Group A streptococcal infection
Group A streptococcus is an ordinary bacterium that almost everybody has met at some point.
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Medicines commonly prescribed for Group A streptococcal infection
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 500 mgActive substance: amoxicillinManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: TABLET, 1000 mgActive substance: amoxicillinManufacturer: Almus Farmaceutica S.A.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 1000 mgActive substance: amoxicillinManufacturer: Laboratorios Cinfa S.A.Prescription required
Group A streptococcus is an ordinary bacterium that almost everybody has met at some point. Most often it causes a sore throat: the throat hurts for a few days, a doctor prescribes an antibiotic, and there the story ends. Far more rarely the same bacterium gets somewhere it has no business being — into the deep layers of skin, into a muscle, into the bloodstream — and then the clock runs in hours rather than days. Both halves of this picture need holding in mind at once. The first explains why a sore throat is no reason to panic and why the prescribed course is finished properly. The second explains why, in rare cases, you cannot wait until morning.
What this bacterium causes
Several different illnesses sit under one name:
- strep throat (streptococcal tonsillitis), the commonest presentation, especially in school-age children;
- scarlet fever, the same infection plus a characteristic rash;
- impetigo, a surface skin infection with blisters and honey-coloured crusts, usually in children;
- erysipelas and cellulitis, infection of the skin and the tissue beneath it, with vivid redness, swelling and heat;
- less often, infection of a wound, infection after childbirth, middle ear infection or sinusitis;
- and very rarely the invasive form, in which the bacterium enters the blood, a muscle or the tissue under the skin and destroys it.
Carriage is common: some people have the streptococcus living in the throat without any symptoms at all. Such carriers are usually not treated, because there is nothing to treat, though they can still pass the bacterium on.
What strep throat looks like
Telling it apart from a viral sore throat by feel alone is hard, but there are pointers. A streptococcal throat typically starts quickly and brings severe pain on swallowing, a temperature, patches on the tonsils, enlarged and tender neck glands, headache and, in children, tummy pain and vomiting. Equally important is what it usually does not bring: a runny nose, a cough, hoarseness or red eyes. If the sore throat comes with a streaming nose and a cough, it is almost certainly a virus and no antibiotic is needed.
The question is settled not by looking but by testing: a rapid test on a throat swab answers in minutes, while a culture takes a couple of days and is more reliable. That is why you should not start an antibiotic "just in case" from what is left in the cupboard at home: after the first dose the test is no longer informative, and treating a viral sore throat with an antibiotic is both pointless and harmful.
While treatment runs, the usual measures help: pain and fever relief at the dose appropriate for the person's age, warm drinks, soft food and rest. Children and teenagers are not given aspirin. Gargles and lozenges ease the pain but do nothing to the infection itself.
Scarlet fever
Scarlet fever is a streptococcal throat infection in which the bacterium produces a toxin that causes a rash. It begins with fever and a sore throat, and a day or two later a fine red rash appears, first on the chest and tummy and then over the whole body. To the touch the skin feels like sandpaper, and that is the most recognisable feature. The rash gathers in the skin folds, a pale ring is left around the mouth, and the tongue is coated white at first and then turns bright red with prominent papillae. After a week to ten days the skin starts to peel, particularly on the fingers.
Scarlet fever is treated with the same antibiotics as ordinary strep throat and, treated in time, leaves nothing behind. But how the child is in themselves must be judged separately from the rash: a child with a rash who is drinking, playing and responding to you, and a child with a rash who is listless, refusing drinks, breathing with difficulty or whose temperature keeps climbing, are two completely different situations. The second needs a doctor straight away.
Why the antibiotic course is finished
Strep throat is not treated with antibiotics merely to shorten the sore throat — that would settle by itself anyway. The main aim is different: to prevent the complications that develop after the person already feels well.
- Acute rheumatic fever appears two to four weeks after an inadequately treated throat infection. The immune system begins attacking the body's own tissues, and the joints, the heart and less often the nervous system suffer. The worst outcome is damage to the heart valves, which stays for life.
- Post-streptococcal glomerulonephritis is inflammation of the kidneys, showing itself as swelling, urine the colour of dark meat washings, passing very little urine, and raised blood pressure.
- Local complications such as an abscess beside a tonsil: the pain suddenly worsens on one side, the mouth is hard to open, even saliva is hard to swallow and the voice changes. That needs same-day attention.
This is why the course a doctor prescribes is finished to the end, even if nothing hurts by the second day. Stopping halfway removes the symptoms but does not guarantee the infection has been cleared. Returning to school, nursery or work is possible around twenty-four hours after starting the antibiotic, once the temperature has settled.
Invasive infection: when you cannot wait
This is the rare and by far the most dangerous form, and it is recognised not by tests but by how fast things get worse. Call an ambulance immediately if even one of these appears:
- severe, rapidly increasing pain in an arm, a leg or a muscle, clearly out of proportion to how the skin looks;
- an area of skin that is visibly reddening, swelling and spreading, especially with purple patches, blisters or dark areas;
- a high temperature with a sharp deterioration over a few hours;
- confusion, heavy drowsiness, being unable to wake the person;
- falling blood pressure: cold clammy skin, pallor or mottling, a fast weak pulse, dizziness on trying to stand;
- in a child, difficulty breathing, grunting on each breath, the tummy sucking in under the ribs, blue or grey lips and skin, floppiness, refusing to drink, passing no urine for many hours;
- a rash that does not fade when pressed with a clear glass.
Do not drive yourself — ask someone to take you or call for an ambulance; in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 is used for this. Tell the call handler if anyone in the household has recently had a sore throat or scarlet fever, because it is an important detail. Invasive infection is treated in hospital with antibiotics into a vein and, where deep tissue is involved, with surgery too, and the outcome depends heavily on how early it is started.
Who is more at risk, and why chickenpox matters
The chance of a severe form is raised by a weakened immune system, diabetes, cancer and treatments that suppress immunity, older age, recent childbirth, any open wounds, burns and fresh surgical scars, and also by a recent bout of flu or another viral infection.
Chickenpox in a child deserves a paragraph of its own. Scratched blisters are a great many small open doorways, and the streptococcus gets through them particularly easily. That is why during chickenpox nails are cut short, hand hygiene is watched and scratching is discouraged as far as possible. And the main rule: if a child with chickenpox was starting to get better and then goes downhill again — the temperature returns or climbs higher than before, one of the spots develops spreading redness, swelling and marked pain, the child becomes listless — do not wait. Such a turn is assessed the same day, and if it is advancing quickly, call an ambulance.
How it spreads and what to do at home
The bacterium passes on through close contact: in droplets from coughs and sneezes, through shared crockery and towels, and in the skin forms through touching a sick person's sores and crusts. Someone stays infectious until treatment starts, and about twenty-four hours on an antibiotic they no longer are.
Simple measures work at home: wash hands often with soap and water, cover the mouth and nose with a tissue when coughing and bin it straight away, do not share plates, glasses or towels with the person who is ill, wash the laundry, and keep any skin sores clean and covered. The rest of the household does not usually need preventive antibiotics — they are given only in particular situations and that is a decision for a doctor. Keeping an eye on how everyone at home feels over the following days is worth doing.
Online consultation
A remote appointment copes well with a sore throat. The doctor will ask how it all started, whether there is a runny nose and a cough, look at the throat on video and say whether this resembles a virus or whether a swab is worth taking; with strep throat confirmed, they will choose an antibiotic with your allergies in mind and explain how long to take it and when it is safe to return to school or work. Online is also a convenient way to sort out a rash: photograph it in daylight, work out whether it is scarlet fever or something else, and come away with a clear plan. Separately, the doctor can go through what to do about a child's chickenpox and which signs to watch so that a change for the worse is not missed. What does not belong in a message thread is discussing rapidly worsening pain in a limb, purple patches on the skin, confusion or a sharp deterioration over a few hours. That conversation is with an ambulance.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Group A streptococcal infection with a doctor online.
