What are the signs and symptoms of strep throat?

Signs and Symptoms of Strep Throat

Strep throat is characterized by sudden-onset sore throat, fever, tonsillopharyngeal erythema with or without exudates, soft palate petechiae, beefy red swollen uvula, and tender enlarged anterior cervical lymph nodes. 1, 2

Classic Clinical Presentation

Key Symptoms

• Sudden-onset sore throat with pain on swallowing 1
• Fever, typically high (>100.4°F/38°C) 2, 3
• Headache, particularly common in both adults and children 2
• Nausea, vomiting, and abdominal pain (especially in children) 1, 2

Key Physical Examination Findings

• Tonsillopharyngeal erythema (inflammation/redness) - a hallmark finding 2
• Patchy tonsillopharyngeal exudates (white or yellow patches) 2, 3
• Tender, enlarged anterior cervical lymph nodes 1, 2
• Palatal petechiae ("doughnut lesions") - highly suggestive when present 2
• Beefy red, swollen uvula 1, 2

Distinguishing from Viral Pharyngitis

The following features suggest viral rather than streptococcal pharyngitis:

• Presence of cough 2, 3
• Coryza (nasal discharge) 2, 4
• Conjunctivitis 2
• Hoarseness 2
• Discrete ulcerative stomatitis (mouth ulcers) 2
• Viral exanthem (characteristic rash) 2
• Diarrhea 3

Diagnostic Challenges

• No single clinical sign is specific enough to definitively diagnose Group A Streptococcal (GAS) pharyngitis without laboratory confirmation 1, 2
• Clinical scoring systems like the modified Centor criteria can help identify patients with low probability of GAS pharyngitis 1, 5
• Even experienced clinicians cannot reliably distinguish streptococcal from viral pharyngitis based solely on physical examination 2

Age-Related Considerations

• Strep throat primarily affects children between 5 and 15 years of age 1, 2
• In children younger than 3 years, classic findings may be less apparent 1, 2
• Infants with Group A streptococcal infections may present with excoriated nares or purulent nasal discharge rather than classic pharyngitis 2

Warning Signs Requiring Urgent Attention

• Difficulty swallowing, neck tenderness or swelling may indicate complications like peritonsillar abscess or other deep space infections 1, 6
• Significant drooling may suggest development of more serious conditions like glottitis 6

Epidemiological Context

• Strep throat is more common in late winter and early spring in temperate climates 2, 5
• History of exposure to a documented case of streptococcal pharyngitis increases the likelihood of strep throat 2
• GAS causes approximately 15-30% of sore throats in children and 5-15% in adults 3, 5