With kids in school, cold season lingering, and allergy season upon us, it’s normal in the spring months to feel some itching and inflammation in the throat. If swelling worsens quickly and swallowing is difficult, it might be a sign of something else: strep throat. Strep throat causes about 5.2 million outpatient visits each year in the U.S., according to the Centers for Disease Control and Prevention.

While anyone can have strep throat, it is most common for school-aged children ages five to 15 years old because strep spreads in close quarters like schools or daycares. To test for strep throat, a health care provider can do a simple throat swab, and if the result is positive, antibiotics are highly effective.

“I usually tell parents it’s good news once we know it is strep throat because we just treat it, and your child should be feeling better in a day or two,” says Dr. Robert Hagerty, pediatrician at the Children’s Hospital of New York at NewYork-Presbyterian. “Strep is pretty straightforward. We see it a lot.”

If left untreated, strep can cause more serious infections and a recent report published in JAMA from researchers at the Centers for Disease Control and Prevention found that cases of invasive strep (when the strep bacteria invade other parts of the body) have been rising in the U.S. over the last decade, from 2013 to 2022. “If your child still has a very high fever or is getting worse after taking antibiotics, there may be something else going on,” says Dr. Hagerty. “But invasive strep is very rare.”

To learn more about the signs of strep throat, how it’s different from having a sore throat, and what symptoms watch out for, Health Matters spoke to Dr. Hagerty.

What is strep throat?

Strep throat is a bacterial infection. A bacteria called streptococcus infects the throat and tonsils, and the body reacts by fighting the infection. That fight triggers irritation, inflammation, and soreness in the throat.

Besides throat discomfort, are there other symptoms of strep throat?

The big ones are fever, headache, and belly pain. Kids with strep throat do not want to eat as much. Sometimes it is because their belly hurts. Sometimes it is because they are nauseous or their throat hurts too much.

Other common symptoms to look for are small white dots on the tonsils in the back of the throat and swollen, tender bumps in the neck called lymph nodes. Our lymph nodes are full of white blood cells and the inflammation is a sign the body is fighting an infection.

Some slightly rarer signs of strep throat include a rash that’s all over the chest and feels like sandpaper. And if your child sticks out their tongue and it is very red, swollen, and bumpy, it is called a “strawberry tongue” and is usually a sign of strep.

How can you tell the difference between strep throat and a regular sore throat?

A sore throat can be caused by a virus or bacteria like streptococcus. If a child has been coughing a lot and has a runny nose, or their eyes are red and irritated — that sounds like a virus to me. A lot of people notice they cough more at night, and that is because of all the mucus from the nose that is going into the throat and causing irritation. If you cough enough, the throat will get inflamed— like if you pinch yourself a couple of times, and your skin turns red and it hurts a little bit, same idea.

Also, patients with a viral sore throat usually do not have too much trouble eating. They may have a runny nose and coughing, but they are able to drink and eat without feeling discomfort.

How does strep spread?

Strep can spread easily. The most common way is through coughing and sneezing in a place with less airflow. Once the bacterium is in the air, all it has to do is get to another mouth, and it can start growing.

How do you test and treat strep throat?

We put a little swab in the back of your throat and get the results back in five minutes.

If it is positive, we can treat it with amoxicillin. Within 24 hours of taking amoxicillin, your child should be fever free. If you are having fevers and you are past the 24-hour mark, then there may be something else that is causing a fever that the antibiotics are not helping.

Does strep throat go away on its own?

For plenty of people, it does. Our immune system can do a decent job killing bacteria. Homeopathic remedies, like swishing with warm salt water, honey, or lemon tea, make your throat feel better — but it is safer to get the antibiotics because there are other risks if strep is untreated.

What are the complications if strep is untreated?

In rare cases, the streptococcus bacteria can spread to other parts of the body and lead to serious illness. For example, it can invade a little bit deeper in the tonsils and cause a retropharyngeal abscess, where the lymph nodes in the back of the throat become infected and can only be treated with surgery. Other rare complications happen when streptococcus enters the bloodstream, which leads to sepsis or meningitis, or gets into the skin and muscles and causes necrotizing fasciitis (a flesh-eating bacterial infection).

How do you avoid getting strep throat?

Masking and coughing into your elbow are ways to control the spread of strep throat. If you have a family member who has strep throat, you can wear a mask and you can encourage them to wear a mask, which will be more helpful.

If somebody with strep coughs on their hands and touches a doorknob, and then you touch the doorknob and then put your hands in your mouth or touch your face, you can give yourself strep,  so wash your hands frequently.