Strep throat, an infection in the tonsils and throat, is caused by streptococcus bacteria.
Fever is a common strep throat symptom, but is it possible to have strep throat without a fever? And could you still spread the infection to other people if you don’t have a fever?
Read on to learn more about strep throat, how it’s spread, the signs to watch out for, and when it’s time to see a doctor.
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Strep throat is often associated with fever, but you can have the condition without developing symptoms.
As well as fever, the most common symptoms of strep throat are:
Sore throat: This symptom can start very quickly. You might get a painful, scratchy, or dry feeling in your throat and pain when swallowing. However, a cough may suggest your symptoms are caused by a virus unrelated to streptococcus bacteria.
Swollen lymph nodes: Lymph nodes are small bean-shaped structures found in many parts of the body. They contain white blood cells (lymphocytes) that help you fight infections. Swollen lymph nodes in the anterior part of your neck may indicate strep throat.
Swollen, red tonsils: You may have strep throat if your tonsils (lumps of tissue at the back of the throat) are swollen and red. You might also see white patches or streaks of pus.
Petechiae: Tiny, red spots on the roof of your mouth may be a sign of strep.
If you believe you have strep throat, visit your doctor to avoid complications and passing the infection on to other people.
Sore throat and fever are both common symptoms of strep throat, but what if you have a sore throat and no fever? Is this a sign of strep throat or another condition?
A sore throat is usually a symptom of a viral infection, while strep throat is a bacterial infection. If you don’t have a fever, but you have a cough, conjunctivitis, a runny nose, and a hoarse voice, you may have a viral infection.
Other causes of a sore throat without fever include:
Tonsillitis: With tonsillitis, you might get red, swollen tonsils with white patches, a severe sore throat, difficulty swallowing, bad breath, and swollen neck glands. Tonsillitis can be caused by a viral or bacterial infection, but it rarely results in fever. Tonsillitis symptoms usually clear up after a few days, but you can see your doctor for an examination. They will prescribe antibiotics in some cases.
Common cold: Sore throat, stuffy nose, sneezing, coughing, watery eyes, and generally feeling tired are all signs of the common cold.
Sexually transmitted diseases (STIs): Some STIs don’t cause symptoms, but a sore throat without a fever can signify oral gonorrhea, herpes, or HIV.
Acid reflux: When acid from your stomach travels up your esophagus, it can cause a sore throat. This can occur with conditions like gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).
Seasonal allergies: Allergic rhinitis (or hay fever) can cause a sore throat without a fever. You might also get a cough; a stuffy, runny nose; itchy eyes, nose, and mouth; swollen, red, watery eyes; headache; and sneezing.
Your symptoms may ease on their own, but you can speak to your doctor to have an examination and get a diagnosis. They may take a swab to test for strep throat.
Your sore throat symptoms may ease within a few days if you don’t have a fever. If your symptoms worsen or do not ease within a few days, speak to your doctor.
You should also see your doctor if you have any of the following symptoms:
Signs of dehydration
Joint pain or swelling
Blood in your phlegm or saliva
Drooling in children
If you have other severe or concerning symptoms, see your doctor. Tell them if you keep getting sore throats.
When you visit your doctor, they will likely take your temperature and examine your throat and the lymph nodes in your neck. If strep throat seems likely, your doctor will perform a throat culture, a rapid antigen test, or both.
A throat culture is a lab test to identify germs that can potentially cause infections in the throat.
Your doctor will use a long sterile cotton swab to collect a sample from the back of your throat and tonsils. The process is painless but may cause gagging when the swab touches these areas.
Your doctor may repeatedly scrape the back of your throat to increase the chances of detecting what’s causing your symptoms. The sample collected will be cultured in the lab to determine if you have the bacterium and whether they grow over time. The test results may take one to two days, depending on the bacteria present.
Like a throat culture, a rapid antigen test uses a long sterile swab to collect a sample from your throat. The sample is examined under a powerful microscope to identify possible antigens like bacteria that may be causing your symptoms.
The test results take less than 20 minutes. If the results show possible antigens, your doctor can prescribe oral antibiotics. If it comes back negative, but the doctor suspects strep throat, they will propose a throat culture for a closer examination.
Your doctor will likely prescribe antibiotics as a primary treatment if your test results are positive.
Amoxicillin and penicillin are the most common treatment options, but your doctor can prescribe another antibiotic if you are allergic to these drugs.
Strep throat is mainly spread through interaction with infected nasal secretions and saliva.
You can still infect other people even if you don’t have symptoms. However, you will stop being contagious once you have taken your treatment for a day or two.
You can catch or spread strep throat in the following ways:
By breathing in respiratory droplets containing bacteria
By touching droplets containing bacteria and transferring them to your mouth or nose
By touching a sore caused by streptococcus bacteria (impetigo)
You should take the prescribed treatment to avoid bacterial resistance to antibiotics, even if you start feeling better. Take precautions when coughing, sneezing, and sharing food and drinks to prevent strep throat from spreading.
Strep throat is a highly transmissible infection — prevention is key. It’s most common in children of school-going age but still affects teens and adults. You can prevent it by practicing good personal hygiene.
The following strategies can help reduce your risk of getting strep throat or passing it on:
Avoid sharing personal items: Sharing items like eating utensils, food, and drinks can accelerate the spread of strep throat bacteria. Other items like pacifiers and toothbrushes also increase the risks of spreading and contracting strep bacteria.
Wash your hands regularly: Regular handwashing is one of the most effective ways of preventing infections like strep throat. Use soap to wash your hands and scrub every part of your hand for at least 20 seconds.
Use hand sanitizer: Hand sanitizers can help eliminate germs if you can’t access soap and water. Sanitizers usually come in portable bottles you can carry anywhere.
If you or someone you know already has strep throat, you can use the following strategies to avoid spreading it:
Keep your environment safe and clean: Surfaces like doorknobs and tabletops can host streptococcus bacteria. Wipe them down regularly.
Take antibiotics: If you’re diagnosed with strep throat, your doctor will likely prescribe antibiotics to fight the bacteria. Take all prescribed medication to prevent bacterial resistance while taking measures to prevent the spread. Remember, you will only be contagious for a day or two after taking your medication.
Maintain physical distance: If you think you have strep throat symptoms, maintain physical distance to avoid passing it on. Ask your doctor to sign you off from school or work until you have taken your medication for at least 24 hours.
Although a sore throat is a symptom of strep throat, not all painful sore throats are caused by strep. Strep throat accounts for a small portion of painful sore throats. Left untreated, strep throat can lead to complications like rheumatic fever and kidney inflammation.
Strep throat and the common cold can cause a sore throat, but other symptoms vary. Signs of the common cold, like sneezing, runny nose, and coughing, suggest a virus is causing your symptoms, not bacteria like streptococcus.
Yes. Strep throat is easy to pass from one person to another. You can still pass the infection on, even if you don’t have symptoms.
Strep throat is a contagious infection with uncomfortable symptoms like fever and sore throat. You can reduce the chances of spreading or contracting the disease by taking several precautions, like practicing good personal hygiene, maintaining physical distance, and taking your prescribed medication.
Although fever is one of the common symptoms of strep throat, you can have the infection without showing any symptoms at all. Therefore, strep throat doesn’t cause fever in all cases.
Strep throat: All you need to know | Centers for Disease Control and Prevention
When to worry about a sore throat | Baylor College of Medicine
Tonsillitis | NHS
Sore throat | Centers for Disease Control and Prevention
Combating antibiotic resistance | U.S. Food and Drug Administration
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