When your kid starts to complain that their throat hurts when they swallow (or you've got the same symptom), your first thought might be strep throat.
Strep throat is a throat and tonsil infection caused by group A Streptococcus bacteria. It's different from a cold, which is usually caused by a virus. But just like the common cold, strep can spread like wildfire, especially among kids.
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"As with other airborne [illnesses], strep is highly contagious," says Louis Morledge, MD, an internist at Northwell Lenox Hill Hospital in New York City.
In addition to throat pain, strep can cause a fever and swollen tonsils, often covered in white patches. Some people with strep also get a stomachache, nausea or vomiting, or a spotty red rash (especially under the arms), per the American Academy of Family Physicians. Unlike a cold, it doesn't usually cause a cough or a runny or stuffy nose.
How Strep Throat Spreads
Strep travels from one person to the next through tiny respiratory droplets that contain strep bacteria. If you're near an infected person when they cough or sneeze, you can catch strep by breathing in the bacteria-laden droplets, Dr. Morledge explains.
The droplets can also land on surfaces (like doorknobs, keyboards or faucet handles). If you touch the infected surface and then touch your mouth, nose or eyes, the bacteria can make you sick, he adds. Sharing cups, utensils or plates with someone who's infected can spread strep, too.
People often spread strep without realizing it. That's because while the infection takes two to five days to cause a sore throat and other symptoms, you can transmit the bacteria to others even before you feel sick, according to the Centers for Disease Control and Prevention (CDC).
How Long Does Strep Throat Last?
It can take up to five days to start having symptoms after catching strep. Once you start to feel sick, it can take seven to 10 days for your symptoms to fully clear with treatment, per the Cleveland Clinic.
That said, you'll notice a big improvement within 12 to 24 hours of starting antibiotics (like amoxicillin), which are typically prescribed for bacterial infections like strep. Once you've passed that benchmark and no longer have a fever, you're in the clear to go back to school or work, per the CDC.
Most doctors prescribe a 10-day course of antibiotics for strep. Even though you'll feel better after the first day, it's important to keep taking your meds until they're finished to completely kill off the infection and keep your symptoms from coming back, according to the Mayo Clinic.
You'll stay sick — and contagious — for much longer without antibiotics, though. "Untreated individuals can be contagious for up to four weeks" after becoming infected, says Donna Casey, MD, an internal medicine physician at Texas Health Presbyterian Hospital Dallas.
Is Strep Throat Contagious After Antibiotics?
You're significantly less contagious once you've been on antibiotics for 24 hours and no longer have a fever. But even after crossing that threshold, it's still possible to spread strep. "Antibiotics can reduce transmission up to 80 percent after 24 hours of therapy," Dr. Casey says.
It's OK to go back to work or school after the 24-hour mark (as long as you're also fever-free), according to the CDC. But you might want to hold off on close contact with people at higher risk of complications from infections (like newborns, older adults or those who are immunocompromised). "As I remind my patients, you're contagious until you finish the full course of medicine," Dr. Morledge says.
Preventing Strep Spread
Though strep is highly contagious, there are a few things you can do to stay healthy and avoid spreading your germs if you do get sick.
Most importantly, be fastidious about washing your hands, especially after coming in contact with high-touch surfaces like doorknobs or faucets, or after caring for a sick family member.
"I suggest to all my patients to double down on hand hygiene during the winter months. Wash hands more frequently than at other times of year and carry antibacterial hand sanitizers for when you cannot access soap and warm water," Dr. Morledge says.
Try not to touch your mouth, nose or eyes, either. "All it takes is a second to touch an infected surface and then your face to transmit the bacterium to yourself," Dr. Morledge says.
Finally, limit your contact with sick people as much as you can, Dr. Casey recommends. You probably can't avoid your sick spouse, roommate or child entirely, but you can take a sick day or reschedule that coffee date or dinner party if someone in your household is feeling under the weather.
Strep Throat FAQ
Here's some more helpful info about strep.
Will strep ever go away without antibiotics?
Strep can clear up on its own without antibiotics, but you'll feel lousy for longer and could be contagious for up to four weeks, Dr. Casey says. Plus, untreated strep infections increase the risk for serious conditions like rheumatic fever, an inflammatory condition that can damage the heart, joints, brain and skin, per the CDC.
Why do adults not get strep?
Most cases of strep occur in kids ages 5 to 15, according to the CDC. "Small children are often naive to the bacteria, which means their bodies have not seen it before and they do not have immunity. Also, children tend to put things in their mouths, and they touch one another with unwashed hands," Dr. Casey says.
Adults can still get infected, though, especially if you have school-aged kids or spend a lot of time around children, per the CDC.
How can I test for strep throat at home?
You can buy strep throat tests online or at your local pharmacy. But they're a little pricey, typically costing between $30 and $50 per test. Plus, they're only about 86 percent accurate, according to a July 2016 Cochrane Library review.
It's fine to use an at-home test if you want to, Dr. Morledge says. But "I tell my patients it's just the first step. I still want to see them in the office and perform my own test before prescribing the most effective medication," he adds. Plus, other illnesses can have similar symptoms, so your doctor might also want to test you for flu or something else.
- American Academy of Family Physicians: "Strep Throat"
- CDC: "Strep Throat: All You Need to Know"
- Cleveland Clinic: "Strep Throat"
- Mayo Clinic: "Antibiotics: Are you misusing them?"
- CDC: "Rheumatic Fever: All You Need to Know"
- Cochrane Library: "Rapid antigen detection test for group A streptococcus in children with pharyngitis"
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