There are two different germs that cause sore throats: viruses and bacteria. Most sore throats are caused by viruses. The one that comes on suddenly is caused by bacteria (germs) called “strep,” short for streptococci (strep toe KAW ki). If untreated, it can lead to complications and be spread to others.
Strep throat is contagious (can be spread to others). The strep bacteria hang out in the nose and throat. When the infected person coughs, sneezes or talks, the germs go into the air. The germs are then breathed in or caught by touching something that the germs are on (contaminated). Strep throat is most common in school age children but anyone can be infected with strep.
Antibiotic medicine must be given as soon as possible to prevent the strep germs from spreading in the body. The bacteria can cause damage to the kidneys or to the heart (Rheumatic fever). Rheumatic fever can cause painful and swollen joints, a specific type of rash, or harm the heart.
There are some people with strep who should not be given antibiotics. Strep bacteria can sometimes live on children’s throats without causing illness. As many as 1 in 5 children are “strep carriers.” This means that they have no symptoms, they are not contagious and their throat strep test stays positive even after taking antibiotics. If your child gets a sore throat and you know that he or she is a strep carrier, the doctor will treat it like a virus.
A child with strep throat, may have some or all of these symptoms:
- Sore throat, especially when swallowing
- Bright red, swollen tonsils, sometimes with white patches or streaks of pus
- "Strawberry" look to the tongue or tiny red spots on the back roof of the mouth
- Swollen, tender glands in the neck
- Headache, irritability or fussiness
- Sleeping more than usual
- Poor appetite, nausea or vomiting, especially in younger children
- Pain in the abdomen (tummy)
- A red rash on the body that "feels like sandpaper." It may appear 12 to 48 hours after the first symptoms. This is known as scarlet fever or scarlatina.
When a child has a cough, hoarseness, red eyes and runny nose, it may be due to a virus, the flu or a different illness rather than strep.
The health provider will examine your child, check for signs and symptoms and do a strep test.
A sample will be taken from the throat and tested. Two cotton-tipped swabs will be swiped over the back of the throat and tonsils. This should not hurt but may cause your child to gag. The lab will do one or more tests on the sample.
- Rapid strep test screen (rapid antigen test): The test usually takes up to half an hour. You will be asked to wait until the test results are read. A “positive” test means your child has strep throat caused by bacteria. If the rapid strep test screen is negative and the doctor still suspects strep, a follow-up test will be done.
- Second test to confirm the rapid strep test: Your child will not need another throat swab done for a follow-up test. The same sample will be tested in a different way to confirm the result of the rapid strep test. If the second test is positive, you will be notified the next day so that your child can be treated with antibiotics. A negative test means the sore throat is likely caused by a virus and does not need antibiotics.
Strep carriers do not need to have repeated strep tests done. Doing throat swabs on children who are strep carriers may cause them to take antibiotics that they do not need.
Treatment with antibiotics
A positive strep test must be treated with antibiotic medicine within a few days to prevent the germs from causing problems. Antibiotics are not given to strep carriers or to treat viruses because and they will not be effective. Antibiotics can have side effects such as diarrhea and rash.
Antibiotic medicine is usually taken by mouth but may be given by injection. Your child should start feeling better within a day or two.
It is very important to take all the medicine for ten days, as ordered, even after starting to feel better (Picture 1). When antibiotics are not used correctly (such as taking too much, missing doses or not finishing a prescription), some bacteria can develop resistance. Resistance can make infections very hard to treat. Sometimes they cannot be treated at all.
If your child is allergic to penicillin, be sure to tell the doctor. Another medicine will be prescribed.
Comfort and care
- If your child has a fever or throat pain, give acetaminophen (such as Tylenol®) or ibuprofen (Advil®, Motrin®) as directed. Read the label to know the right dose for your child. Do not give aspirin or products that contain aspirin.
- Give your child lots of liquids, such as water, Pedialyte, apple juice or popsicles. Give small amounts of liquid often.
- Give soft foods that are easy to swallow, such as applesauce, mashed potatoes, hot cereal or eggs. Your child may not want to eat much if it hurts to swallow.
- To soothe a sore throat offer:
- For children over age 1, warm fluids such as chicken broth or apple juice
- For children over age 4, throat or cough lozenges or throat sprays. Read the label to know the right dose for your child. Do not use throat sprays that contain benzocaine, as this could cause a drug reaction.
- For children over age 6 who are able to gargle without swallowing, a mixture of ½ teaspoon of table salt in 8 ounces of warm water. Swish and gargle the mixture 2 to 3 times a day for the next few days. Do not let your child swallow the salt water; have him spit it out.
How to protect others
- Everyone should wash hands often with soap or hand sanitizer. Good handwashing prevents the spread of infection.
- Cover the mouth when coughing or sneezing. Give your child a paper bag and have him put his used tissues in the bag. Moisture from the child's nose and mouth is contagious.
- Do not share drinking cups or eating utensils.
- Throw away your child's toothbrush and buy a new one as soon as the illness is over. (Strep throat germs may still be on your child's toothbrush.)
- Keep your child away from others for 24 hours after the medicine is started and until he has no fever.
- Tell the school nurse and your child’s teacher that your child has strep throat. It is important for school personnel to know so that other parents can be told to watch for symptoms in their children.
- If anyone in the family gets a sore throat, he should be checked by a doctor to see if medical treatment is needed.
When to call the doctor
- has a fever more than 102˚F that lasts more than 2 days after taking an antibiotic
- has a sore throat that lasts more than 3 days after taking an antibiotic
- develops a rash or diarrhea after taking antibiotics
- Starts drooling, cannot talk or voice becomes muffled
When to return to school or daycare
Your child should stay home from school or childcare until he has taken antibiotic medicine for 24 hours and has no fever.
HH-I-122 11/89, Revised 10/17 Copyright 1989, Nationwide Children’s Hospital