We’ve all experienced the discomfort of a sore throat. It could be due to various reasons, from the common cold and flu to COVID-19 or seasonal allergies. But it might also be strep throat, a bacterial infection that, while it can occur anytime, is more prevalent in late autumn, winter, or early spring. Knowing what to anticipate is crucial to determine if you’re dealing with strep throat or just a viral infection.
Strep throat, medically known as streptococcal pharyngitis, is a common ailment, leading to approximately 5.2 million outpatient visits in the U.S. each year. It’s also responsible for about 2.8 million antibiotic prescriptions annually for non-Medicare age patients, according to the Centers for Disease Control and Prevention. While it can affect anyone, strep throat is most common among children aged 5–15 years and is less frequent in children under 3. Group A strep pharyngitis typically peaks during winter and spring in the U.S.
To provide clarity on this common infection, we consulted with medical experts, Dr. Whitney Hardy, a family physician and associate medical director for primary care at Ochsner Health in Gretna, Louisiana, and Dr. Nikita Patel, a pediatrician at Ochsner Health in Marrero, Louisiana. They shared key insights on what patients should understand about strep throat, including its duration and how to manage it effectively.
Understanding Strep Throat: A Bacterial Infection
“Strep throat is a bacterial infection of the throat and tonsils,” explains Dr. Hardy. “The key difference between strep throat and other causes of sore throat—which are mostly viral—is that strep throat is specifically caused by bacteria.”
Dr. Patel adds, “A specific bacterium called group A Streptococcus is responsible for a range of symptoms. It causes the typical sore throat symptoms we recognize as strep throat.”
How Quickly Do Strep Throat Symptoms Appear?
Strep throat symptoms can manifest rapidly. “Strep throat can present in various ways, depending on age,” Dr. Patel notes. “In individuals over 3 years old exposed to strep throat, common symptoms often include fever, sore throat, and fatigue.”
“Patients might also experience headaches and abdominal pain,” Dr. Patel continues. “Looking at the back of the throat, you may see redness and sometimes white patches of exudates, which look like pus or streaks.”
Dr. Hardy mentions, “In more severe cases, there can be swelling in the neck glands.”
Strep Throat Symptoms vs. Viral Sore Throat: The Cough Factor
“When discussing symptoms, it’s important to differentiate strep throat from viral pharyngitis or a viral sore throat,” says Dr. Hardy. “One key differentiator is the presence of a cough.”
“Typically, strep throat does not involve a cough, meaning you won’t cough up phlegm,” she clarifies. “You’ll primarily have fever, sore throat, and other symptoms. A cough suggests a viral illness because strep throat mainly affects the upper respiratory tract, not the lower respiratory tract.”
Strep Throat in Babies: Atypical Presentation
In children younger than 3, strep throat is less common and may not present with the typical sore throat. “In younger children, strep throat might manifest with significant congestion and fatigue,” Dr. Patel explains.
“This is where a detailed medical history is crucial,” she emphasizes. “If we learn that an older sibling who attends school has similar symptoms, we need to consider the possibility of strep throat in the younger child and whether testing is necessary.”
Contagious Nature of Strep Throat and Incubation Period
“One challenge with strep throat is its incubation period. During the two-to-five-day window before symptoms fully appear, an individual can still be contagious,” Dr. Hardy points out. “Strep throat is highly contagious and primarily spreads through respiratory droplets.”
Dr. Patel elaborates, “If someone doesn’t practice good hand hygiene or cover their mouth when coughing or sneezing, they can release particles from the back of their throat. These droplets can also temporarily live on surfaces, facilitating spread.”
Diagnosing Strep Throat: The Importance of Testing
“Two common tests are available to confirm strep throat. The most common is the rapid antigen test, which uses swabs,” Dr. Patel explains. “These tests may use two swabs at once to collect a sample from the back of the throat or tonsils.”
Dr. Hardy notes that rapid strep tests are convenient for in-office use. “We can get results in about 15 minutes.”
“Another test, the rapid molecular test, is gaining popularity,” she adds. “It’s more expensive but requires only a single swab sample from the throat or tonsils.”
“Because the rapid molecular test is more accurate, a throat culture is usually unnecessary,” Dr. Patel mentions. “The traditional rapid test sometimes yields false negatives, which is why a throat culture, where bacteria growth is checked, is sometimes sent out as a follow-up.”
Alt text: A pediatrician gently swabs the throat of a young child to perform a rapid strep test in a clinic, ensuring accurate diagnosis of potential strep throat infection.
How Long Does Strep Throat Last and What Affects Recovery Time?
Addressing the key question, “How Long Does Strep Throat Last depends on the individual,” Dr. Hardy states. “With antibiotics, most people improve within about five to seven days.” This is the typical duration of strep throat when treated promptly.
“Recovery can take longer in some cases, especially if it’s a severe infection,” she adds. “Older individuals or those with weakened immune systems might need more time to recover from strep throat.”
Regarding contagiousness, “Typically, you are no longer contagious within 24 to 48 hours after starting antibiotics,” Dr. Hardy clarifies. When considering returning to work, school, or daily activities, “resolution of fever is a good indicator.”
“Additionally, symptoms like voice loss, weakness, and fatigue should also improve before resuming your routine,” she advises.
Treatment: Why Antibiotics are Crucial for Strep Throat
“Since strep throat is a bacterial infection, it’s unlikely to resolve on its own without antibiotics,” Dr. Hardy emphasizes. “The most commonly prescribed antibiotics are amoxicillin and penicillin.”
A course of antibiotics for strep throat typically lasts “about 10 days to ensure complete eradication of the bacteria,” she explains. “However, contagiousness significantly decreases within 24 to 48 hours of starting antibiotics.”
“Often, patients start feeling better even after the first dose,” she notes. “Nevertheless, it’s crucial for both children and adults to complete the full course of antibiotics as prescribed to ensure the infection is completely cleared and to prevent complications.”
Can You Get Strep Throat Again? Reinfection and Carriers
“Unfortunately, yes, reinfection with strep throat is possible,” Dr. Hardy confirms. “Sometimes, the strep bacteria can persist in the tonsils even after treatment.”
“Such individuals become strep carriers. They might not have active symptoms but can still harbor the bacteria. If their immune system weakens, the infection could reactivate,” she adds.
Dr. Patel mentions, “Recurrent episodes of tonsillitis or strep throat are common reasons for families to consult an ear, nose, and throat (ENT) specialist. Frequent recurrences might warrant further discussion and management.”
Strep Throat After Tonsil Removal: Is it Still Possible?
Even after tonsil removal, “the risk of strep throat is significantly reduced because the bacteria typically infect the tonsils,” Dr. Hardy explains. However, it’s not eliminated.
“A common misconception is that tonsil removal prevents strep throat entirely,” Dr. Patel clarifies. “Strep throat is just one manifestation of strep A bacteria. Infection can still occur in other parts of the throat.”
“You can still get strep throat in different areas of your throat,” she reiterates. “Strep A bacteria can also cause skin rashes and other types of infections.”
Relieving Strep Throat Symptoms at Home: Comfort Measures
“Strep throat pain can be quite intense,” says Dr. Hardy. Fortunately, several home remedies can help alleviate symptoms.
“Avoid very hot or spicy foods,” she advises. “Opt for a soft, bland diet and avoid smoky environments.”
“Warm saltwater gargles and hot tea with honey can be soothing,” Dr. Hardy suggests. “Over-the-counter pain relievers like Tylenol or ibuprofen can help reduce fever and manage pain.”
Preventing Strep Throat: Infection Control Protocols
To protect yourself and others from strep throat, “handwashing is fundamental,” Dr. Hardy emphasizes. “Always cover coughs and sneezes.”
“Avoid sharing drinks and utensils and limit contact with others as much as possible when sick,” she recommends.
Keeping Environments Clean: Reducing Spread
“Regularly clean and disinfect frequently touched surfaces,” Dr. Hardy advises. “Use disinfectant wipes or soap and water on items like light switches, countertops, and appliances.”
“After starting strep throat treatment, consider replacing toothbrushes and washing items like stuffed animals that the infected person sleeps with,” Dr. Patel adds.
Hydration: Essential for Recovery, Especially in Children
“Maintaining hydration is crucial, especially for children with strep throat,” Dr. Patel stresses. “If a child struggles to swallow or shows signs of dehydration, it’s important to seek medical attention.”
“Cold items can sometimes ease swallowing difficulties by numbing the throat,” she suggests. “Pedialyte popsicles can be helpful for children, providing both fluids and electrolytes while being soothing.”
Potential Complications of Strep Throat: What to Watch For
“Families should be aware of potential complications from strep throat, especially if untreated or improperly treated,” Dr. Patel cautions.
Complications can include “abscesses or more serious infections in or around the tonsils,” she explains. “A peritonsillar abscess, a pocket of infection behind the tonsils, can be extremely painful and requires medical intervention beyond oral antibiotics.”
“Post-streptococcal glomerulonephritis is another rare complication related to the immune system’s response to certain strep strains, potentially affecting kidney function,” she notes. “This is not caused by a strep toxin directly.”
Rheumatic fever is also a serious complication to be aware of. “Rheumatic fever can affect the heart, joints, brain, and skin if strep throat is not properly treated. It can develop one to five weeks after a strep throat infection.”
By understanding strep throat, its typical duration, and appropriate management, you can navigate this common infection effectively and support a quicker recovery. Remember to consult healthcare professionals for diagnosis and treatment to prevent complications and ensure proper care.
