A complete guide to strep throat infection

[4 MIN READ]

In this article:

• Strep throat is a bacterial infection caused by Group A streptococcus. Infection rates tend to go up during “strep season,” which typically lasts from December through April.

• The number of people diagnosed with a serious strep infection reached a record high last year. The increase in illness has mostly affected adults, according to the CDC. 

• A family medicine doctor at Providence talks about strep throat – its symptoms, causes, how it spreads, prevention and treatment options. 

Tea with honey could be the ideal way to toast the season this year – strep throat season, that is.

Cases of strep throat increase every December through April, making those months “high season” for the common infection. And children are not the only ones who can be affected. Over the past decade, strep infections have increased primarily in adults, with numbers reaching an all-time high in 2023, according to the Centers for Disease Control and Prevention (CDC). 

We talked to Vahe Mooradian, M.D., a Providence family medicine doctor at Facey Medical Group – Northridge, about recognizing strep throat and tips to keep the infection from derailing your holiday season. Here’s what he shared.

What is strep throat?

“Strep throat is a bacterial infection in your throat and tonsils that causes inflammation, swelling and soreness. Strep throat affects both children and adults, but the condition is most common in children between 5 and 15 years old,” says Dr. Mooradian.

Group A streptococcus and strep throat

The “strep” in strep throat is short for Streptococcus bacteria. There are several types of Streptococcus bacteria. Group A is responsible for most cases of strep throat.

In addition to strep throat, Group A strep bacteria also causes: 

• Cellulitis and other flesh-eating diseases, such as necrotizing fasciitis
• Impetigo skin infection
• Scarlet fever
• Toxic shock syndrome 

How strep throat spreads

It’s very easy to share strep germs, according to Dr. Mooradian. The infection spreads through tiny droplets that are sprayed into the air when someone with strep coughs or sneezes. 

“Strep throat is extremely contagious. It’s spread by person-to-person contact with fluids from your nose or saliva,” says Dr. Mooradian. “Strep throat is contagious until you have been treated with antibiotics that kill the bacteria responsible for your aching throat.” 

Anyone can get strep, but according to the CDC, several factors can increase your risk, including:

• Being between 5 and 15 years old
• Close contact with someone who has strep throat
• Crowded settings such as daycare centers, schools or senior centers
• Having a job that puts you in frequent contact with children, such as a healthcare provider or teacher
• Having a school-age child or a child in daycare

Common symptoms of strep throat

Symptoms of strep throat appear within two to five days after you’ve been exposed to the strep germ. They range from mild to severe, depending on the infection. 

“Symptoms of strep throat typically have a rapid onset and include painful swallowing, redness and inflammation in the throat, particularly around the tonsils,” says Dr. Mooradian. “Additionally, some people may develop a rash. In some children, vomiting can occur.”

Other symptoms of strep throat may include: 

• Fever that begins suddenly and is often higher on the second day of infection
• Headache and nausea
• Pain when swallowing
• Swollen lymph nodes
• White spots on the throat

Symptoms that differentiate strep from a viral infection

You can have a sore throat and not have a strep infection. In fact, more sore throats are caused by viruses than by bacteria. Dr. Mooradian suggests taking stock of your symptoms and calling your doctor if you’re showing strep signs.

“Viral infections often include symptoms like cough, body aches and sometimes flu- or COVID-like symptoms. Strep rarely presents with a runny nose, sinus congestion or cough. That can help differentiate it from viral infections,” he explains.

Diagnosing strep throat 

Your doctor can often rule out strep throat based on your symptoms, such as a runny nose or cough that indicates a viral infection. They will also check your throat and lymph nodes for signs of swelling and inflammation and ask about other health issues you may be experiencing.

For a definitive diagnosis, you will need a strep test. There are two types: a rapid strep test and a throat culture.

How a rapid strep test works

“To diagnose strep throat, clinics often use a rapid strep test, which provides fast results and is approximately 90% effective,” says Dr. Mooradian.

During the rapid stress test, your doctor uses a long cotton swab to retrieve a sample of mucus or fluid from the back of your throat. Test results are available within 15 minutes or less.

When a throat culture is needed

“If a rapid test for strep is negative but clinical signs strongly suggest it, a throat culture can be ordered. Results take two to three days. In cases of mild fever, a doctor might wait for culture results, but more severe symptoms may warrant immediate treatment,” says Dr. Mooradian.

Treatment options for strep throat

Treatment for strep throat usually involves amoxicillin, a penicillin-based antibiotic. For those allergic to penicillin, several alternative medications are also effective. The important thing is to eliminate the bacteria that's making you ill. And for that, you need antibiotics, according to Dr. Mooradian.

“Home remedies, such as tea with honey, may address your symptoms, but they won't eliminate the bacteria making you ill. Antibiotics are necessary to treat the bacterial infection and prevent complications,” he says. 

It’s important to finish all the medication as prescribed – even if you don’t feel like you’re sick anymore – to ensure all the Group A bacteria are destroyed. If you stop taking your antibiotics too soon, any remaining bacteria can linger in your throat and prompt another round of illness and the potential for serious complications.

Home remedies and over-the-counter medications for soothing symptoms

Although over-the-counter medications and home remedies cannot kill bacteria, they can relieve symptoms and soothe a sore throat. 

According to the National Institutes of Health, the following tips could help you feel better:

• Drink plenty of warm liquids, such as tea with honey or lemon.
• Gargle with warm salt water several times a day.
• Suck on throat lozenges or hard candies.
• Try pain medication (such as acetaminophen or ibuprofen) to reduce fever and body aches.
• Use a cool mist vaporizer or humidifier to moisten the air.

Tonsillectomy

“Tonsillectomy, or surgical removal of the tonsils, may be considered if you experience frequent strep infections,” says Dr. Mooradian. “Frequent is defined as seven or more infections in one year, five infections per year over two years, or three infections per year over three years.”

Possible complications of untreated strep throat

Strep symptoms typically get better within a week of starting treatment.

“If left untreated, however, the infection can lead to more serious health issues like rheumatic fever, which can affect the heart, kidneys and other organs,” says Dr. Mooradian. “Rare but serious complications include abscess formation around the tonsils and strep-related kidney infections.”

How to prevent the spread of strep throat

“To prevent infection, it's essential to maintain a healthy immune system through good sleep and nutrition and avoid sharing food or drinks with someone with strep,” says Dr. Mooradian.

These tips from the American Academy of Family Physicians can also help prevent strep throat:

• Avoid sharing utensils (such as glasses, spoons or forks) while sick.
• Cover your mouth when you sneeze or cough.
• Replace your toothbrush after you’ve finished your course of antibiotics.
• Wash your hands frequently.

Is strep contagious? How to protect others

Strep throat is contagious, and individuals should remain isolated and on antibiotics for at least 24 hours before being around others, says Dr. Mooradian. 

When it’s safe to return to work or school 

How do you know when it’s safe to return to work or send your child back to school?

Give it time, says Dr. Mooradian. “Most people with strep are contagious until they’ve been on antibiotics for 24 to 48 hours. You should stay home until you're fever-free and you’ve been on antibiotics for at least a full day,” he explains.

When to see a doctor for strep throat

Contact your doctor if you experience any warning signs of strep throat. You should also seek professional medical care if you don't feel better within 24 to 48 hours of starting treatment.

“As a parent, you might consider calling a doctor if your child complains of pain when swallowing, or if younger children are refusing milk, vomiting or running a fever,” says Dr. Mooradian. 

Contributing caregiver

Vahe Mooradian, M.D., is a Providence family medicine doctor at Facey Medical Group – Northridge.

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Related resources 

Does your child have a sore throat or strep? 

Does your child have a cold, or is it seasonal allergies? 

Kids’ Respiratory Illnesses 101

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.