Understanding strep A

From what it is, through to the illnesses it can cause & signs & symptoms to look out for, we help you understand strep A

You might have heard of group A strep, often known as strep A, or perhaps you’re aware of one of the illnesses it can cause, like tonsillitis, impetigo or scarlet fever. But what do you need to know?

We’ll talk you through some of the milder illnesses that can be caused by strep A, and what to do if you think you or your child are affected, plus what signs and symptoms of more serious infections to look out for and what action to take.

If you’re immediately concerned about your health or the health of a child or family member, contact your GP or call 111.

What is group A strep (GAS)?

Group A streptococcus (GAS), often known as strep A, is a common type of bacteria that is  found in the throat or on the skin.

Many people carry group A strep harmlessly, without getting ill. Usually, if illness does develop, it’s mild and easily treated, however some infections can be more serious.

How to help prevent a strep A infection

Infections like strep A can spread easily to other people. To help reduce the chance of catching or spreading an infection there are some simple steps you can take:

• Ensure you wash your hands regularly and thoroughly with soap and water for at least 20 seconds

• Teach your child how to wash their hands properly, and get them into a good habit of doing this regularly whether they’re unwell or not

• Use a tissue to catch coughs and sneezes, throw those tissues away as soon as possible after use and wash your hands immediately after

• If you or your child are unwell, avoid contact with others until you’re better

What types of illness can be caused by strep A?

Tonsillitis

What is tonsillitis?

Tonsillitis is one of the infections that can be caused by strep A and is when the tonsils at the back of your throat become infected. It commonly occurs in childhood but can also affect teenagers and adults.

Symptoms usually lasts between three and four days.

What are the symptoms of tonsillitis?

Tonsillitis can feel like a really bad cold or flu. The main symptoms of tonsillitis can include:

• Red, swollen tonsils

• A sore throat

• Problems swallowing

• A high temperature of 38C or above

• A cough

• A headache

• Feeling sick

• Earache

• Feeling tired

More severe symptoms can include:

• Painful, swollen glands in your neck

• White pus-filled spots on your tonsils

• Bad breath

A rare complication of tonsillitis is quinsy. This is where an abscess develops between your tonsil and the wall of your throat.

The symptoms of quinsy can include:

• A severe sore throat that quickly gets worse

• Swelling inside the mouth and throat

• Difficulty speaking

• Difficulty swallowing

• Difficulty breathing

• Difficulty opening your mouth

If you or your child have any of the symptoms of quinsy, call 999 or go to A&E.

What to do if you think you or your child has tonsillitis

Tonsillitis usually gets better on its own within a few days, but there are options available to you to help manage the symptoms.

• Self-treatment: this includes getting plenty of rest, drinking cool drinks to soothe your throat, taking paracetamol or ibuprofen (or for children, pain relief appropriate for their age – ensure you follow the dosage instructions carefully) and gargling with warm, salty water (children should not attempt this)

• Speak to your local Boots pharmacy team: your pharmacy team can provide advice and suggest treatment like lozenges, throat sprays and antiseptics

Speak to your GP if:

• You have white, pus-filled spots on your tonsils

• The sore throat is so painful that it’s difficult to eat or drink

• If your symptoms don’t get better within four days

Impetigo

What is impetigo?

Impetigo is a skin infection that can also be caused by strep A. Impetigo is a very contagious but not usually a serious infection. It’s common in young children, although anyone can get it.

It usually gets better within seven to 10 days if you get treatment.

What are the symptoms of impetigo

The initial symptoms of impetigo are red sores or blisters, although the redness might be harder to see in brown or black skin.

Crusty, golden-brown patches then occur when the blisters have burst. These patches can grow, spread to other parts of your body, be itchy and sometimes painful.

What to do if you think you or your child has impetigo 

If you think you or your child has impetigo, contact your GP. Because impetigo is very contagious, you should check with your GP surgery over the phone before you go into the practice –they may recommend a phone appointment to prevent the spread of the infection.

If appropriate, your GP may be able to prescribe an antibiotic cream or if it’s really bad, antibiotic tablets/liquid or a non-antibiotic cream to treat symptoms.

How to prevent the spread of impetigo

Because impetigo is so contagious, there are several steps you should take to prevent the spread to other parts of the body or to other people:

• Stay away from work, school, the gym and any other situations where you’re likely to come into close contact with people

• Wash towels and sheets at a high temperature, and do not share towels or sheets

• Keep sores, blisters and crusty patches clean and dry, and cover with loose clothing or gauze bandages

• Wash your hands frequently, and do not touch the sores, blisters or crusty patches

• Clean any toys with detergent and warm water if your child has impetigo

Scarlet fever

What is scarlet fever?

Scarlet fever is a contagious infection that can be caused by strep A, that most often affects young children.

What are the symptoms of scarlet fever?

The first symptoms of scarlet fever are often flu-like and can include:

• A high temperature

• A sore throat

• Swollen neck glands

After 12 to 48 hours, a rash appears that has small, raised bumps, and begins on the chest and stomach before spreading. The rash gives your skin a rough, sandpapery texture.

On white skin, the rash looks pink or red. On brown or black skin, it can be harder to see the change in colour, but there will still be visible raised bumps and you’ll still be able to feel the rash.

A white coating also appears on the tongue, which leaves the tongue red, swollen and covered in small bumps when it peels. This is sometimes called ‘strawberry tongue’.

Cheeks may appear red, although the rash doesn’t appear on the face – this may be harder to see on brown or black skin.

What to do if you think you or your child has scarlet fever

If you or your child has scarlet fever symptoms, contact your GP. As with impetigo, because scarlet fever is very contagious, the doctor may recommend a phone consultation rather than a face-to-face appointment.

If you or your child are diagnosed with scarlet fever, your GP may prescribe antibiotics to help you recover more quickly, reduce the chance of developing a serious illness and reduce the chance that you’ll pass the infection to someone else.

In addition, you can help to relieve symptoms of scarlet fever at home by drinking cool fluids, taking painkillers to reduce fever ( for children, pain relief appropriate to their age – ensure you follow the dosage instructions carefully) and using calamine lotion or antihistamine tablets/liquid to reduce itching (always read the label and check the dosage instructions for age-appropriate doses before giving to children). 

How to prevent the spread of scarlet fever

Scarlet fever is very contagious, and you can spread it to other people up to six days before you get symptoms and until 24 hours after you start taking antibiotics. If you don’t take antibiotics, you can spread scarlet fever for two to three weeks after your symptoms start.

To help prevent the spread you should:

• Stay away from school or work for at least 24 hours after you take your first dose of antibiotics

• Wash hands frequently

• Use tissues when sneezing or coughing, and bin those tissues immediately after use

• Don’t share cutlery, cups, towels, clothes, bedding or baths with anyone who has scarlet fever

Should I be concerned about scarlet fever?

Scarlet fever can be a serious illness, but it’s easily treatable with antibiotics.

Complications are rare, but can include ear infections, throat abscesses, sinusitis, pneumonia, meningitis and rheumatic fever.

Remember, if you suspect that you or your child have scarlet fever, contact your GP immediately to seek treatment.

Can group A strep cause more serious infections

In rare cases, group A strep can cause a more serious infection, known as invasive GAS (group A strep).

What is invasive GAS? (group A strep)

Invasive GAS (iGAS) is a rare but serious complication of group A strep. It occurs when strep A bacteria gets past the body’s natural defences and into a part of the body where it isn’t usually found, for instance the blood, muscles or lungs.

This might happen when a sore in the skin allows the bacteria into the blood stream, or when someone has a condition that affects their immune system and ability to fight off illness.

What are the symptoms of invasive group A strep?

Early symptoms of invasive group A strep include:

• A high temperature

•  Severe muscle aches

• Localised muscle tenderness

• Increasing pain, swelling and redness at the site of a wound

• Unexplained diarrhoea or vomiting

Invasive group A strep infections can be treated with antibiotics, but it’s important to seek treatment straight away so they don’t become more severe. If you or your child have any of the symptoms of iGAS contact your GP or call NHS 111 immediately.

What to do if your child is unwell

As a parent, it can be very worrying if your child is unwell, so it’s important to know what signs and symptoms to look out for that may need urgent attention.

Contact NHS 111 or your GP if:

• Your child has been unwell and is getting worse

• They’re feeding or eating much less than normal

• They’ve had a dry nappy for 12 hours or more and are  showing other signs of dehydration, like sunken eyes or few or no tears when they cry

• Your baby is under three months old and has a temperature of 38C, or is three to six months old and has a temperature of 39C or higher

• Your baby feels sweaty, or hotter than usual when you touch their back or chest

• Your child is very tired or irritable 

Call 999 or go to A&E if:

• Your child is struggling to breathe – they might be making grunting noises, or you might notice their tummy sucking under their ribs

•  There are pauses when your child breathes

• Their skin, tongue or lips are blue

• They’re floppy, and will not wake up or stay awake

Remember, serious illness caused by strep A is very rare, however as a parent, it’s important to trust your own judgement and seek medical advice if you’re concerned.