What are the signs and symptoms of strep throat?

With strep throat infection, the throat can become red and swollen. White patches may be visible on the back of the throat and the tonsils, suggesting the presence of pus. The presence of fever, swollen and often tender lymph nodes on the sides of the neck, and white patches on the tonsils along with the absence of cough raise the suspicion for strep pharyngitis.

Not all of these signs need to be present with strep tonsillopharyngitis. On the other hand, their presence is not specific only to strep throat.

Throat infection with strep bacteria can cause a variety of symptoms associated with inflammation of the throat and its nearby structures. Symptoms usually begin within a few days (1-4 days) after exposure to the bacteria (incubation period).

The strep throat rash is caused by toxins released from the bacteria, and not necessarily because of the spread of infection to the skin. A strep infection accompanied by this characteristic rash is what is known as "scarlet fever." Scarlet fever can occur in about 10% of children with a strep throat infection, and typically starts around the face and neck area and can spread to the chest, abdomen, and groin region.

It has a classic description of "goose bumps on sunburned skin." The rash may start within 12 to 24 hours of the onset of fever and may last for several days. Peeling of the skin of the fingertips may accompany the rash of scarlet fever.

Typical signs of strep throat infection are:

• fever;
• swollen, tender lymph nodes on the sides of the neck (cervical lymphadenopathy);
• white patches seen on the tonsils and throat (tonsillar exudates).

Other features that are more likely to be seen in tonsillopharyngitis due to viral causes include the following:

• conjunctivitis (eye redness),
• runny nose (coryza),
• skin rash (exanthem or small spotted rash),
• generalized weakness and malaise,
• muscle aches and pains,
• cough,
• hoarseness,
• diarrhea, and/or
• oral ulcers.