Strep throat

Strep throat is a sore throat that is caused by a bacteria. Without treatment it can lead to rheumatic fever. Get your child checked by your healthcare provider whenever they have a sore throat.

Key points about strep throat

  1. Strep throat is different from a viral sore throat you might get with a cold. Strep throat is caused by a bacteria called Streptococcus.
  2. Without treatment, strep throat can cause rheumatic fever. Rheumatic fever can damage your heart.  
  3. Strep throat is contagious. It is spread by close contact, often by breathing in droplets from an infected person’s coughs and sneezes. It can also be spread through shared food or drinks.
  4. Living close to other people, such as your family home, or school and university hostels, makes it easy to pass on strep throat from one person to another.
  5. Children aged between 5–15 years have the highest rate of strep throat. 

Note: This page is about strep throat. Read about sore throats in general and sore throats in children

For people at higher risk of rheumatic fever, it is very important that a sore throat is always checked early by a nurse or GP. This is because untreated strep throat can cause rheumatic fever and heart damage for life.

You are at higher risk of rheumatic fever if:

  • you have had rheumatic fever before
  • someone in your family or household has had rheumatic fever.

Or if you have 2 or more of the following:

  • Māori or Pasifika ethnicity
  • Aged 3–35 years
  • Live in poorer or crowded living conditions.

What is the cause of strep throat?

Strep throat is a sore throat that is caused by a bacteria called Streptococcus. Strep throat is contagious and can be spread by breathing in droplets from an infected person's coughs and sneezes. It can also be spread through shared food or drinks. 

What are the symptoms of strep throat? 

Symptoms of strep throat can include:

  • a painful or scratchy throat, especially when you swallow
  • difficulty swallowing
  • redness at the back of your mouth
  • fever
  • bad breath
  • the glands in your neck are swollen
  • your tonsils are large and covered in white stuff
  • headache
  • stomach pain
  • nausea and vomiting
  • sometimes, you may also have a skin rash along with fever and sore throat, this condition is known as scarlet fever.

When to see your doctor

It's very difficult to tell the difference between a viral sore throat and strep throat. Every time your child has a sore throat take them to get their throat checked straight away. This could be by your doctor or nurse or at a school clinic. 

Don’t wait to see if your child’s throat gets better. ‘Strep throat’ needs to be treated immediately. Treating sore throats early can stop rheumatic fever from developing. 

Ask your children to tell you when they have a sore throat so they can be checked. Your child may get a lot of sore throats but you need to get it checked every time and straight away.

Video source: KidsHealth. Copyright Kylie Sullivan 2017. Licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. 

Who is at risk of getting rheumatic fever from strep throat? 

You are at higher risk of rheumatic fever if:

  • you have had rheumatic fever before
  • someone in your family or household has had rheumatic fever.

Or if you have 2 or more of the following:

  • Māori or Pasifika ethnicity
  • Aged 3–35 years
  • Live in poorer or crowded living conditions.

How is strep throat diagnosed?

Strep infection is diagnosed by doing a throat swab.

How is strep throat treated?

The treatment of strep throat depends on your risk of getting rheumatic fever. If you are at low risk, treatment is aimed at self-care to ease the pain and the infection will get better on its own in a few days. However, some people will also need antibiotic medicine.

Self-care

  • Suck a teaspoon of honey (not safe for children under one year) or gargle salt water.
  • Try a medicated lozenge, gargle or throat spray if you are an adult.
  • Take paracetamol – check doses carefully and ask your doctor or pharmacist whether it is safe for you.

Antibiotic medicine

If you have a higher risk of getting rheumatic fever, or if you have a high risk of spreading the bacteria, eg, you are a healthcare worker, residential care worker, food handler, teacher, childcare worker or student, treatment with antibiotics may be started as soon a throat swab is done.

  • Antibiotics (penicillin or amoxicillin) are normally given for 10 days. You should finish the full course to make sure the strep throat does not cause rheumatic fever.
  • A one-off antibiotic injection to treat a strep throat might be a good alternative for children if you think they may find it hard to take the full 10-day course of capsules or liquid.
  • Keep children away from school or early childhood centres for at least 24 hours after they start antibiotics, to reduce the risk of spreading the strep bacteria. 

How can I prevent strep throat spreading?

Do the following to help stop infections spreading or coming back:

  • Cover your mouth and nose with a tissue when you sneeze or cough.
  • Avoid close physical contact such as kissing when you are sick, and don’t share eating or drinking utensils (eg, cups or knives and forks).
  • Try to create space between your children when they sleep, to limit the chance of germs being spread through coughs and sneezes. 

Learn more

The following links provide further information about strep throat. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Strep throat – a patient's guide Family Doctor, NZ
Strep throat
Centers for Disease Control and Prevention, US

References

  1. Rheumatic fever Ministry of Health, NZ, 2019
  2. Sore throat Ministry of Health, NZ, 2019
  3. Anderson A, Spray J. Beyond awareness: Towards a critically conscious health promotion for rheumatic fever in Aotearoa, New Zealand Social Science & Medicine. 2020 Feb; 247: 112798.

Reviewed by

Dr Sharon Leitch is a general practitioner and clinical research training fellow in the Department of General Practice and Rural Health at the University of Otago. Her area of research is patient safety in primary care and safe medicine use.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Sharon Leitch, clinical research training fellow, Department of General Practice and Rural Health, University of Otago Last reviewed: 24 Jul 2020