Strep throat isn’t the most common cause of a sore throat, but it can be one of the most painful. Aside from the telltale pain, other characteristic symptoms of strep include swollen lymph nodes and a red rash in your mouth.
Strep throat is caused by a type of bacteria called Group A Streptococcus. The infection is more common in school-age kids than adults, but it can happen to anyone.
If left untreated, it can also cause serious problems, like rheumatic fever, heart valve damage, and sepsis or blood poisoning.
The good news is that strep throat is easily treated with antibiotics if it’s diagnosed correctly. “It would not be good if someone were to not come in to get a diagnosis and then end up with complications when it is so easy to treat,” says Aaron Prussin, MD, assistant professor of otolaryngology-head and neck surgery at the University of Utah School of Medicine. Antibiotics can help someone with strep feel better faster and prevent those complications.
Know these signs of strep throat so you can zap it early.
Not surprisingly, a fiery sore throat is the hallmark symptom of strep throat, and it is often one of the earliest symptoms. The sore throat also makes it painful to swallow.
Sore throats can be a sign of many other illnesses, notably upper respiratory infections like colds or tonsillitis. This makes it difficult–but not impossible–to tell the difference.
A sore throat from strep usually comes on quickly, not slowly, and lasts more than a day or two. It also doesn’t come with typical cold symptoms like a cough, runny or stuffy nose, or hoarseness.
“None of those other symptoms are seen in streptococcal sore throat, or at least not typically,” says Michael Grosso, MD, chair of pediatrics and chief medical officer at Huntington Hospital in New York.
Treatment with a course of antibiotics, usually in the penicillin class, may shorten the duration of strep but, importantly, the meds also prevent more serious complications.
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Swollen lymph nodes
Swollen lymph nodes indicate that your body is mobilizing immune cells to fight an infection. In the case of strep throat, it’s usually the lymph nodes in the front of your neck that are swollen and painful–and you’ll know it. “[They’re] not subtle lumps and they’re tender,” says Mark E. Rupp, MD, professor and chief of the division of infectious diseases at the University of Nebraska Medical Center.
But even if your lymph nodes do feel swollen, only a lab test ordered by your doctor can tell if you have strep for sure. “Whether symptoms are caused by strep or a viral infection can only be determined by a strep screen and culture,” says Dr. Prussin.
There are two ways to diagnose strep throat. One is a throat culture, a swab of your throat for bacteria that has to be analyzed in a lab, which usually takes a couple of days to come back. The other is known as a “rapid strep test” with results that come back in as little as an hour. If a rapid test is negative but all other signs still point to strep, your doctor might then order a throat culture, which tends to be more accurate.
Make sure you have a correct diagnosis before you get treated with antibiotics.
Another classic symptom of strep throat is a fever. It’s one among “a constellation of symptoms physicians have traditionally been trained to look for that are more indicative of strep throat,” explains Dr. Rupp.
The presence of a fever can help differentiate strep from a sore throat caused by a cold, which usually doesn’t cause an elevated temperature. “We look for the absence of symptoms that are more indicative of a viral upper respiratory infection, like cough and nasal congestion,” he says.
Although symptoms can be different, strep is spread much the same way as colds and other respiratory infections: through droplets expelled by sneezing or coughing. If you come in with those droplets, you might pick up the bug. As with colds and the flu, washing your hands and avoiding touching your face are good ways to prevent the spread of strep.
Tonsils are actually lymph nodes in the back of the mouth and they, too, become enlarged with strep throat.
The larger size of the tonsils should be obvious when you look at the back of your throat. “Open your mouth wide and shine a light directly in or bounce it off a mirror,” says Dr. Rupp. The tonsils may also look red or have white patches or streaks.
You can still get strep even if you don’t have tonsils, though it’s not as common.
If someone is getting strep frequently, doctors often recommend having the tonsils removed. “It probably means bacteria are just hanging out in the tonsils,” Dr. Prussin says. If you’ve had three bouts of strep a year for the last three years, five infections a year for the last two years, or a whopping seven infections in the past year, you might be a good candidate for the surgery, he says, although those guidelines can be adjusted person to person.
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Red spots or rash
A red rash, called petechiae, often appears toward the back of the roof of the mouth in people with strep throat. “When we see the spots on the roof of the mouth, we can say with a fairly high grade of confidence that we’re looking at strep,” says Dr. Grosso (although you still need a lab-confirmed diagnosis).
A red rash on the skin also caused by group A strep bacteria is known as scarlet fever and can accompany strep throat. This is very different from the scarlet fever that was a leading cause of death among children in the 18th and 19th centuries. “That’s not the clinical behavior of the condition we see [now],” says Dr. Grosso. Scarlet fever related to strep throat is mild and should go away quickly with a course of antibiotics.
Nausea and vomiting as a result of strep throat aren’t all that common. If they do happen, it’s more often in younger children.
It’s more likely that nausea and vomiting are a result of a viral infection, says Philip G. Chen, MD, assistant professor and program director of rhinology in the otolaryngology-head and neck surgery department at the University of Texas Health Science Center, not a bacterial infection like strep.
However, everyone’s experience with strep throat is slightly different. The chemicals your body creates as the immune system ramps up to fight an infection can lead to a number of symptoms, including fatigue, nausea, vomiting, fever, and more, Dr. Chen says. “Talk to your physician about your specific symptoms.”
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Headaches are another possible symptom of strep throat, especially in children over the age of three. Again, the presence of other strep throat symptoms and a lab test can confirm this.
Without a sore throat, it’s more likely your headache is due to some other cause. “It’s important to be a little judicious about doing testing where it’s unlikely to be strep,” Dr. Grosso says. Over-testing can lead to over-treatment with antibiotics. Overuse of these meds can contribute to antibiotic resistance, when strains of bacteria become resistant to treatment.