Surprising strep throat symptoms that doctors really wish you knew

This is a common illness, and if you or your child have ever had that sudden, painful sore throat, you know how miserable it can be. You might wonder: how do I know if it’s strep, or just a virus?

This article is the first installment in our four-part series dedicated to helping you understand streptococcus pharyngitis. You can click here to learn if strep symptoms can go away on their own, strep throat testing options, or strep throat treatment.

Let’s dive in!

Also known as streptococcus pharyngitis, it is a bacterial infection in the throat and tonsils caused by Group A Streptococcus, or Streptococcus pyogenes, a type of bacteria​.

This infection makes your throat very sore and inflamed. Other causes of sore throat can include respiratory viruses, seasonal allergies, or post-nasal drip.

Finding out the cause of a sore throat is important because antibiotics (which kill bacteria) can treat strep, whereas they won’t help a viral sore throat. Strep throat can affect anyone, but it’s most common in school-aged children and teens, ages 5-15 years.¹ Adults can get it too, although viral sore throats are more frequent in adults​.

Strep symptoms may come on suddenly. I’ll share the classic signs and some of the things doctors look for on the physical exam:

• Very sore throat that starts quickly:
  • Your throat often feels extremely painful, and it may hurt to swallow. The throat and tonsils usually look red and swollen​.
• White spots or pus on the tonsils:
  • Some cases cause white streaks or spots of pus on the back of the throat or tonsils​. This is not always present, but if it is, strep is the likely culprit. I’m shocked at how often my patients do NOT look in the mirror to check how their tonsils look.
• Tiny red spots on the roof of the mouth:
  • Occasionally strep throat causes small red dots (called petechiae) on the palate near the back of your mouth​.
• Swollen lymph nodes in the neck:
  • The glands on the sides of your neck may become tender and enlarged. Note, these glands are part of your immune system and can be sore as your body fights the infection​.
• Fever:
  • It often causes a fever (often 101°F or higher) that starts quickly​. You might also get chills.
• Breath smells:
  • Some folks have noticed a certain odor that comes with strep throat. TBH I most often see moms mentioning the smell from their children with strep. A mom just ‘nose’ sometimes.
• Whitish tongue:
  • Sometimes the tongue can have a whitish appearance, and the papillae on the tongue (the tiny bumps) look more prominent or darker than usual. This is also called strawberry tongue. Look at your tongue on the regular, so you’ll know if something is off.

Yes. Some people with strep throat– especially children – can have fever, headache, stomach pain, nausea, or vomiting, even without a sore throat.

Anecdotally, when I see a child with fever, headache, and belly ache, without sore throat. If their throat appears slightly red, I’ll send a throat swab- and it’s often positive for strep!

Another variation more common in children is a red rough-textured rash (scarlet fever) and fever. These patients may or may not have sore throat. It is tested and treated in the same way- a throat swab and antibiotics.