Strep throat is a common respiratory disease that tends to affect more children than adults, but it can affect anyone at any age. And while it tends to be somewhat more prevalent in the winter months, strep throat can strike at any time of the year.
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"Strep throat is a bacterial infection of the throat caused by group A strep bacteria (Strep pyogenes)," says Dr. Rajsree Nambudripad, an integrative medicine specialist with St. Jude Medical Center in Fullerton, California. "It is considered a serious sore throat that needs to be diagnosed and treated with antibiotics to prevent the spread and also to prevent complications."
Although children are more likely to develop strep throat, adults still can get it, Nambudripad says."For example, up to three in 10 children with a sore throat will have strep throat. In adults, only about one in 10 adults with a sore throat will have strep throat," but those who work with children are more likely to come down with it, she says. "If you have school-aged children or work in a school or day care, you have a higher chance of contracting strep throat." Similarly, "adults who work in crowded places like military training camps are also more likely to get strep throat."
Dr. Sophia Tolliver, a family medicine physician at the Ohio State University Wexner Medical Center, says strep infections are most commonly diagnosed in children aged five to 15 years.
She also notes that that group A streptococcus infections can be invasive or non-invasive. Non-invasive infections can result in:
- Strep throat.
- Scarlet fever. A red rash over much of the body accompanied by sore throat and high fever.
- Impetigo. A skin infection that causes red sores typically on the face, hands and feet.
- Ear infections.
Invasive group A strep infections can result in serious complications including:
- Impetigo. Some cases of impetigo – a highly contagious skin infection causing red sores on the face – can be very severe and painful.
- Rheumatic fever. A rare condition that can cause pain in the joints, skin problems, involuntary movements and lasting damage to the heart.
- Heart disease. Damage to the heart valves can result from untreated strep that causes rheumatic fever.
"Unfortunately, the CDC does not track non-invasive group A strep infections," Tolliver says. "However, it's estimated that between 11,000 to 13,000 cases of invasive group A strep occur each year in the United States."
Know the Signs of Strep Throat
If you've been feeling a little under the weather, keep an eye out for the following seven signs and symptoms that may signal you're dealing with more than just a garden variety cold and may have a case of strep instead.
- Sore throat. The condition's hallmark symptom is a very sore throat. It tends to come on suddenly, and can be very intense.
- Painful swallowing. Because the tissues in the throat become inflamed and swollen, this can make swallowing difficult and very painful.
- Absence of cough. With a common cold caused by a virial infection, you'll typically have a cough. But with strep throat, this is less likely, Nambudripad says. "'Absence of cough' is a classic way that doctors distinguish strep throat from viruses." Nasal congestion and body aches are also more commonly associated with viruses than a strep infection.
- Red or swollen tonsils. The tonsils are two lymph nodes that sit on either side of the back of your throat. They're part of your immune system and the first line of defense when there's an infection in the throat. Your tonsils may also show white patches or streaks of pus.
- Swollen lymph nodes. The lymph nodes on either side of your neck may also show signs of battling an infection in your throat by swelling and becoming tender.
- Headache or abdominal pain. Headache and stomach pain are common with strep throat. While it's less common in adults than children, you may also experience nausea or vomiting.
- High fever. The CDC reports that pain and fever without a cough are common signs of strep throat.
Diagnosis and Treatment
Not just a sore throat, strep can become a dangerous condition, and you should take the possibility of having strep throat seriously. "It's best to see your doctor to figure out if you have a viral throat infection or strep throat. Your doctor can use their clinical judgment and also a rapid strep test in the office to see if you may have strep throat," Nambudripad says. "If you have classic symptoms, but a negative rapid strep test, your doctor can send a throat culture to the lab to make sure you don't have strep throat."
Once strep has been diagnosed, you'll be given antibiotics to kill the bacteria that are causing the infection. "Strep throat is treated with antibiotics in both children and adults," Nambudripad says. A 10-day course of penicillin or amoxicillin are the most common treatments. "In adults, a simple Z-pack (azithromycin) might be used for convenience, but be aware that resistance to azithromycin is common in some communities."
However, not everyone can take penicillin because of potentially dangerous allergic reactions. If you have a penicillin allergy, you may be given alternative antibiotics such as cephalexin, cefadroxil, azithromycin, clarithromycin or clindamycin, Nambudripad says.
When strep is correctly diagnosed and treated, relief usually comes quickly. "Most people with strep throat notice they feel significantly better within one to two days of starting antibiotics. If you truly have a viral infection, you won't feel much difference with the antibiotics. Most viral infections last for about one week," Nambudripad says.
She also encourages people to use antibiotics responsibly, closely following the doctor's orders so as to not encourage the development of antibiotic resistance. "It's best to take the most narrow-spectrum antibiotic for strep throat to prevent antibiotic resistance and other side effects. For example, if you can take penicillin for your strep throat, this is preferred over taking something stronger like Augmentin (amoxicillin/clavulanate) which is typically reserved for more serious infections."
Though it might be tempting to pile on a strong antibiotic if you're not feeling well, she says "stronger antibiotics won't clear your strep throat faster, and they're more likely to cause digestive side effects," such as nausea and diarrhea. "They are also more likely to disrupt your gut microbiome (the bacterial ecosystem in the gut) and lead to a serious infection of the colon called C. diff colitis which presents with profuse, watery diarrhea."
Prevent the Spread
Strep throat is spread by contact with bodily fluids, such as nasal secretions or saliva. The good news is that "only people with active strep throat infection are contagious," Nambudripad says.
But even if you're not certain whether someone else has an active strep infection, you should always try to limit contact with sneezes and coughs and other fluids that may transmit not only strep, but a wide variety of other common viruses and bacteria that can cause illness.
Prevention is always the best option, and Tolliver offers a few tips for limiting the spread of the strep bacteria via saliva and mucus:
- Remember to wash your hands often.
- Avoid sharing eating utensils and dishes.
- Cover all coughs and sneezes.
- Change toothbrushes after antibiotic treatment begins.
