A common upper respiratory infection, streptococcal pharyngitis (strep throat) is caused by Streptococcus pyogenes. This gram-positive bacterium appears as chains of cocci, as seen below. Rebecca Lancefield serologically classified streptococci in the 1930s using carbohydrate antigens from the bacterial cell walls. S. pyogenes is the sole member of the Lancefield group A streptococci and is often referred to as GAS, or group A strep.

Similar to streptococcal infections of the skin, the mucosal membranes of the pharynx are damaged by the release of a variety of exoenzymes and exotoxins by this extracellular pathogen. Many strains of S. pyogenes can degrade connective tissues by using hyaluronidase, collagenase and streptokinase. Streptokinase activates plasmin, which leads to degradation of fibrin and, in turn, dissolution of blood clots, which assists in the spread of the pathogen. Released toxins include streptolysins that can destroy red and white blood cells. The classic signs of streptococcal pharyngitis are a fever higher than 38 °C (100.4 °F); intense pharyngeal pain; erythema associated with pharyngeal inflammation; and swollen, dark-red palatine tonsils, often dotted with patches of pus; and petechiae (microcapillary hemorrhages) on the soft or hard palate (roof of the mouth) (Figure). The submandibular lymph nodes beneath the angle of the jaw are also often swollen during strep throat.

Some strains of group A streptococci produce erythrogenic toxin. This exotoxin is encoded by a temperate bacteriophage (bacterial virus) and is an example of phage conversion. The toxin attacks the plasma membranes of capillary endothelial cells and leads to scarlet fever (or scarlatina), a disseminated fine red rash on the skin, and strawberry tongue, a red rash on the tongue (Figure). Severe cases may even lead to streptococcal toxic shock syndrome (STSS), which results from massive superantigen production that leads to septic shock and death.

S. pyogenes can be easily spread by direct contact or droplet transmission through coughing and sneezing. The disease can be diagnosed quickly using a rapid enzyme immunoassay for the group A antigen. However, due to a significant rate of false-negative results (up to 30%), culture identification is still the gold standard to confirm pharyngitis due to S. pyogenes. S. pyogenes can be identified as a catalase-negative, beta hemolytic bacterium that is susceptible to 0.04 units of bacitracin. Antibiotic resistance is limited for this bacterium, so most β-lactams remain effective; oral amoxicillin and intramuscular penicillin G are those most commonly prescribed.

Sequelae of S. pyogenes Infections

One reason strep throat infections are aggressively treated with antibiotics is because they can lead to serious sequelae, later clinical consequences of a primary infection. It is estimated that 1%–3% of untreated S. pyogenes infections can be followed by nonsuppurative (without the production of pus) sequelae that develop 1–3 weeks after the acute infection has resolved. Two such sequelae are acute rheumatic fever and acute glomerulonephritis.

Acute rheumatic fever can follow pharyngitis caused by specific rheumatogenic strains of S. pyogenes (strains 1, 3, 5, 6, and 18). Although the exact mechanism responsible for this sequela remains unclear, molecular mimicry between the M protein of rheumatogenic strains of S. pyogenes and heart tissue is thought to initiate the autoimmune attack. The most serious and lethal clinical manifestation of rheumatic fever is damage to and inflammation of the heart (carditis). Acute glomerulonephritis also results from an immune response to streptococcal antigens following pharyngitis and cutaneous infections. Acute glomerulonephritis develops within 6–10 days after pharyngitis, but can take up to 21 days after a cutaneous infection. Similar to acute rheumatic fever, there are strong associations between specific nephritogenic strains of S. pyogenes and acute glomerulonephritis, and evidence suggests a role for antigen mimicry and autoimmunity. However, the primary mechanism of acute glomerulonephritis appears to be the formation of immune complexes between S. pyogenes antigens and antibodies, and their deposition between endothelial cells of the glomeruli of kidney. Inflammatory response against the immune complexes leads to damage and inflammation of the glomeruli (glomerulonephritis).

Cellulitis and erysipelas

Cellulitis is inflammation of the skin and deep underlying tissues. Erysipelas is an inflammatory disease of the upper layers of the skin. Group A strep (streptococcal) bacteria are the most common cause of cellulitis and erysipelas.

Impetigo

Impetigo is an infection of the top layers of the skin and is most common among children ages 2 to 6 years. It usually starts when bacteria get into a cut, scratch, or insect bite.

Scarlet fever

Scarlet fever – or scarlatina – is a bacterial infection caused by group A Streptococcus or "group A strep." This illness affects a small percentage of people who have strep throat or, less commonly, streptococcal skin infections.

Severe strep infections

Some types of group A strep bacteria cause severe infections, such as

• Bacteremia (bloodstream infections)
• Toxic shock syndrome (multi-organ infection)
• Necrotizing fasciitis (flesh-eating disease)

Strep throat

Many things can cause that unpleasant, scratchy, and sometimes painful condition known as a sore throat. Viruses, bacteria, allergens, environmental irritants (such as cigarette smoke), chronic postnasal drip, and fungi can all cause a sore throat. While many sore throats will get better without treatment, some throat infections—including strep throat—may need antibiotic treatment.

Rheumatic fever may develop if strep throat or scarlet fever infections are not treated properly or after strep skin infections (impetigo). Bacteria called group A Streptococcus (group A strep) cause these infections. It usually takes about 1 to 5 weeks after one of these infections for rheumatic fever to develop.

Rheumatic fever is not contagious

People cannot catch rheumatic fever from someone else because it is an immune response and not an infection. However, people with a group A strep infection can spread the bacteria to others.

Fever and painful, tender joints are common symptoms

Symptoms of rheumatic fever can include:

• Fever
• Arthritis (painful, tender joints), most commonly in the knees, ankles, elbows, and wrists
• Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
• Fatigue (tiredness)
• Chorea (jerky, uncontrollable body movements)

Rarely, symptoms can include nodules (painless lumps) near joints or a rash that has pink rings with a clear center.

In addition, someone with rheumatic fever can have:

• A new heart murmur
• An enlarged heart
• Fluid around the heart

Some people are at increased risk

Anyone can get rheumatic fever after having strep throat, scarlet fever, or impetigo. There are some factors that can increase the risk of getting rheumatic fever.

Age

Rheumatic fever is more common in school-age children (5 through 15 years old). Rheumatic fever is very rare in children younger than 3 years old and adults.

Group settings

Infectious illnesses, including group A strep infections, tend to spread wherever large groups of people gather. Crowded conditions can increase the risk of getting strep throat, scarlet fever, or impetigo, and thus rheumatic fever if they are not treated properly. These settings include:

• Schools
• Daycare centers
• Military training facilities

Other health factors

Someone who had rheumatic fever in the past is more likely to get rheumatic fever again if they get strep throat, scarlet fever, or impetigo again.

Many tests, considerations help doctors diagnose rheumatic fever

There is no single test used to diagnose rheumatic fever. Instead, doctors can look for signs of illness, check the patient’s medical history, and use many tests, including:

• A throat swab to look for a group A strep infection
• A blood test to look for antibodies to see if the patient recently had a group A strep infection
• Electrocardiogram or EKG (a test of how well the heart is working)
• Echocardiography or echo (a test that creates a movie of the heart muscle working)

Treatment focuses on managing inflammation, symptoms

Doctors treat symptoms of rheumatic fever with medicines to reduce fever, pain, and general inflammation.

In addition, all patients with rheumatic fever should get antibiotics that treat group A strep infections.

People who develop rheumatic heart disease (long-term heart damage) with symptoms of heart failure may require medicines to help manage this as well.

Serious complications include long-term heart damage

If rheumatic fever is not treated promptly, rheumatic heart disease may occur. Rheumatic heart disease weakens the valves between the chambers of the heart. Severe rheumatic heart disease can require heart surgery and result in death.

Protect yourself and others

Having a group A strep infection does not protect someone from getting infected again in the future. People can also get rheumatic fever more than once. However, there are things people can do to protect themselves and others.

Good hygiene

The best way to keep from getting or spreading group A strep bacteria is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating.

Preventive antibiotics

The main ways to prevent rheumatic fever are to

• Treat group A strep infections with antibiotics
• Prevent group A strep infections in the first place
• Use preventive antibiotics for people who had rheumatic fever in the past

Preventive antibiotics help protect people who had rheumatic fever from getting it again. Doctors also call this prophylaxis (pro-fuh-LAK-sis) or “secondary prevention.”

People may need antibiotic prophylaxis over a period of many years (often until 21 years old). Prophylaxis can include daily antibiotics by mouth or a shot into the muscle every few weeks.

Necrotizing fasciitis (NECK-re-tie-zing FASH-e-i-tis) is a rare bacterial infection that spreads quickly in the body and can cause death.

Accurate diagnosis, rapid antibiotic treatment, and prompt surgery are important to stopping this infection.

See a doctor right away if your skin becomes red, warm, swollen, or very painful soon after an injury or surgery.

Group A strep thought to be most common cause

There are many types of bacteria that can cause the “flesh-eating disease” called necrotizing fasciitis. Public health experts believe group A Streptococcus (group A strep) are the most common cause of necrotizing fasciitis. This web page only focuses on necrotizing fasciitis caused by group A strep bacteria.

Bacteria that live in water, including Vibrio vulnificus, can also cause necrotizing fasciitis. Learn about Vibrio wound infections.

How you get necrotizing fasciitis

The bacteria most commonly enter the body through a break in the skin. Different breaks in the skin can include:

• Cuts and scrapes
• Burns
• Insect bites
• Puncture wounds (including those due to intravenous [IV] drug use)
• Surgical wounds

However, people can also get necrotizing fasciitis after blunt trauma (an injury that does not break the skin).

Necrotizing fasciitis is rarely contagious

Most cases of necrotizing fasciitis occur randomly. It is very rare for someone with necrotizing fasciitis to spread the infection to other people. For this reason, doctors usually do not give preventive antibiotics to close contacts of someone with necrotizing fasciitis.

What’s in a Name?

Necrotizing means causing the death of tissues. Fasciitis means inflammation of the fascia (the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels).

Symptoms can often be confusing and develop quickly

The infection often spreads very quickly.

Early symptoms of necrotizing fasciitis can include:

• 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

See a doctor right away if you have these symptoms after an injury or surgery. Even though minor illnesses can cause symptoms like these, people should not delay getting medical care.

Later symptoms of necrotizing fasciitis can include:

• Ulcers, blisters, or black spots on the skin
• Changes in the color of the skin
• Pus or oozing from the infected area
• Dizziness
• Fatigue (tiredness)
• Diarrhea or nausea

Some people are at increased risk

While anyone can get necrotizing fasciitis, it is rare.

Other health factors

Most people who get this illness have other health problems that may lower their body’s ability to fight infections. Some conditions that weaken the body’s immune system include:

• Diabetes
• Kidney disease
• Cirrhosis (scarring) of the liver
• Cancer

Diagnosis can be difficult and acting fast is key

There are many infections that look similar to necrotizing fasciitis in the early stages, which can make diagnosis difficult. In addition to looking at the injury or infection, doctors can diagnose necrotizing fasciitis by:

• Performing a biopsy (taking a tissue sample)
• Looking at bloodwork for signs of infection and muscle damage
• Looking at imaging (CT scan, MRI, ultrasound) of the damaged area

However, it is important to start treatment as soon as possible. Therefore, doctors may not wait for test results if they think a patient might have necrotizing fasciitis.

Prompt treatment is key

Necrotizing fasciitis is a very serious illness that requires care in a hospital. Antibiotics and surgery are typically the first lines of defense if a doctor suspects a patient has necrotizing fasciitis.

Antibiotics

To try to stop the infection, doctors give antibiotics through an IV, which allows medicine to flow into a vein.

Sometimes, however, antibiotics cannot reach all the infected areas because the bacteria have killed too much tissue and reduced blood flow. When this happens, doctors must surgically remove the dead tissue.

Surgery

Since necrotizing fasciitis can spread so rapidly, patients often must get surgery done very quickly. It is not unusual for someone with necrotizing fasciitis to end up needing multiple surgeries. In serious cases, the patient may need a blood transfusion.

Serious complications are common

Necrotizing fasciitis can lead to

• Sepsis
• Shock
• Organ failure

It can also result in life-long complications from loss of limbs or severe scarring due to surgically removing infected tissue.

Looking at data from the most recent five years:

• Even with treatment, up to 1 in 5 people with necrotizing fasciitis died from the infection
• Up to 1 in 3 people who got both necrotizing fasciitis and streptococcal toxic shock syndrome at the same time died from their infections

Prevent necrotizing fasciitis

There are no vaccines to prevent group A strep infections, but there are things you can do to help protect yourself and others.

To help prevent group A step infections, you should:

• Wash your hands often
• Clean and care for wounds

Clean and care for wounds

Protect wounds and infections

If you have an open wound or skin infection, avoid spending time in:

• Hot tubs
• Swimming pools
• Natural bodies of water (e.g., lakes, rivers, oceans)

Care for fungal infections

Care for fungal infections like athlete’s foot to help prevent group A strep infections. Learn about athlete’s foot (ringworm).

If your child has a sore throat and a rash, it may be scarlet fever (also called scarlatina). Your child’s doctor can do a quick strep test to find out. If your child has scarlet fever, antibiotics can help your child feel better faster and prevent long-term health problems. Antibiotics can also help protect others from getting sick.

Bacteria Cause Scarlet Fever

Bacteria called group A Streptococcus or group A strep cause scarlet fever. The bacteria sometimes make a poison (toxin), which causes a rash — the “scarlet” of scarlet fever.

How You Get Scarlet Fever

Group A strep live in the nose and throat and can easily spread to other people. It is important to know that all infected people do not have symptoms or seem sick. People who are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.

People can get sick if they:

• Breathe in those droplets
• Touch something with droplets on it and then touch their mouth or nose
• Drink from the same glass or eat from the same plate as a sick person
• Touch sores on the skin caused by group A strep (impetigo)

Rarely, people can spread group A strep through food that is not handled properly. Experts do not believe pets or household items, like toys, spread these bacteria.

Common Signs, Symptoms of Scarlet Fever

• Very red, sore throat
• Fever (101 °F or higher)
• Whitish coating on the tongue early in the illness
• “Strawberry” (red and bumpy) tongue
• Red skin rash that has a sandpaper feel
• Bright red skin in the creases of the underarm, elbow, and groin (the area where your stomach meets your thighs)
• Swollen glands in the neck

Other general symptoms:

• Headache or body aches
• Nausea, vomiting, or abdominal pain

Scarlet Fever: What to Expect

In general, scarlet fever is a mild infection. It usually takes two to five days for someone exposed to group A strep to become sick. Illness usually begins with a fever and sore throat. There may also be chills, vomiting, or abdominal pain. The tongue may have a whitish coating and appear swollen. It may also have a “strawberry”-like (red and bumpy) appearance. The throat and tonsils may be very red and sore, and swallowing may be painful.

One or two days after the illness begins, a red rash usually appears. However, the rash can appear before illness or up to 7 days later. The rash may first appear on the neck, underarm, and groin (the area where your stomach meets your thighs). Over time, the rash spreads over the body. The rash usually begins as small, flat blotches that slowly become fine bumps that feel like sandpaper.

Although the cheeks might look flushed (rosy), there may be a pale area around the mouth. Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash. The rash from scarlet fever fades in about 7 days. As the rash fades, the skin may peel around the fingertips, toes, and groin area. This peeling can last up to several weeks.

Children and Certain Adults Are at Increased Risk

Anyone can get scarlet fever, but there are some factors that can increase the risk of getting this infection.

Scarlet fever, like strep throat, is more common in children than adults. It is most common in children 5 through 15 years old. It is rare in children younger than 3 years old. Adults who are at increased risk for scarlet fever include:

• Parents of school-aged children
• Adults who are often in contact with children

Close contact with another person with scarlet fever is the most common risk factor for illness. For example, if someone has scarlet fever, it often spreads to other people in their household.

Infectious illnesses tend to spread wherever large groups of people gather together. Crowded conditions can increase the risk of getting a group A strep infection. These settings include:

• Schools
• Daycare centers
• Military training facilities

Doctors Can Test for and Treat Scarlet Fever

Many viruses and bacteria can cause an illness that includes a red rash and sore throat. Only a rapid strep test or a throat culture can determine if group A strep are the cause.

A rapid strep test involves swabbing the throat and testing the swab. The test quickly shows if group A strep are causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects scarlet fever, then the doctor can take a throat culture swab. A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use in children and teens since they can get rheumatic fever from an untreated scarlet fever infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following scarlet fever.

Antibiotics Get You Well Fast

Doctors treat scarlet fever with antibiotics. Either penicillin or amoxicillin are recommended as a first choice for people who are not allergic to penicillin. Doctors can use other antibiotics to treat scarlet fever in people who are allergic to penicillin.

Benefits of antibiotics include:

• Decreasing how long someone is sick
• Decreasing symptoms (feeling better)
• Preventing the bacteria from spreading to others
• Preventing serious complications like rheumatic fever

Long-term Health Problems Are Not Common but Can Happen

Complications are rare but can occur after having scarlet fever. This can happen if the bacteria spread to other parts of the body. Complications can include:

• Abscesses (pockets of pus) around the tonsils
• Swollen lymph nodes in the neck
• Ear, sinus, and skin infections
• Pneumonia (lung infection)
• Rheumatic fever (a heart disease)
• Post-streptococcal glomerulonephritis (a kidney disease)
• Arthritis (joint inflammation)

Treatment with antibiotics can prevent most of these health problems.

Protect Yourself and Others

People can get scarlet fever more than once. Having scarlet fever does not protect someone from getting it again in the future. While there is no vaccine to prevent scarlet fever, there are things people can do to protect themselves and others.

Good Hygiene Helps Prevent Group A Strep Infections

The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating. To practice good hygiene, you should:

• Cover your mouth and nose with a tissue when you cough or sneeze
• Put your used tissue in the waste basket
• Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue
• Wash your hands often with soap and water for at least 20 seconds
• Use an alcohol-based hand rub if soap and water are not available

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

Antibiotics Help Prevent Spreading the Infection to Others

People with scarlet fever should stay home from work, school, or daycare until they:

• No longer have a fever
  AND
• Have taken antibiotics for at least 12 hours

Take the prescription exactly as the doctor says to. Don’t stop taking the medicine, even if you or your child feel better, unless the doctor says to stop.

Worried your sore throat may be strep throat? Doctors can do a quick test to see if a sore throat is strep throat. Antibiotics can help people with strep throat feel better faster and prevent spreading it to others.

Bacteria Cause Strep Throat

Viruses are the most common cause of a sore throat. However, strep throat is an infection in the throat and tonsils caused by bacteria called group A Streptococcus (group A strep).

How You Get Strep Throat

Group A strep live in the nose and throat and can easily spread to other people. People who are infected spread the bacteria by talking, coughing, or sneezing, which creates small respiratory droplets that contain the bacteria. They can also spread the bacteria from infected sores on their skin.

It usually takes two to five days for someone exposed to group A strep to become ill with strep throat.

It is important to know that some infected people do not have symptoms or seem sick. People sick with strep throat are much more contagious than those who do not have symptoms.

People can get sick if they:

• Breathe in respiratory droplets that contain the bacteria
• Touch something with those droplets on it and then touch their mouth or nose
• Drink from the same glass or eat from the same plate as a person infected with group A strep
• Touch sores on the skin caused by group A strep (impetigo) or come into contact with fluid from the sores

Rarely, people can spread group A strep through food that is not handled properly.

Pain and Fever without a Cough Are Common Signs and Symptoms

In general, strep throat is a mild infection, but it can be very painful. The most common symptoms of strep throat include:

• Sore throat that can start very quickly
• Pain when swallowing
• Fever
• Red and swollen tonsils, sometimes with white patches or streaks of pus
• Tiny, red spots (petechiae — pronounced pi-TEE-kee-eye) on the roof of the mouth (the soft or hard palate)
• Swollen lymph nodes in the front of the neck

Other symptoms may include a headache, stomach pain, nausea, or vomiting — especially in children. Someone with strep throat may also have a rash; when this happens it is known as scarlet fever (scarlatina).

The following symptoms suggest a virus is the cause of the illness instead of strep throat:

• Cough
• Runny nose
• Hoarseness (changes in your voice that make it sound breathy, raspy, or strained)
• Conjunctivitis (pink eye)

Children and Certain Adults Are at Increased Risk

Anyone can get strep throat, but there are some factors that can increase the risk of getting this common infection.

Strep throat is more common in children than adults. It is most common in children 5 through 15 years old. It is very rare in children younger than 3 years old.

Adults who are at increased risk for strep throat include:

• Parents of school-aged children
• Adults who are often in contact with children

Close contact with another person with strep throat is the most common risk factor for illness. For example, if someone has strep throat, the bacteria often spread to other people in their household.

Infectious illnesses tend to spread wherever large groups of people gather. Crowded settings can increase the risk of getting a group A strep infection. These settings include:

• Schools
• Daycare centers
• Military training facilities

Strep Throat: More Common in Children

• Up to 3 in 10 children with a sore throat have strep throat
• About 1 in 10 adults with a sore throat has strep throat

A Simple Test Gives Fast Results

A doctor will determine what type of illness you have by asking about symptoms and doing a physical exam. If they think you might have strep throat, they will swab your throat to test for strep throat. There are two types of tests for strep throat: a rapid strep test and throat culture.

A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep is causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects strep throat, then the doctor can take a throat culture swab. A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use in children and teens since they can get rheumatic fever from an untreated strep throat infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following a strep throat infection.

Someone with strep throat should start feeling better in just a day or two after starting antibiotics. Call the doctor if you or your child are not feeling better after taking antibiotics for 48 hours.

Antibiotics Get You Well Fast

Doctors treat strep throat with antibiotics. Either penicillin or amoxicillin are recommended as a first choice for people who are not allergic to penicillin. Doctors can use other antibiotics to treat strep throat in people who are allergic to penicillin.

Benefits of antibiotics include:

• Decreasing how long someone is sick
• Decreasing symptoms (feeling better)
• Preventing the bacteria from spreading to others
• Preventing serious complications like rheumatic fever

Someone who tests positive for strep throat but has no symptoms (called a “carrier”) usually does not need antibiotics. They are less likely to spread the bacteria to others and very unlikely to get complications. If a carrier gets a sore throat illness caused by a virus, the rapid strep test can be positive. In these cases it can be hard to know what is causing the sore throat. If someone keeps getting a sore throat after taking the right antibiotics, they may be a strep carrier and have a viral throat infection. Talk to a doctor if you think you or your child may be a strep carrier.

Serious Complications Are Not Common but Can Happen

Complications can occur after a strep throat infection. This can happen if the bacteria spread to other parts of the body. Complications can include:

• Abscesses (pockets of pus) around the tonsils or in the neck
• Swollen lymph nodes in the neck
• Sinus infections
• Ear infections
• Rheumatic fever (a heart disease)
• Post-streptococcal glomerulonephritis (a kidney disease)

Protect Yourself and Others

People can get strep throat more than once. Having strep throat does not protect someone from getting it again in the future. While there is no vaccine to prevent strep throat, there are things people can do to protect themselves and others.

Good hygiene helps prevent group A strep infections

The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating.

To practice good hygiene, you should:

• Cover your mouth and nose with a tissue when you cough or sneeze.
• Put your used tissue in the waste basket.
• Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue.
• Wash your hands often with soap and water for at least 20 seconds.
• Use an alcohol-based hand rub if soap and water are not available.

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

Wash your hands often to help prevent germs from spreading.

Antibiotics help prevent spreading the infection to others

People with strep throat should stay home from work, school, or daycare until they:

• No longer have a fever
• AND
• Have taken antibiotics for at least 12 hours

Take the prescription exactly as the doctor says to. Don’t stop taking the medicine, even if you or your child feel better, unless the doctor says to stop.

Streptococcal toxic shock syndrome (STSS) is a rare, but serious bacterial infection. STSS can develop very quickly into low blood pressure, multiple organ failure, and even death.

Group A strep bacteria cause STSS

Bacteria called group A Streptococcus (group A strep) can cause STSS when they spread into deep tissues and the bloodstream.

How you get STSS

For nearly half of people who get STSS, experts do not know how the bacteria got into the body. Sometimes the bacteria get into the body through openings in the skin, like an injury or surgical wound. The bacteria can also get into the body through mucus membranes, like the skin inside the nose and throat.

STSS is rarely contagious

It is very rare for someone with STSS to spread the infection to other people. However, any group A strep infection can turn into STSS and it is very easy to spread group A strep bacteria.

Illness gets worse soon after symptoms appear

STSS often begins with the following 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:

• Hypotension (low blood pressure)
• Tachycardia (faster than normal heart rate)
• Tachypnea (rapid breathing)
• Organ failure (other signs that organs are not working)
  • Examples: Someone with kidney failure may not make urine. Someone with liver failure may bleed or bruise a lot or their skin and eyes may turn yellow.

Seek medical attention immediately if you have signs or symptoms of STSS.

Some people are at increased risk

Anyone can get STSS, but there are some factors that can increase your risk of getting this infection.

Age

STSS is most common in adults 65 years old or older.

Infections or injuries that break the skin

People with an open wound are at increased risk for STSS. This can include people who recently had

• Surgery
• A viral infection that caused open sores (such as varicella that causes chickenpox and shingles)

Other health factors

People with diabetes or alcohol use disorder, previously known as alcohol dependence or alcoholism, are at increased risk for STSS.

Many tests, considerations help doctors diagnose STSS

There is no single test used to diagnose STSS. Instead, doctors may:

• Collect blood or other samples to test for group A strep infection
• Order tests to see how well different organs are working

Doctors diagnose STSS when they find group A strep bacteria in a patient who also has:

• Low blood pressure
• Problems with two or more of the following organs:
  • Kidney
  • Liver
  • Lung
  • Blood
  • Skin
  • Soft tissue (tissue beneath the skin and muscles)

STSS needs treatment in a hospital

Doctors treat STSS with antibiotics. People with STSS need care in a hospital. They often need fluids given through a vein and other treatments to help treat shock and organ failure. Many people with STSS also need surgery to remove infected tissue.

Serious complications are common

STSS often results in complications from organs shutting down and the body going into shock, including:

• Limbs removed through surgery
• Severe scarring from having infected tissues removed through surgery

Even with treatment, STSS can be deadly. Out of 10 people with STSS, as many as 3 people will die from the infection.

Protect yourself and others

While there is no vaccine to prevent STSS, there are things people can do to protect themselves.

Good wound care

Good wound care is the best way to prevent bacterial skin infections.

• Clean all minor cuts and injuries that break the skin (like blisters and scrapes) with soap and water.
• Clean and cover draining or open wounds with clean, dry bandages until they heal.
• See a doctor for puncture and other deep or serious wounds.
• If you have an open wound or active infection, avoid spending time in:
  • Hot tubs
  • Swimming pools
  • Natural bodies of water (e.g., lakes, rivers, oceans)

Good hygiene

The best way to keep from getting or spreading group A strep bacteria is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating.

To prevent group A strep infections, you should:

• Cover your mouth and nose with a tissue when you cough or sneeze.
• Put your used tissue in the waste basket.
• Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue.
• Wash your hands often with soap and water for at least 20 seconds.
• Use an alcohol-based hand rub if soap and water are not available.

You should also wash glasses, utensils, and plates after someone who is sick uses them. After they have been washed, these items are safe for others to use.

Antibiotics

It is very rare for someone with STSS to spread the infection to other people. For this reason, doctors usually do not give preventive antibiotics to people who are under the age of 65 years and in close contact with someone with STSS. People who live together would be an example of close contacts. However, doctors may consider giving antibiotics to close contacts who are 65 years old or older and at higher risk of getting STSS.