pus is a natural result of the immune system fighting an infection. It is mostly a buildup of dead white blood cells that form when the body’s immune system responds to an infection.
They are often accompanied by a raw and scratchy feeling in the throat. Difficulty in swallowing can also be experienced.
While these patches in themselves are not life-threatening, complications of the related throat infection can be. If there are other symptoms that accompany these white patches, it is best to seek medical help. These white patches may also be a symptom of other diseases and only a doctor can determine the actual underlying cause.
10. Swollen and tender lymph nodes in the neck
Swollen lymph nodes are a sign that the immune system is fighting a strep throat infection. As the infection is trying to set in, the body will send white blood cells to fight it. The lymph nodes swell when they get full of white blood cells and other debris.
Lymph nodes act as filters or checkpoints for viruses, and abnormal or diseased cells that pass through the lymph channels.
The swollen lumps can be as small as a bean or as big as a cherry. They are also described to be painful to the touch or hurt with certain movements like turning the head or with chewing.
As the antibiotics eliminate the infection, the lymph nodes would gradually revert back to its normal size and the discomfort along with it goes away too.
Complications of strep throat can develop if the bacterium causing the infection spreads to other parts of the body.
- Rashes (Scarlet fever) – This is characterized by a bright red rash on the body, usually accompanied by a high fever and sore throat. It was once a serious childhood complication of strep throat but antibiotic treatments have made it less threatening. Still, if left untreated, it can result in more serious conditions that may affect the heart kidneys and other parts of the body.
- Middle ear infection – This arises when the bacteria from a throat infection travels to the eustachian tubes and middle ear.
- Sinus infection – Strep infection is capable of affecting the nasal cavity, sinuses, and the face due to its close proximity to the throat area.
- Pneumonia- The bacteria that create strep throat can spread to other parts of your body, like the lungs, if antibiotics don’t kill them.
- Meningitis – This is the infection to the lining of the brain and spinal canal that can take place due to untreated strep throat infection
- Kidney disease – Strep throat can cause inflammation in the kidneys.
- Rheumatic fever – A rare but potentially life-threatening complication of strep throat because of the danger it poses to the heart.