Strep Throat: Symptoms, Signs, and Complications

Strep throat is a bacterial infection with a number of classic signs and symptoms, such as:

• Sore throat
• Swelling in the back of the throat
• Enlarged tonsils
• Bad breath
• Fever
• Chills
• Headaches
• Decreased appetite

All of these can occur with bacterial or viral infections, so the signs and symptoms alone cannot be used to diagnose strep throat.

If you have signs and symptoms of step throat, your doctor will determine if strep testing is necessary.

This article explains common symptoms and complications related to strep throat and when to get emergency medical attention.

Frequent Strep Throat Symptoms

The most common signs and symptoms of strep throat include:

• Sore throat, especially when swallowing
• Fever and chills 
• Headaches
• Fatigue and lack of energy
• Decreased appetite
• Enlarged lymph nodes, which may feel like lumps on your neck or in your armpits 
• Small red or purple spots on the roof of your mouth
• Swelling and redness at the back of your throat
• White patches on the back of your throat
• Halitosis (bad breath)

Strep throat most often affects children ages 5 to 15. Children may show similar symptoms to adults but are more likely to have headaches, stomach pain, or nausea and vomiting.

After being exposed to the bacteria, it may take a few days before you start feeling sick. This period is known as the incubation period.

When you begin to experience symptoms or notice signs, you should start taking precautions not to infect those around you. You can spread the infection to other people through sneezing and coughing. You can also spread the infection by touching objects if your hands have been in contact with your saliva and mucus. Covering your mouth when coughing or sneezing, avoiding sharing beverages, and regular hand washing can help.

Rare Symptoms

Some less common symptoms of strep throat include:

• Nausea and vomiting
• Rash on your chest and neck
• Abdominal pain
• Muscle aches
• Stiff joints
• Painful lymph nodes

Having these symptoms doesn’t necessarily mean your infection is more dangerous or likely to cause serious complications.

Urgent Signs and Symptoms

Strep throat is rarely dangerous, but it can sometimes lead to medical emergencies.

Complications of Strep Throat

Strep throat can lead to serious complications, although they are rare. These complications are more likely if your infection isn’t treated or if your immune system is weak. In some cases, complications may occur without a clear reason.

Complications are generally divided into two categories: suppurative (pus-forming) and non-suppurative (non-pus-forming). While these terms are more relevant to healthcare providers, they influence your treatment options.

Pus-Forming Complications 

These may require an intervention such as surgery to drain the pus.

The three most common pus-forming complications that can occur after strep throat are:

• Peritonsillar abscess: An abscess is a walled-off collection of bacteria that may create a bump, and it can form behind and in front of the tonsil due to strep throat. This may begin two to eight days after a sore throat and may be associated with having an antibiotic-resistant infection. 
• Otitis media: An infection of the middle ear can develop. It is often characterized by pain, fever, and fluid drainage. 
• Sinusitis (sinus infection): Most of the time, sinusitis is a mild infection caused by a virus, but when it occurs as a complication of strep throat, it is caused by a bacterial infection and requires antibiotic treatment. 

Non-Pus-Forming Complications

These are often treated with oral or intravenous medication that works to treat the whole body.

Common non-suppurative complications that can occur after strep throat include:

• Arthritis may develop, which is characterized by swollen joints and generalized pain.
• Generalized swelling can occur throughout the body, especially in the abdomen, face, eyes, feet, ankles, or hands.
• Rheumatic fever may result from an autoimmune reaction to the infection. The antibodies that your body forms against the strep bacteria may react against your own tissues. Rheumatic fever can affect your heart, joints, and brain and result in chronic rheumatic heart disease.
• Scarlet fever can result from strep throat, brought on by an erythrotoxin produced by the bacteria. Warning signs of scarlet fever include changes in the color or amount of your urine, severe joint pain, high fever, rash, seizures, or other neurological changes. Scarlet fever is usually accompanied by a sandpaper-like rash and sometimes a red bumpy tongue, in addition to other strep throat symptoms.
• Post-streptococcal glomerulonephritis, a kidney condition that may occur after strep throat, can be very serious, resulting in kidney failure. Symptoms include decreased urine output, rust-colored urine, and bloody urine.
• Toxic shock syndrome (TSS) is an uncommon complication.
• Henoch-Schonlein purpura, an autoimmune syndrome associated with Group A strep, results in low platelets and bruising. Other serious symptoms may also occur involving the kidneys and digestive tract.

Other Causes of Throat Pain

Other conditions are easy to mistake for strep throat, such as the common cold. In fact, the most common cause of throat pain is typically a virus. Common symptoms of viruses that you should not expect to experience if you have strep throat include:

• Runny nose
• Cough
• Hoarse voice
• Pink or crusty eyes
• Diarrhea

Mononucleosis is another condition that can be similar to strep throat. Both cause sore throat, but mononucleosis does not cause enlarged tonsils or red and white patches in the throat. People with mononucleosis also experience extreme fatigue.

Viral infections normally improve on their own. The antibiotics used for treating strep throat are not beneficial if you have a viral infection. Strep throat can only be diagnosed with a rapid strep test or throat culture, so it is best to see a healthcare provider if you or your child have a sore throat that does not improve after 48 hours.