By Kate Marino

Nationwide, children’s doctors are seeing an increase in severe Strep A, also known as strep throat. While most strep infections are mild and can be treated at home like other illnesses, such as influenza (flu) and respiratory syncytial virus (RSV), the illness can sometimes become more serious. 

Strep A is common, especially in kids ages 5-15, and usually resolves with treatment. In terms of ways to prevent it, Tiffany Kimbrough, M.D.,the medical director of the complex care clinic at the Children’s Hospital of Richmond at VCU, says the same methods for avoiding the colds, flu and COVID-19 apply. These include frequently and thoroughly washing your hands, covering yourself when coughing and sneezing, as well as staying home and away from others when sick.

Kimbrough has answers from some commonly asked questions from parents and caregivers about Strep A: 

How can someone get Strep A?

Group A Streptococcus bacteria are most commonly spread through respiratory droplets when an infected person sneezes, coughs or sometimes simply talks and another person breathes in those droplets. The bacteria can also spread when people share food and drinks, or when someone touches a surface with the bacteria, then touches their own eyes, nose or mouth.

What are the common symptoms of a Strep A infection? 

The most common symptom of Strep A is a sore throat. It can be quite painful, especially when swallowing. Other symptoms may include:

• Fever
• Headache
• Swollen lymph nodes in the neck
• Red and swollen tonsils
• Tiny red spots on the back roof of the mouth
• White patches on the tonsils
• Nausea or vomiting, especially in young kids
• Rash 

Cough and runny nose are not typical symptoms of Strep A. The following symptoms are a sign that emergency care is needed:

• Swelling of extremities
• Decreased level of alertness
• Rapid breathing
• Changes in skin color
• Ulcers or blisters on the skin
• Severe abdominal pain
• Decreased urination

For milder symptoms, it’s best to check in with your child’s pediatrician before going to the emergency room.

When is Strep A serious? 

Strep A is fairly common, especially for kids between 5 and 15 years old. It usually resolves with treatment. 

If left untreated, the bacteria can spread to other parts of the body and develop into rare but serious conditions, including kidney inflammation, rheumatic fever, scarlet fever or poststreptococcal reactive arthritis. 

How is Strep A typically treated? 

Many of the Strep A symptoms are similar to those of viral infections, like influenza. Before prescribing treatment, a doctor will take a throat culture with a quick swab of the back of the throat. If the test comes back positive for Strep A, antibiotic treatment is needed – typically penicillin or amoxicillin for 10 days.

Most kids will feel better and no longer be contagious after a couple doses, but it’s important that they take the entire course of the antibiotics to fully knock out the bacteria and limit further complications. For recurrent cases of strep throat, we sometimes recommend removing the tonsils.

How is the reduced supply of antibiotics and children’s pain relievers/fever reducers impacting treatment of Strep A?

An early spike in viral illnesses caused a run on children’s fever reducers and pain relievers, leading caregivers to search store shelves or consider non-medication options for helping their children find relief. Now, an increased demand for antibiotics – which are used to treat bacterial infections – all at once, following a decreased need over the past two years while kids were staying well, has led to a shortage in those too. We’ve been calling around to see who has our prescribed treatments in stock or using alternative options when safe and appropriate.  

How can everyone help prevent the spread of Strep A?

The same infection prevention measures we use for colds, flu and COVID-19 are essential in preventing the spread of Strep A. This includes frequent and thorough hand washing, cough and sneeze etiquette, and staying home and away from others when sick.

A version of this story was originally published on the Advancing Children’s Health Blog at Children’s Hospital of Richmond at VCU. 

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