Strep–Not Just a Sore Throat

Strep is short for Streptococcus, a bacterium identified in four groups–A, B, C, and G.  A and B cause most of the strep infections in humans. The bacteria, called Streptococcus A (is also known as Streptococcus pyogenes, in case you were wondering), causes the majority of the strep throat, respiratory, and other skin infections you might have encountered. These infections can range from minor illnesses to serious and life-threatening diseases. Strep A is a very contagious bacteria spread through droplets in the air when an infected person coughs or sneezes, or through sharing food or drinks. It can also be picked up on surfaces and transferred to you when you touch your nose, mouth, or eyes. Another good reason to wash your hand frequently. 

Group A Strep is opportunistic, that is, if it’s present on your skin, face, or other areas and there’s a small scratch or tiny opening in the skin, it will take the “opportunity” to slip into the body, multiply and cause symptoms. 

Remember, our body’s first line of immune defense is our skin, and second is washing hands and decreasing the opportunity for any microbe, strep or otherwise, to multiply.  

Asymptomatic Carriers and Transmitters of Strep

Now that we’ve lived through the Covid pandemic, we are more familiar with how people can transmit infections without symptoms, which is known as asymptomatic transmission. This is also true for Strep. There are many people who “carry” different groups of Strep in their bodies without any symptoms or serious consequences and transmit Strep to others without knowing– which is known as asymptomatic transmission. 

Group A Streptococcus can cause:

• Strep throat – a sore, red throat with pain that usually comes on quickly can include:

• Painful swallowing
• Red and swollen tonsils, sometimes with white patches or streaks of pus
• Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate)
• Swollen, tender lymph nodes in your neck
• Fever
• Headache
• Rash
• Nausea or vomiting, (mainly in younger children)
• Body aches

• Scarlet fever – an illness that follows strep throat, most common in children 5 to 15, and has these symptoms:
• Almost always accompanied by a sore throat and a high fever.

• Scarlet fever features a bright red sunburn type rash that covers much of the body. 
• Red lines in the folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the surrounding rash.
• The face may appear flushed except around the mouth.
• The tongue looks red and bumpy, and often has a white coating. 

• Impetigo – a highly contagious skin infection seen in infants and young children
• Reddish sores, often around the nose and mouth, can spread elsewhere on the body.

• Rheumatic fever – Rheumatic fever may develop when strep throat or scarlet fever infections are not treated properly with antibiotics, and is thought to be an immune system inflammatory response. Most common in children and not contagious.

Symptoms of rheumatic fever can include:

• Fever
• Painful, tender joints (arthritis), most commonly in the knees, ankles, elbows, and wrists
• Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
• Fatigue
• Jerky, uncontrollable body movements (called “chorea”)

• Streptococcal toxic shock syndrome (STSS) is a rare, but serious condition that occurs when the strep bacteria spread into deep tissues and the bloodstream. STSS is most common in adults 65 years or older. STSS can rapidly lead to dangerously low blood pressure, multiple organ failure, and even death. Symptoms:

• Fever and chills
• Muscle aches
• Nausea and vomiting

After the first symptoms start, it usually only takes about 24 to 48 hours for low blood pressure to develop. Once this happens, STSS quickly gets much more serious:

• Low blood pressure (hypotension)
• Faster than normal heart rate (tachycardia)
• Rapid breathing (tachypnea)
• Signs of organ failure begin

• Necrotizing fasciitis (flesh-eating disease). Although other bacteria can cause this, public health experts believe group A Streptococcus is the most common cause of necrotizing fasciitis. Necrotizing fasciitis is a very serious condition that requires care in a hospital. Antibiotics and surgery are typically the first lines of defense. 

See a health care provider right away if you have these early symptoms after an injury or surgery:

• A red, warm, or swollen area of skin that spreads quickly

• Severe pain, including pain beyond the area of the skin that is red, warm, or swollen
• Fever

Group B Strep

It’s very common for people to have Group B Streptococcus (GBS) and not have any symptoms at all. About 10- 15% of women never know that they are carrying Group B Strep, until they’re tested in pregnancy. Group B strep is commonly found in our urinary tracts, digestive systems, and reproductive tracts, but usually does not cause any health problems, symptoms, or noticeable infections. 

However, this is one of the common causes of bladder and urinary tract infections. If you are having symptoms of burning with urination, the feeling that you have to go all the time, a sense of urgency and/or pelvic pain, do see your healthcare provider. 

Pregnancy and Group B Strep

If you are pregnant, however, the infection can move to your urinary tract, placenta, womb, and amniotic fluid and even without symptoms can be passed to your baby during labor and delivery. Administering antibiotics during labor can prevent newborns from blood infections, pneumonia, and meningitis. Pregnant women should be tested for GBS late in the pregnancy, usually between weeks 35 and 37 with a simple culture test. If they are positive, they’ll be given antibiotics during labor to protect the baby. 

Research has shown that treating GBS in the 1^st or 2^nd trimester does not prevent it from coming back. It’s more protective and more effective to treat with antibiotics once labor has started. 

Group C and G Streptococci Illnesses are Rare

Less is known about group C and G streptococci because the diseases caused by these bacteria are rare. Group C and G strep most commonly lives in animals such as horses and cattle and can spread to humans through raw milk or close contact with these animals. There has been some online chatter about dogs spreading strep, this is not true. Dogs can get what is called “kennel cough” but this is not spread to humans. 

Just like all other streptococci infections these must be treated promptly with antibiotics. They are potentially dangerous, especially in the elderly.

An Ounce of Prevention

A positive outcome of our experience with the COVID-19 pandemic is that we are aware more than ever before of how infection spreads. Our new habits can serve to prevent us from getting a variety of infections and illnesses in the future.

To Prevent Strep Infection:

• Wash your hands. 20 second hand-washing is the best way to prevent all kinds of infections. Remind children to keep it up!
• Cover your mouth and nose with an elbow or tissue when you cough or sneeze.
• Don’t share drinking glasses or eating utensils, and wash dishes in hot, soapy water or in a dishwasher.
• Take care of wounds. Any lacerations, abrasions, burns, and puncture wounds can quickly become infected. The area must be cleaned with soap and water and kept clean with a bandage. 
• Take all the antibiotics prescribed to you – even when you feel better!