Frequent and Rare Strep Throat Symptoms

Strep throat is a bacterial infection with a number of classic signs and symptoms, such as:

  • Sore throat
  • Swelling in the back of the throat
  • Enlarged tonsils
  • Bad breath
  • Fever
  • Chills
  • Headaches
  • Decreased appetite

All of these can occur with bacterial or viral infections, so the signs and symptoms alone cannot be used to diagnose strep throat.

If you have signs and symptoms of step throat, your doctor will determine if strep testing is necessary.

This article explains common symptoms and complications related to strep throat and when to get emergency medical attention.

strep throat symptoms
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Frequent Strep Throat Symptoms

The most common signs and symptoms of strep throat include:

  • Sore throat, especially when swallowing
  • Fever and chills 
  • Headaches
  • Fatigue and lack of energy
  • Decreased appetite
  • Enlarged lymph nodes, which may feel like lumps on the sides of your neck or in your armpits
  • Small red or purple spots on the roof of your mouth
  • Swelling in the back of your throat
  • Redness around the back of your throat
  • White patches on the back of your throat
  • Halitosis (bad breath)

Strep throat is most common in children between the ages of 5 and 15. Symptoms of strep throat in children are similar to those in adults, but children are more likely to experience headaches, stomach pain, and/or nausea and vomiting. 

It will take a few days after you are exposed to the bacteria before you begin to feel sick. The time between exposure and the development of symptoms is called the incubation period.

Strep throat typically has an incubation period of 2-5 days, and you can begin to be contagious during this timeframe.

When you begin to experience symptoms or notice signs, you should start taking precautions not to infect those around you. You can spread the infection to other people through sneezing and coughing. You can also spread the infection by touching objects if your hands have been in contact with your saliva and mucus. Covering your mouth when coughing or sneezing, avoiding sharing beverages, and regular hand washing can help.

Rare Symptoms

You might experience less common symptoms of strep throat. Their presence does not necessarily mean that your infection is more dangerous or more likely to cause serious complications.

  • Nausea and vomiting
  • Rash on your chest and neck
  • Abdominal pain
  • Muscle aches
  • Stiff joints
  • Painful lymph nodes

Urgent Signs and Symptoms

Strep throat is not usually dangerous, but it can cause medical emergencies, though this is rare.

When to Seek Emergency Care

If you have strep and experience the following symptoms, seek medical care right away.

  • Trouble breathing or shortness of breath
  • Dizziness, feeling faint or passing out
  • Blue or pale lips or fingers
  • Trouble swallowing

Complications of Strep Throat

Strep throat can cause a number of serious complications, though they are rare. These are more likely to occur if your infection is not treated or if you have a weak immune system. Sometimes, however, serious complications can occur without an obvious reason. 

The complications of strep throat are typically divided into two main categories: suppurative (pus-forming) and non-suppurative (non-pus-forming). These classifications mean more to doctors than to patients, but the distinction will dictate your treatment.

Pus-Forming Complications 

These may require an intervention such as surgery to drain the pus.

The three most common pus-forming complications that can occur after strep throat are:

  • Peritonsillar abscess: An abscess is a walled-off collection of bacteria that may create a bump, and it can form behind and in front of the tonsil due to strep throat. This may begin two to eight days after a sore throat and may be associated with having an antibiotic-resistant infection. 
  • Otitis media: An infection of the middle ear can develop. It is often characterized by pain, fever, and fluid drainage. 
  • Sinusitis (sinus infection): Most of the time, sinusitis is a mild infection caused by a virus, but when it occurs as a complication of strep throat, it is caused by a bacterial infection and requires antibiotic treatment. 

Non-Pus-Forming Complications

These are often treated with oral or intravenous medication that works to treat the whole body.

Common non-suppurative complications that can occur after strep throat include:

  • Arthritis may develop, which is characterized by swollen joints and generalized pain.
  • Generalized swelling can occur throughout the body, especially in the abdomen, face, eyes, feet, ankles, or hands.
  • Rheumatic fever may result from an autoimmune reaction to the infection. The antibodies that your body forms against the strep bacteria may react against your own tissues. Rheumatic fever can affect your heart, joints, and brain and result in chronic rheumatic heart disease.
  • Scarlet fever can result from strep throat, brought on by an erythrotoxin produced by the bacteria. Warning signs of scarlet fever include changes in the color or amount of your urine, severe joint pain, high fever, rash, seizures, or other neurological changes. Scarlet fever is usually accompanied by a sandpaper-like rash and sometimes a red bumpy tongue, in addition to other strep throat symptoms.
  • Post-streptococcal glomerulonephritis, a kidney condition that may occur after strep throat, can be very serious, resulting in kidney failure. Symptoms include decreased urine output, rust-colored urine, and bloody urine.
  • Toxic shock syndrome (TSS) is an uncommon complication.
  • Henoch-Schonlein purpura, an autoimmune syndrome associated with Group A strep, results in low platelets and bruising. Other serious symptoms may also occur involving the kidneys and digestive tract.

Other Causes of Throat Pain

Other conditions are easy to mistake for strep throat, such as the common cold. In fact, the most common cause of throat pain is typically a virus. Common symptoms of viruses that you should not expect to experience if you have strep throat include:

  • Runny nose
  • Cough
  • Hoarse voice
  • Pink or crusty eyes
  • Diarrhea

Mononucleosis is another condition that can be similar to strep throat. Both cause sore throat, but mononucleosis does not cause enlarged tonsils or red and white patches in the throat. People with mononucleosis also experience extreme fatigue.

Viral infections normally improve on their own. The antibiotics used for treating strep throat are not beneficial if you have a viral infection. Strep throat can only be diagnosed with a rapid strep test or throat culture, so it is best to see a healthcare provider if you or your child have a sore throat that does not improve after 48 hours.


Strep throat is a bacterial infection that causes a sore throat, fever, and swelling of the tonsils or the back of the throat. It can also cause symptoms like bad breath and red spots on the roof of your mouth, or white patches in the back of the throat.

Strep throat can cause complications if it's left untreated, including scarlet fever and uncommon complications such as toxic shock syndrome. 

Strep throat can be confused with other types of sore throat, most of which are caused by viruses. See a healthcare provider for a diagnosis if you have a sore throat that doesn't improve after 48 hours. 

A Word From Verywell

You might be tempted to conclude that a very painful sore throat is strep throat, but most sore throats are caused by viruses. The only way to be sure that your sore throat is caused by strep throat is to see a healthcare provider for a diagnosis. Antibiotics will help fight strep throat, but they won't do anything for sore throats caused by viruses.

If you have a sore throat that doesn't seem to be getting better after a few days of rest, or if you have a fever and a sore throat without any of the classic symptoms of a cold, such as runny nose and cough, make an appointment with your healthcare provider.

Frequently Asked Questions

  • Does strep throat cause diarrhea?

    No. Strep throat can cause abdominal pain and nausea, but if you have diarrhea with strep throat, it’s likely due to another cause, such as a different viral or bacterial infection.

  • Why does strep throat cause bad breath?

    The bacteria that cause strep throat also cause halitosis. The bacteria travel into the mouth via nasal passages or from the back of the throat. Halitosis can also be caused by upper respiratory infections, tonsillitis, or a lung infection.

  • How long will it take for strep throat symptoms to go away?

    Treated with antibiotics, strep throat symptoms begin to go away within the first two doses. After 24 hours, you should no longer be contagious. Remember that even if you are feeling better, it is important to take your entire course of antibiotics.

  • Can strep throat go away on its own?

    While it’s possible for strep throat to clear up on its own, it takes significantly longer, and you’ll remain highly contagious for about three weeks. Untreated, you also risk serious complications such as scarlet fever and rheumatic fever.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Strep throat: all you need to know.

  2. U.S. National Library of Medicine. Strep throat.

  3. Nasirian H, Tarvijeslami S, Matini E, Bayesh S, Omaraee Y. A clinical decision rule for streptococcal pharyngitis management: An update. J Lab Physicians. 2017;9(2):116-120. doi:10.4103/0974-2727.199635

  4. Martin JM. The Mysteries of Streptococcal Pharyngitis. Curr Treat Options Pediatr. 2015;1(2):180-189. doi:10.1007/s40746-015-0013-9

  5. Kenealy T. Sore throat. BMJ Clin Evid. 2007;2007

  6. Pathak H, Marshall T. Post-streptococcal reactive arthritis: where are we now. BMJ Case Rep. 2016;2016. doi:10.1136/bcr-2016-215552

  7. Pardo S, Perera TB. Scarlet Fever. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

  8. Andrey DO, Ferry T, Siegenthaler N, et al. Unusual staphylococcal toxic shock syndrome presenting as a scarlet-like fever. New Microbes New Infect. 2015;8:10-3. doi:10.1016/j.nmni.2015.08.002

  9. Arslansoyu Çamlar S, Soylu A, Akil İ, et al. Henoch-Schonlein purpura, post-streptococcal glomerulonephritis and acute rheumatic carditis after Group A β-haemolytic streptococcal infection. Paediatr Int Child Health. 2018;38(1):73-75. doi:10.1080/20469047.2017.1284394

  10. Igarashi H, Nago N, Kiyokawa H, Fukushi M. Abdominal pain and nausea in the diagnosis of streptococcal pharyngitis in boys. Int J Gen Med. 2017;10:311-318. doi:10.2147%2FIJGM.S144310

  11. Shirasu M, Touhara K. The scent of disease: volatile organic compounds of the human body related to disease and disorder. Journal of Biochemistry. 2011;150(3):257-266. doi:10.1093/jb/mvr090

  12. Center for Disease Control and Prevention. Strep throat.

Additional Reading

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.