What’s the big deal if I miss strep throat?

Ear infections or sinus infections:

The bacteria can move into your middle ear and cause an ear infection, or up into the sinuses and cause a sinusitis​. If you notice ear pain or sinus pressure after a bout of strep, it could mean the infection has traveled.

Abscess around the tonsils:

An untreated strep infection can lead to a peritonsillar abscess, which is a pocket of pus that forms near the tonsil​. This can cause severe throat pain (often worse on one side), difficulty swallowing, drooling, jaw pain, and even difficulty breathing if the abscess is large. Abscesses usually require drainage by a doctor and additional treatment.

Scarlet fever:

Strep can trigger a body-wide rash known as scarlet fever. This causes a red, sandpaper-y (small, rough, bumpy) rash that often starts on the neck and chest and then spreads, along with a high fever​. In the pre-antibiotic era, scarlet fever was greatly feared; today it’s treatable (it’s the same strep infection, just with a rash).

Rheumatic fever:

This is one of the most serious complications. Rheumatic fever is an inflammatory disease that can develop about 2-4 weeks after an untreated strep infection. It can cause damage to the heart valves, inflammation in the joints, skin rash, and other issues​. Rheumatic fever can lead to long-term, and sometimes irreversible heart problems. Treating strep throat promptly with antibiotics can almost always prevent rheumatic fever.

While less common in the US, rheumatic fever still affects 282,000 people each year and causes 163,000 deaths each year.² Rheumatic fever is a major reason strep infections should be identified and treated, promptly.

Kidney inflammation:

Another potential complication is something called post-streptococcal glomerulonephritis – essentially, inflammation of the kidneys following a strep infection​. This can cause issues like blood in the urine, swelling, and high blood pressure. It’s relatively rare, and most people (especially children) recover fully, but in some cases it can cause lasting kidney problems. A clue that you might have this is reddish-brown or discolored urine, especially after a strep (throat or skin) infection.

Invasive streptococcal infections:

In very rare cases, the strep bacteria can spread through the bloodstream and cause severe invasive infections. These can include cellulitis (skin infection), streptococcal toxic shock syndrome, or osteomyelitis (bone infection). These can be serious, life-threatening conditions.

Anecdotally when kids returned to school unmasked after the pandemic, I saw dozens of children in the kids emergency room with invasive streptococcus. This infection should be taken seriously.

Abnormal movements:

Sydenham chorea is a condition that causes sudden, uncontrollable movements, mood swings, and muscle weakness—often showing up weeks or even months after a strep infection that wasn’t fully treated. Like PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), it happens when the immune system mistakenly attacks parts of the brain after a strep infection, reminding us how important it is to treat strep seriously to prevent these neurological issues.