Can You Die From Strep Throat? Symptoms You Shouldn't Ignore

Strep throat (also called streptococcal pharyngitis) is a condition caused by group A beta-hemolytic streptococcus bacteria, i.e., Streptococcus pyogenes. As with other bacteria, S. pyogenes is susceptible to specific antibacterials. However, if left untreated, strep throat can lead to serious complications that may have fatal consequences.

If you have strep throat symptoms, it's important to contact your doctor and get appropriate treatment. After a short examination, your doctor will likely prescribe antibiotics, and you can start feeling better in just a few days.

Can you die from strep throat? While extremely unlikely, death from strep throat complications is possible. Let's take a closer look at this condition, its symptoms, and its complications.

What is strep throat?

Strep throat is a medical condition caused by a certain bacteria — Streptococcus pyogenes. This bacteria is also called group A beta-hemolytic streptococcus. The common presentation of this disease is acute pharyngitis (acute onset of sore throat and inflammation). 

However, not all pain in the throat is a sign of strep throat. Sometimes, you can have similar symptoms due to viral pharyngitis. But a lack of cough, nasal congestion, and discharge usually indicates a bacterial rather than viral cause.

It's important to get a correct diagnosis, so once you start experiencing symptoms of strep throat, speak to your doctor.

Keep in mind that the course of treatment for bacterial and viral infections is drastically different. Viral infections cannot be treated with antibiotics, as viruses are not alive. So taking antibiotics for viruses won't make you feel better. Meanwhile, avoiding antibiotics when you have strep throat can lead to complications.

Strep throat is the most common cause of bacterial pharyngitis in children and adolescents and accounts for almost 30% of cases of pharyngitis in children between ages 5 and 15. However, adults can get it too, and group A strep (GAS) is the most common bacterial cause of acute pharyngitis in adults.¹

The condition is contagious. The transmission rate from a patient with GAS to close contacts is about 35%. It can spread from person to person through numerous transmission modes, including airborne and droplet.²

Symptoms of strep throat

Symptoms of strep throat are similar to viral respiratory infection. Only a doctor can diagnose the condition exactly. 

Classic signs and symptoms of GAS pharyngitis are:

• Acute onset sore throat

• Pain when swallowing

• Fever greater than 100.4⁰F

• Red and swollen tonsils

• White patches or streaks of pus on tonsils (patchy tonsillar exudates)

• Red spots on the roof of the mouth (palatal petechiae, i.e., scarlatiniform rash)

• Strawberry tongue (e.g., scarlet fever)

• Swollen, tender, prominent lymph nodes in the neck

Not all people who have strep throat experience symptoms. A person can test positive for strep throat without feeling sick. These people are termed carriers. They usually don't require treatment. Carriers are unlikely to spread bacteria to others and are at low risk of developing complications of GAS.

Diagnosis and treatment

Strep throat is less common than throat pain caused by a viral infection, particularly in the era of SARS-CoV-2. Streptococcal pharyngitis accounts for around 15–30% of acute pharyngitis cases in children and 5–20% in adults.³

To diagnose strep throat, the doctor:

• Tests for GAS either with a throat culture or with a rapid antigen test (RAT)

• Conducts a physical exam

If your healthcare provider suspects a bacterial infection, they will order a strep test. A strep test is quick and painless. The doctor swipes the tip of a cotton swab at the back of your throat. Then they test the swab to look for bacteria. The rapid strep test takes around 20 minutes.

If the doctor diagnoses strep throat, they will set up a course of treatment based on your symptoms and medical history. The main part of the treatment is antibiotics.

The typical antibiotics that treat group A streptococcus bacteria are penicillin and amoxicillin, as there’s no resistance to these drugs (beta-lactam resistance) inherent to GAS except in cases of penicillin allergy. The doctor may prescribe either pills, liquids, or shots. If you are allergic to penicillin, the healthcare provider can suggest alternatives.

To alleviate symptoms of strep throat, your doctor can suggest drinking warm liquids and taking over-the-counter pain relievers.

Complications

When left untreated, bacteria can spread from the throat to other parts of your body and cause complications. These are either suppurative:

• Tonsillopharyngeal cellulitis 

• Abscesses– pockets of pus around your tonsils 

• Otitis media– middle ear infection

• Necrotizing fasciitis 

• Meningitis or brain abscess (extremely rare)– infection of protective membranes that cover your brain and spinal cord

• Jugular vein septic thrombophlebitis (Lemierre syndrome)

• Streptococcal bacteremia 

Or nonsuppurative:

• Acute rheumatic fever – immune response to GAS infection that may cause inflammation or swelling of the heart, brain, joints, and skin

• Acute glomerulonephritis- inflammation of the part of your kidneys that filters blood

• Scarlet fever

• PANDAS (pediatric autoimmune neuropsychiatric disorder associated with group A streptococci)

• Streptococcal toxic shock syndrome

• Poststreptococcal reactive arthritis (PSRA)

Toxic shock syndrome (TSS)

Streptococcal toxic shock syndrome is a life-threatening condition that occurs when GAS causes invasive disease in normally sterile body parts such as blood or CSF. It causes TSS through the release of toxins in about a third of invasive GAS disease cases. 

Although TSS by definition requires invasive infection, patients meeting TSS criteria in the absence of isolation of GAS from a sterile site, with positive GAS in non-sterile sites such as the throat, can also be diagnosed with probable TSS — although this is extremely rare.

The clinical criteria for streptococcal TSS are:

• Hypotension, multiorgan involvement with two or more of:

  • Renal impairment

  • Coagulopathy

  • ARS

  • Liver involvement

  • Soft tissue necrosis

  • Erythematous macular rash

• It's a medical emergency. Toxic shock syndrome progresses quickly, and if not addressed immediately, it can be fatal. 

How to prevent strep throat

Since strep throat is a highly contagious condition that spreads through airborne mechanisms, droplets, and person-person contact/interaction, among other things, you can prevent it by:

• Wearing a tight-fitting respirator quality mask, especially in congregate settings

• Avoiding people with symptoms of respiratory tract infections.

• Not touching your mouth or nose after touching surfaces or items handled by other people, and washing your hands/sanitizing your hands when appropriate

To prevent complications of strep throat, speak to your doctor as soon as you start experiencing symptoms. You need to follow the doctor's orders carefully and inform them if antibacterial therapy doesn't help after two days.

The lowdown

While strep throat is perfectly treatable, some people don't get medical assistance on time. This can lead to serious complications, some of which may have fatal consequences.

Strep throat symptoms can be similar to the signs of a viral infection and vice versa. That's why it's important to consult a doctor and set up the right course of treatment.

Frequently asked questions

How serious is strep throat in adults?

Strep throat in adults is similar to strep throat in children. It requires antibacterial therapy. If left untreated, it could lead to serious complications.  

What happens if strep throat is left untreated?

When you don't treat strep throat, bacteria can spread to other parts of your body and cause serious complications, including rheumatic fever and meningitis.

How does strep throat turn into toxic shock?

When you don't treat strep throat, bacteria can spread deep into your tissues and bloodstream. This can cause an invasive infection in locales that are typically sterile, such as the brain or blood. The bacteria then growing in these locales secrete toxins, against which your body releases inflammatory cytokines, which then in turn can cause a capillary leak and tissue damage.