Strep Throat Symptoms and Diagnosis

It’s spread when you’re exposed to secretions from an infected person’s respiratory tract, often when that person coughs or sneezes. It’s most common in the winter and spring.

It’s important to get tested for, and diagnosed with, strep throat before starting any treatment for your infection. Once you receive a diagnosis of strep throat, prompt treatment with antibiotics can prevent complications.

Symptoms of Strep Throat

Symptoms can be mild or severe, and often include:

• Sore throat that comes on suddenly
• Fever that may begin suddenly (often highest on the second day)

  [3]

• Red appearance to the throat, sometimes with white patches or pus
• Small red spots toward the back of the roof of your mouth
• Chills and body aches
• Painful swallowing
• Tender, enlarged lymph nodes in your neck
• Headache
• Nausea or vomiting (especially in young children)

  [4]

• Abdominal pain

• A red rash that feels like sandpaper
• Bright red appearance to creases of armpits or groin
• Red, swollen tongue

What Does Strep Throat Look Like?

Some people believe that you can identify strep throat by its appearance, but this is a widespread misconception, says Nipunie S. Rajapakse, MD, a pediatric infectious disease specialist at the Mayo Clinic in Rochester, Minnesota.

“No doctor or parent can tell whether a child has strep just by looking at the throat,” she emphasizes. Even when a doctor strongly suspects that an infection is strep throat, a throat swab is necessary to confirm the diagnosis.

When strep throat is present, it typically gives a very red appearance to the throat and tonsils. There is often also a white coating on some of or all the reddened areas.

“Some people take the white coating to mean that it’s caused by strep for sure,” Dr. Rajapakse says. “But we know that with certain viruses, which are a much more common cause of sore throat in kids, you get this white coating as well.”

The red area in an infected person’s throat may extend to the roof of the mouth, sometimes appearing to “trail off” as red dots in that area.

There may also be visible areas of pus — usually bumpy-looking white or yellow secretions — on the tonsils or back of the throat.

When to Get Tested for Strep

While it’s important to note any of these symptoms and report them to your doctor when making an appointment, your doctor will also be interested in what symptoms you don’t have.

“If you really just have fever, sore throat, and enlarged lymph nodes in your neck, then strep is more likely to be the cause of your symptoms,” says Rajapakse.

• Runny nose
• Cough
• Hoarseness
• Pink eye (conjunctivitis)
• Mouth sores

• Sore throat along with swollen lymph nodes in your neck
• Sore throat lasting more than 48 hours
• Fever above 101 degrees F or lasting more than 48 hours
• Sore throat along with a rash on the neck or body
• Trouble swallowing or breathing

Strep Throat Diagnosis

• Looking at the back of the throat
• Taking your or your child’s temperature
• Feeling the neck for enlarged or tender lymph nodes
• Checking the neck and body for signs of a rash

If your doctor suspects strep throat based on this examination, they will swab your throat to test the secretions for the presence of strep bacteria.

A rapid strep test can give results within minutes, Rajapakse says, and is the only test needed if the result is positive for strep.

If a rapid test comes back negative, that doesn’t mean for sure that you don’t have it. “A small percentage of people who have a negative rapid test will have a positive culture,” Rajapakse notes — and the lab test is considered definitive.

If your rapid test results are negative, your doctor will probably order a lab culture test. It can take several days to get the results from this test.

Your doctor will most likely start you on a course of antibiotics as soon as you test positive for strep.

The Takeaway

• Most sore throats are caused by a viral infection, not group A streptococcus.
• Symptoms that indicate strep include sudden throat pain with fever, red throat with spots of pus or white patches, and enlarged lymph nodes in your neck.
• You should get tested for strep if you have these symptoms, particularly if you don’t have a cough, runny nose, or other symptoms that would point to a viral infection.
• Your doctor can diagnose strep throat with a rapid test or a more definitive bacteria culture.