Signs and Symptoms of Strep Throat
Strep throat presents with sudden onset of sore throat, pain on swallowing, fever, tonsillopharyngeal erythema with or without exudates, palatal petechiae, beefy red swollen uvula, and tender enlarged anterior cervical lymph nodes. 1
Classic Clinical Findings
- Sudden onset of sore throat and pain when swallowing 2, 1
- Tonsillopharyngeal erythema (inflammation) is a hallmark finding 2, 1
- Patchy tonsillopharyngeal exudates may be present 2, 1
- Tender, enlarged anterior cervical lymph nodes (lymphadenitis) 2, 1
- Palatal petechiae ("doughnut lesions") are highly suggestive when present 1
- Beefy red, swollen uvula is characteristic 1
- Fever, typically ranging from high to very high 1
Associated Systemic Symptoms
- Headache is commonly reported 2, 1
- Nausea, vomiting, and abdominal pain, especially in children 2, 1
- Most common in children 5-15 years of age 2, 1
- More common during winter or early spring 2, 1
- History of exposure to streptococcal pharyngitis increases likelihood 1
- Scarlatiniform rash may be present 2
Distinguishing from Viral Pharyngitis
Strep throat symptoms often overlap with viral pharyngitis, making clinical diagnosis challenging. The following features suggest a viral rather than streptococcal etiology:
- Conjunctivitis (pink eye) 2, 1
- Coryza (nasal discharge) 2, 1
- Cough 2, 1
- Hoarseness 2, 1
- Discrete ulcerative stomatitis (mouth ulcers) 2, 1
- Viral exanthem (characteristic rash) 2, 1
- Diarrhea 2, 1
Diagnostic Considerations
- No single clinical finding or combination is specific enough to definitively diagnose streptococcal pharyngitis without laboratory confirmation 1, 3
- Even experienced clinicians cannot reliably distinguish streptococcal from viral pharyngitis based solely on physical examination 1
- Diagnosis should be confirmed using rapid antigen detection test and/or culture of a throat swab 2
- Clinical scoring systems like modified Centor criteria can help identify patients with low probability of Group A streptococcal pharyngitis 3
Age-Related Considerations
- In children younger than 3 years, classic findings may be less apparent 1
- Infants with Group A streptococcal infections may present with excoriated nares or purulent nasal discharge rather than classic pharyngitis 1
- Only about 20-30% of patients present with all the classic symptoms 4
Clinical Pitfalls
- Physicians often overdiagnose streptococcal pharyngitis based on clinical features alone, leading to unnecessary antibiotic use 4
- Relying solely on clinical signs without microbiological confirmation may lead to inappropriate antibiotic prescribing 3
- Only 10% of adults seeking care for a sore throat have group A beta-hemolytic streptococcal pharyngitis, yet 60% or more receive antibiotics 5