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Strep Throat Solutions: When Sore Throats Get Serious

Medically reviewed by Carmen Fookes, BPharm. Last updated on July 7, 2022.

Sore Throats: Numerous Causes, Not All Serious

Sore throats are common. Most are caused by viruses, but throats can also become sore as a result of smoking, allergies, air irritants (such as pollution, air conditioning), or yelling too much. Bacteria can also occasionally cause sore throats or complicate an already existing viral sore throat.

Sometimes it is easy to identify the cause. Viral sore throats are generally accompanied by cold symptoms, such as a runny nose, watery eyes, or a cough. Sore throats caused by pollutants generally get better once the person extracts themselves from the cause - whether it be smoking or bad air.

Bacterial sore throats tend to come on quickly and are more likely to affect children rather than adults. They have a higher chance of complications and generally require more attention than other sore throat causes. Although many different types of bacteria can cause a sore throat, Streptococcus pyrogene bacteria, a type of Group A streptococci, are the most commonly seen. Sore throats caused by S. pyrogenes are referred to as Strep throats.

Strep Throats: Always Be Mindful As A Possible Cause

Generally, Strep sore throats tend to be very painful and symptoms persist for a lot longer than sore throats due to another cause. Swallowing may be particularly difficult.

Other symptoms that are more likely to occur with a Strep throat include:

  • A very red and swollen-looking throat and tonsils; sometimes streaks of pus or red spots on the roof of the mouth are visible
  • Headache
  • Fever and chills
  • Swollen and tender glands (lymph nodes) in the neck
  • Vomiting or nausea (mostly in children).

Some people are susceptible to the toxins (poisons) produced by the S. pyrogenes bacteria, and develop a bright red rash that feels like sandpaper to the touch. A rash caused by S. pyrogenes bacteria is known as Scarlet Fever (also called scarlatina). Although it usually follows a sore throat, it may also occur after school sores (impetigo).

Scarlet Fever: The Rash That Feels Like Sandpaper

Untreated, as many as one in ten children with Step throat will develop Scarlet Fever, although the incidence is markedly reduced with timely antibiotic use. Children over the age of three at preschool or people exposed to overcrowded environments such as boarding schools or military camps are most at risk.

Most cases occur in children between the ages of five and fifteen, particularly those exposed to other people with scarlet fever. In older teenagers and adults, the condition is less common because most people have developed antibodies to the toxins produced by S. pyrogenes which prevent the toxins from having an effect on other tissues.

The rash typically starts on the neck, underarm or groin as small, flat red blotches that gradually become fine bumps and feel rough to the touch. In the body folds (such as in the armpits, elbows, and groin) the rash may appear a brighter red (called Pastia's lines). Facial flushing is common although a pale area may remain around the mouth. After seven days, the rash fades and some skin peeling may occur over the next month or longer, particularly around the fingertips, toes and groin area.

Left Untreated Scarlet Fever Can Be Deadly

Left untreated, Scarlet fever may progress to:

In the pre-antibiotic era, death occurred in 15-20% of people with Scarlet fever. Nowadays, most people fully recover within four to five days with antibiotics.

Rheumatic Fever: Higher Prevalence In American Samoans

Rheumatic fever can develop following a Strep throat infection or scarlet fever. Although rare in the contiguous U.S., the disease is still prevalent in children of Samoan descent living in Hawaii and residents of American Samoa.

Symptoms of rheumatic fever usually manifest 14 to 28 days after a S. pyrogens infection. Because the bacteria trick the body's immune system into attacking healthy tissues, the disease can affect the heart, joints, skin, and the brain. Symptoms of rheumatic fever include:

  • Fever
  • Abdominal pain
  • Chest pain or shortness of breath
  • Joint swelling, pain, redness, or warmth
  • Nose bleeds
  • A rash on the upper part of the arms or legs (usually ring-shaped or snake-like)
  • Skin nodules or lumps
  • Unusual crying or laughing or quick jerky movements of the face, hands, or feet.

Rheumatic fever has the potential to cause life-long cardiac problems if not treated promptly or properly. Antibiotics are effective at preventing the disease if administered within nine days of symptoms. Children who develop rheumatic fever may need regular penicillin injections until the age of 21 or for 10 years after diagnosis.

Throat Swab Can Determine If Your Sore Throat Is Strep Throat

A throat swab taken by a doctor and then cultured in a laboratory is the only way to definitively tell if a sore throat is a Strep throat. If the result is positive, your doctor will prescribe antibiotics to prevent any complications, reduce symptoms, and prevent spread to other people.

S. pyrogens bacteria are easily transmitted and can be spread by coughing or sneezing or after coming into contact with infected droplets, and then touching your mouth, nose or eyes. Transmission of bacteria can also occur via contact with people with Scarlet fever, or other group A skin infections. Without treatment, people are contagious for one to two weeks after symptoms appear.

The best way to prevent infection is to wash your hands often and always before eating or after being in contact with an infected person. Do not share utensils, linen, or personal items. People with Strep throat or scarlet fever should stay home for at least 24 hours after starting antibiotics or until they feel well enough to return to school or work.

Treatment Is With Antibiotics For Ten Days

Penicillin or amoxicillin are the most common antibiotics used to treat Strep throat.

Treatment is usually given for ten days and liquid antibiotics can be given to children who are unable to swallow tablets or capsules. Some patients may benefit from a single shot of penicillin intramuscularly. Erythromycin is typically used in people allergic to penicillin.

Completing the full course of antibiotics is very important, even though symptoms usually resolve within four to five days. Symptom resolution does not necessarily mean all the infection has been cleared from the body, and incomplete courses encourage the development of resistant bacteria.

Fingernails should be kept short to discourage scratching if a rash is present and soft foods and cool drinks are kinder on a painful throat.

Other Treatments To Help Ease Symptoms

Acetaminophen (Tylenol) may also be taken to ease the pain of the sore throat, and sucking throat lozenges can also help. Natural remedies such as honey, slippery elm, licorice, and marshmallow root are also soothing.

If an itch is present, antihistamines such as cetirizine (Zyrtec) taken orally may stop the urge to scratch and the skin should be kept moisturized with emollients.

Finished: Strep Throat Solutions: When Sore Throats Get Serious

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  • Group A Streptococcal (GAS) Disease. Centers for Disease Control and Prevention Updated Nov 2022
  • Scarlet Fever. NHS Choices.
  • Scarlet Fever. Updated Sept 2015. Dermnet NZ
  • Scarlet Fever. Centers for Disease Control and Prevention. 2022.
  • Rheumatic Fever. Medline Plus. US National Library of Medicine. 2022

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.