What are the signs and symptoms of strep throat?
Siamak T. Nabili, MD, MPH
Throat infection with strep bacteria can cause a variety of symptoms associated with inflammation of the throat and its nearby structures. Symptoms usually begin within a few days (one to four days) after contracting the infection (incubation period).
With strep throat infection, the throat can become red and swollen. White patches may be visible on the back of the throat and the tonsils, suggesting the presence of pus. The presence of fever, swollen lymph nodes on the sides of the neck, and white patches on the tonsils -- along with the absence of cough -- raise the suspicion for strep pharyngitis. Not all of these signs need to be present with strep pharyngitis. On the other hand, their presence is not specific only to strep throat.
Typical signs of strep throat infection are:
- Swollen, tender lymph nodes on the sides of the neck (cervical lymphadenopathy)
- White patches seen on the tonsils and throat (tonsillar exudates)
Some other more non-specific signs and symptoms of strep throat, which can also be seen in pharyngitis due to other causes are:
- Sudden onset of sore throat
- Odynophagia (painful swallowing)
- Nausea, vomiting, abdominal pain
- Red, swollen soft palate (uvula)
- Rash (diffuse red patchy rash)
The strep throat rash is caused by toxins released from the bacteria, and not necessarily because of the spread of infection to the skin. This rash is also known as scarlet fever, which can occur in about 10% of children with strep throat infection, and typically starts around the face and neck area and can spread to the rest of the body. It has a raised, rough "sand-paper" quality. The rash may start within 12 to 24 hours of the onset of fever and may last for several days.
Other features that are more likely to be seen in pharyngitis due to viral causes include the following:
- Conjunctivitis (eye redness)
- Runny nose (coryza)
- Skin rash (exanthem or small spotted rash)
- Generalized weakness and malaise
- Muscle aches and pains
- Oral ulcers