Streptococcal Pharyngitis: Causes, Symptoms, Diagnosis, Complications, Treatment and Prevention

Knowing if you or your child have strep is essential so you can receive the proper treatment.

Bacteria are responsible for cases of group A beta-hemolytic streptococcal pharyngitis, being the most common bacterial etiology.

A positive antigen rapid detection test can be considered a definitive test for treatment; a negative result should be followed by a confirmatory culture when strep throat is strongly suspected.

Treatment goals include

  • prevention of suppurative and non-suppurative complications,
  • reduction of clinical signs and symptoms,
  • reduction of bacterial transmission, and
  • minimization of adverse effects of antimicrobials.

The selection of antibiotics must be made carefully due to allergies that occur in some patients. Patient education can help reduce recurrence.

Causes of strep throat

Pharyngitis caused by group A beta-hemolytic streptococci, commonly called “strep throat,” has an incubation period of two to five days and is most common in children five to 12 years of age.

The disease can occur in groups and is most often diagnosed in the winter.


Group A beta-hemolytic streptococci are transmitted by direct person-to-person contact, probably through droplets of saliva or nasal secretions and crowding.

Outbreaks resulting from human contamination of food during preparation have also been reported.

Most cases of beta-hemolytic streptococcal pharyngitis are acute illnesses with a predominant sore throat, a temperature above 38.5 ° C, fever, chills, myalgias, headaches, and nausea.

Physical findings may include petechiae on the palate, pharynx, tonsils, erythema, exudates, and cervical adenopathy. However, many patients do not fit the image of textbooks. Children, for example, may present with abdominal pain or vomiting.

Symptoms of strep throat

A sore throat is the main sign that your child has strep.

Colds and other viruses can also cause a sore throat. One way to tell the difference is that a virus can often cause a runny nose.

With strep, a sore throat comes on quickly. Your throat feels raw, and it hurts to swallow.

Strep is also more likely to cause these other symptoms:

  • A fever of 101 F or higher.
  • Swollen and red tonsils.
  • White patches in the throat.
  • Small red spots on the roof of the mouth.
  • Loss of appetite
  • Stomach ache.
  • Headache.
  • Nausea, vomiting
  • Eruption

Call your doctor if you or a child in your care has these symptoms.

How is it diagnosed?

Your doctor will ask about your child’s symptoms. A test is the only sure way to detect strep from other viruses that cause a sore throat. There are two kinds:

Rapid Strep Test – Can identify a case in just a few minutes. The doctor will gently hold down your child’s tongue with a depressor.

Then, you will use a cotton swab to remove some mucus from the back of your throat.

You will get results in 20 minutes or less. If the test is positive, which means there is strep, the doctor will prescribe antibiotics to treat it.

If the test is negative, which means that the strep bacteria could not be found, the doctor may send the sample to a lab for a longer follow-up.

Throat culture: You will rub the throat swab sample into a particular dish. If your child has strep throat, strep bacteria will grow in him.

It usually takes about two days to get results from a throat culture. You can confirm whether your child has strep throat or not.

When to see a doctor

Call your doctor if you or your child have any of these signs and symptoms:

  • A sore throat accompanied by tender and swollen lymph glands.
  • A sore throat that lasts more than 48 hours.
  • Fever greater than 101 F (38.3 C) in older children or fever that lasts more than 48 hours.
  • A sore throat accompanied by a rash.
  • Trouble breathing or swallowing
  • If strep has been diagnosed, there is a lack of improvement after taking antibiotics for 48 hours.

Possible complications of strep throat

Strep complications are rare today, thanks to better diagnosis and treatment. However, untreated strep can cause serious illnesses, such as:

  • Sinus or tonsil infections.
  • Rheumatic fever can damage the heart, brain, and joints.
  • Kidney disease is called glomerulonephritis.

Prompt treatment with antibiotics can help prevent these problems.


Although penicillin is effective, it has drawbacks. About 10% of patients are allergic to penicillin, and sticking to a dosing schedule of four times a day could be difficult.

The intramuscular route can overcome dosing compliance problems, but injection is excruciating.

Amoxicillin is less expensive and has a narrower spectrum in antimicrobial activity, given once a day. Suspensions of this drug taste better than penicillin suspensions.

However, side effects such as gastrointestinal problems and skin rashes can occur.

Erythromycin is recommended as the first alternative in patients allergic to penicillin; being better absorbed when administered with food and is as effective as penicillin. However, studies have shown that 15 to 20% of patients cannot tolerate its effects.

The broad spectrum of Azithromycin allows for daily administration and a shorter course of treatment.

It is also associated with a low incidence of gastrointestinal side effects, and a four-day course of this antibiotic is as practical as a 10-day course.

Self-care tips

Try these home treatments to ease symptoms:

  • Gargle with a mixture of a quarter teaspoon of salt and 8 ounces of warm water.
  • Take ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to lower fever and relieve pain. Do not give aspirin to children or teenagers. It can cause a rare but dangerous condition called Reye’s syndrome.
  • Suck on a throat lozenge or a piece of hard candy. Do not give small sweets to children under four years of age.
  • Drink hot liquids like tea and broth. Alternatively, suck on something cold, like ice cream.
  • Get plenty of rest.

How to prevent it from spreading

Please keep your child out of school or daycare until the fever is gone and they have taken antibiotics for at least 24 hours—the same for you and your workplace.

Other tips:

  • Do not share cups, plates, forks, or other personal items with someone sick.
  • Ask children to cover their mouths with a tissue or sleeve every time they cough or sneeze.
  • Have everyone in the house wash their hands or use an alcohol-based hand sanitizer many times a day.

Prevention of strep throat

To prevent strep infection:

  • Clean your hands: Proper hand cleaning is the best way to prevent all kinds of infections. This is why it is essential to wash your hands regularly and teach your children to wash their hands properly with soap and water or an alcohol-based hand sanitizer.
  • Cover your mouth: Teach your children to cover their mouths when coughing or sneezing.
  • Do not Share Personal Items – Do not share glasses or eating utensils—Wash dishes in hot soapy water or a dishwasher.