What is Strep Throat?

One of the first childhood illnesses we begin to see in the office once the kids are back in school is “strep throat.” There are 2 things that parents know about strep throat:

  • “It’s always going around at school.”
  • “I don’t want my kid to get it.”

Both comments, as it happens, are likely true. Most school-aged kids will get strep throat from someone, somewhere, sometime. But with decisive action and appropriate treatment, strep throat should not be feared. Let’s learn.

What is strep throat?

Acute group-A streptococcal (GAS) pharyngotonsillitis, or “strep throat,” is a bacterial infection caused by a very large family of bacteria.

Think of “strep” as the last name of the largest family that you know. Now give each of those family members a different first name. So it is with the GAS family, and each of its 120 members. Each member of the strep family is related to one another, but still a unique individual. So, each individual can cause a unique infection.

In other words, a person could get strep throat 120 times, but never be infected by the same family member twice.

The GAS bacteria love the warm, moist area in the back of the throat; so if it happens to find that area, it will settle in and begin to grow. When it grows, it causes the symptoms of strep throat.

What are the symptoms of strep throat?

The symptoms of strep throat can hit like a truck, or be very subtle.

Achild with a fever, pain with swallowing, fatigue, headache, or nausea may have strep throat.

Some kids get a rash with a strep infection, called scarlet fever.

Symptoms of GAS infection do NOT include runny nose, cough, or watery eyes. If your child is having trouble with any of these symptoms, call your doctor to see what they would like you to do.

How do you get strep throat?

Kids get strep throat from their classmates and friends by sharing the bacteria in respiratory secretions. In other words, strep is spread through spit and snot.

Who gets strep throat?

Strep throat is most commonly seen in school-aged children and adolescents.

It is NOT common for children under 3 to get classic strep throat without a known infected acquaintance. It is also rare for children under 3 to get complications of strep infection. Your pediatrician’s clinical experience, therefore, will determine if a child under the age 3 need to gets tested (“swabbed”) for strep throat.

How is strep throat diagnosed?

The dreadedthroat swab.

This is vitally important for the diagnosis of strep throat because (despite what many will tell you) it is nearly impossible to tell if an individual is infected with strep throat just by looking at the throat. An examiner can be suspicious of strep from an exam, but to truly diagnose the infection a test must be performed.

Trust me, I have seen hundreds of red throats and I still get fooled by a sneaky strep infection every now and then.

It is important to know that the throat swab test only determines that one of the many members of the strep family is causing an infection. The test does NOT tell us which one of the family members is present.

This is important to remember if your child should happen to get back to back strep throat infections - see the next section.

How is it treated?

Antibiotics are given to children who have tested positive for the strep bacteria.

If your child has not been tested for strep, but is offered antibiotics because it “looks like” strep... Be wary. Again, it is not possible to know if someone has strep throat just by looking in their throat.

It is very unlikely that strep will not respond to antibiotic therapy, if completed as prescribed by your doctor. If your child finishes all the antibiotic and gets the symptoms of strep throat again, it is most likely a different member in the GAS family causing a new infection... And a little bit of simple bad luck. Another round of antibiotics would be needed if your child tested positive.

Is it contagious?

Yes. A person with strep throat was likely contagious, or able to spread infected spit or snot to another person, for 2-5 days BEFORE they even developed a sore throat. A person remains contagious until they have been on antibiotics for 24 hours.

What if strep throat is not treated?

As with any untreated bacterial infection, complications are possible. The most common complications of strep throat are persisting infection in the form of an abscess,rheumatic feverleading to heart problems, or damage to the kidneys.

Other more rare complications exist, so talk with your doctor if you are concerned about your child.

A very interesting issue that often has parents and doctors scratching their heads is children who seem to have recurring strep throat. Are these kids getting repeated infections and need additional intervention, or do they simply have GAS living comfortably and harmlessly in the back of the throat?

Dr. Melissa Arca, a mom and pediatrician in California, recently discussed this concern. Read Dr. Arca’s great explanation of how children can be a“strep carrier.”


American Academy of Pediatrics. [Group A Streptococcal Infections]. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book:  Red Book: 2009 Report of the Committee on Infectious Diseases. 28th Ed. Elk Grove Village, IL: American Academy of Pediatics; 2009: [online]