Streptococcal infections are any type of infection caused by the streptococcal, or “strep” group of bacteria. Streptococci are divided into group A, group B, group C, and group G.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a70c2800-4bce-4e1f-823a-47f27c8a1f25 Some of these create relatively mild, treatable conditions, such as strep throat , while others can lead to life-threatening infections of the blood or organs. Anyone can be affected, from babies and small children to older adults.e60dc2a1-f33c-4a05-9b50-8e3e8e597629be601423-8aa8-4bea-a8cc-1ab847db93d0 Here’s what to know about how the different types of streptococcal infections are transmitted, treated, and prevented.
Common Group A Streptococcal Infections A Types Group A strep, sometimes called GAS, tends to affect the throat and the skin. People may carry GAS in these areas yet not show any symptoms of illness. Most group A strep infections cause relatively mild illness, but on rare occasions, these bacteria can lead to severe and even life-threatening disease.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296a18a10d-6d2d-4e71-82d9-19de384cfb2f Group A strep infections spread through direct contact with mucus from the nose or throat, or through contact with infected wounds or sores. Some research indicates that people with underlying conditions such as diabetes, heart disease, cancer, or obesity may be at higher risk of contracting group A strep infection.e60dc2a1-f33c-4a05-9b50-8e3e8e59762940a372d5-bdb1-4b83-8d9f-f9db405b060a Illnesses caused by infection with group A strep include: Strep Throat In general, strep throat is a mild illness, but it can be very painful. Anyone can get strep throat, but it’s more common among children ages 5 to 15. Parents and adults who are often in contact with children of these ages are more likely to get strep throat than adults who are not.e60dc2a1-f33c-4a05-9b50-8e3e8e59762944a9ebfb-7e58-41aa-bebb-ef06b22b175f Symptoms include :e60dc2a1-f33c-4a05-9b50-8e3e8e59762944a9ebfb-7e58-41aa-bebb-ef06b22b175f A sore throat that comes on very quickly Pain when swallowing Fever Red and swollen tonsils (sometimes with white patches or streaks of pus) Small red spots on the roof of the mouth Swollen lymph nodes in the front of the neck Strep throat may also be accompanied by headache, abdominal pain, nausea, or vomiting, especially in children. Illness typically manifests two to five days after exposure. A doctor cannot tell if someone has strep throat just by looking, so a diagnostic test is needed. A rapid strep test involves swabbing the throat and running a lab test to see if GAS is the cause of the illness. While most sore throats are caused by viruses, strep throat is caused by bacteria and therefore can be treated with antibiotics . “If throat pain becomes more severe instead of improving after the first couple of days on antibiotics, it’s important to seek follow up care,” says Christian Nechyba, MD , a pediatrician with Duke Health in Wake Forest, North Carolina, “It’s also important to seek care right away if you have difficulty drinking, have significant neck swelling, or have fevers that last longer than a couple of days after starting treatment.” Scarlet Fever Also referred to as scarlatina, scarlet fever is a relatively mild illness characterized by:e60dc2a1-f33c-4a05-9b50-8e3e8e59762934a9e7de-8544-4c56-a6b8-444a12ec2728 A very red sore throat A rough, red rash on the skin A “strawberry,” or red and bumpy, tongue Fever Swollen glands in the neck A whitish coating on the tongue Bright red skin in the underarm, elbow, or groin The illness typically begins with a fever and sore throat. The rash, caused by a toxin made by group A strep bacteria, usually appears a day or two later, although it can begin before the illness or up to seven days later. Untreated cases of strep throat can turn into scarlet fever. Scarlet fever is highly contagious. It can be spread from person to person when someone coughs or sneezes; the bacteria travel in small droplets in the air. You can get sick by breathing in those droplets, or by touching something that the droplets have landed on and touching your nose or mouth.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296a18a10d-6d2d-4e71-82d9-19de384cfb2f The availability of rapid strep throat testing, which allows for early treatment, has made scarlet fever less common over time, says Dawn Sokol, MD , a pediatric infectious disease specialist at Ochsner Children’s Health Center in New Orleans. Scarlet fever is treated with a course of antibiotics. Complications sometimes occur and can include abscesses around the tonsils, swollen lymph nodes in the neck, and sinus and ear infections.e60dc2a1-f33c-4a05-9b50-8e3e8e59762934a9e7de-8544-4c56-a6b8-444a12ec2728 Other, rarer complications, such as rheumatic fever, can affect the heart. Rheumatic fever is an inflammatory disease that can develop if strep throat or scarlet fever is not properly treated.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cdc4f485-1a99-4b99-8af8-2b2650013ed8 Symptoms of rheumatic fever include: Swelling and pain in the joints Skin rashes Fever In serious cases, there can be damage to the heart valves. This is known as rheumatic heart disease. Rheumatic fever in itself is not contagious, but the strep infection that leads to it can be spread from person to person. Preventing rheumatic fever involves promptly treating strep throat with antibiotics to stop the infection before it triggers an immune response that harms the body’s tissues.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cdc4f485-1a99-4b99-8af8-2b2650013ed8 Like strep throat, scarlet fever is more common in children than adults, particularly those ages 5 through 15. Close contact with someone who has the infection is the biggest risk factor for getting the illness. There is no vaccine for scarlet fever, but people can protect themselves by practicing good hygiene , including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a396031b-5b61-47f3-97bc-5fc2be29d7b2 Using a tissue to cover the mouth when sneezing or coughing Washing hands frequently Using alcohol-based hand sanitizer if soap and water are unavailable Coughing or sneezing into the upper sleeve or elbow, rather than the hands, if a tissue is not available Impetigo Impetigo is an infection of the top layers of skin that typically starts when bacteria gets into a cut, scratch, or insect bite. It is usually caused by the bacteria Staphylococcus aureus but can also be caused by group A strep. It is most common among children ages 2 to 5.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a14ace9c-d289-4e8e-9f18-fbbd841c0915 Symptoms begin as itchy, red, or pimple-like sores surrounded by red skin, usually on the face, arms, or legs, that are filled with pus. Impetigo is contagious and can be spread by contact with sores or nasal discharge. It can be treated with a round of antibiotics.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a14ace9c-d289-4e8e-9f18-fbbd841c0915 Post-Streptococcal Glomerulonephritis Also referred to as PSGN, this is a kidney disease that can develop after a GAS infection. But PSGN is not a GAS infection of the kidneys — it’s a result of the body’s immune system fighting off the group A strep infection. PSGN usually occurs 10 days after strep throat or scarlet fever and about three weeks after a GAS skin infection.e60dc2a1-f33c-4a05-9b50-8e3e8e59762903cd864f-57f5-4d8e-b643-d0d43eaf2a98 Symptoms of PSGN include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762903cd864f-57f5-4d8e-b643-d0d43eaf2a98 Dark, reddish-brown urine Swelling in the face, hands, and feet Decreased amount of urine or decreased need to urinate Fatigue The condition is treated by managing symptoms, including limiting salt and water intake or prescribing medication to reduce swelling. Antibiotics can also help kill any strep A bacteria left in the body. Most people with PSGN recover within a few weeks, but in rare instances, long-term kidney damage, including kidney failure, can occur.e60dc2a1-f33c-4a05-9b50-8e3e8e59762903cd864f-57f5-4d8e-b643-d0d43eaf2a98
Severe and Rare Group A Strep Illnesses Rare A Very rare, but potentially life-threatening, manifestations of strep A infection include: Necrotizing Fasciitis Necrotizing fasciitis is a rare but serious bacterial infection that spreads quickly in the body and can be fatal. It is often, but not always, caused by group A strep bacteria when the bacteria enter the body through a break in the skin, such as a cut, burn, or surgical wound.e60dc2a1-f33c-4a05-9b50-8e3e8e59762953b92e20-3a47-448f-8584-287a1db217da Symptoms often begin with sudden pain, swelling, and redness in the affected area, which may look like a simple skin injury at first. As the infection spreads, the skin may turn dark, blister, or die. Necrotizing fasciitis is not contagious. The infection requires immediate medical care, including antibiotics and often surgery to remove infected tissue.e60dc2a1-f33c-4a05-9b50-8e3e8e59762953b92e20-3a47-448f-8584-287a1db217da Streptococcal Toxic Shock Syndrome Streptococcal toxic shock syndrome (STSS) is a rare but life-threatening illness caused by toxins produced by group A strep bacteria. It often starts with a minor skin infection, sore throat, or even after surgery or childbirth. The infection can quickly enter the bloodstream and affect multiple organs.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294a5e08dc-7899-4e0a-a4e5-feae8c40d453 Symptoms begin suddenly and include fever, chills, low blood pressure, muscle aches, and confusion. As it progresses, it can lead to organ failure and shock. Strep toxic shock syndrome is not contagious, but it must be treated in a hospital with antibiotics and supportive care to stabilize blood pressure and preserve organ function.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294a5e08dc-7899-4e0a-a4e5-feae8c40d453
Group B Streptococcus B Types Group B streptococcus, also known as group B strep or GBS, is a type of bacteria that can cause illness in people of all ages, though it can be particularly severe in newborns, most commonly causing sepsis, pneumonia, and meningitis. In adults, the most common health issues caused by GBS include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629af8b245a-c787-4fbb-b2e8-90e6bc659a89 Urinary tract infections Skin infections Bloodstream infections Pneumonia Skin and soft-tissue infections Bone and joint infections Group B Streptococcus in Babies Some people normally carry group B strep in their gastrointestinal tract, genital tract, or urinary tract without showing symptoms. Up to 30 percent of pregnant women carry group B streptococci in their genital tract and may pass the bacteria to their infants during birth.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295137e4de-fe29-4c8e-aadd-87a555148fc0 In babies, group B strep infections occur as either early-onset (younger than 1 week old) or late-onset (1 week to 3 months old). “The source of infection is often unknown for infants with group B strep illness that begins more than a week after birth,” Sokol says. “There are effective strategies to prevent early-onset infection but not late-onset disease.” Women are screened at 35 to 37 weeks of pregnancy with a vaginal and rectal swab. If streptococcus B is found, the mother is given ampicillin during labor. Other indications for ampicillin are a previous baby with group B strep, unknown group B strep status, and fever, preterm labor of prolonged rupture of membranes.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991fd77cd-8677-4d35-86c9-453352b21f48 “There is no preventive antibiotic given to the infant or special testing required,” Sokol says. Symptoms of GBS infection in newborn babies usually develop within the first few hours or days after giving birth and include being floppy or unresponsive, poor feeding, grunting when breathing, and unusually fast or slow breathing and heartbeat. GBS can cause life-threatening sepsis, pneumonia, or meningitis in newborns.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991fd77cd-8677-4d35-86c9-453352b21f48 Group B Streptococcus in Adults Group B strep infection occurs less frequently in adults than in babies, but it can affect anyone. The sources of disease caused by GBS in adults are unknown, but the gastrointestinal and genitourinary tracts may be the source of infection. GBS can cause sepsis, bacteremia, and pneumonia in the elderly and adults with certain underlying conditions or weakened immune systems. If the infection leads to sepsis or pneumonia, it can be fatal.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b44d7d5e-4947-46b0-b321-409554bcf982 On average, 1 in 20 nonpregnant adults with an invasive strep B infection dies. The chance of GBS infection increases with age. Younger adults who do not have any other medical conditions have a lower risk of death from GBS.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b44d7d5e-4947-46b0-b321-409554bcf982
Streptococcus Pneumoniae (Pneumococcus) Pneumococcus This is a type of bacteria that can cause several different infections, ranging from mild to serious. It most commonly leads to ear infections, sinus infections, and pneumonia, but can also cause more severe illnesses like bloodstream infections and meningitis.e60dc2a1-f33c-4a05-9b50-8e3e8e59762904c69ff9-2283-4b5b-bc8f-d8b2b57a0446 Pneumococcus spreads from person to person through coughing, sneezing, or close contact. Symptoms depend on the type of infection but may include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297b48865d-e397-4ff9-8ae4-414cc8709ebb Fever Cough Ear pain Shortness of breath Stiff neck Young children, older adults, and people with weakened immune systems are at higher risk for serious illness. Streptococcus pneumoniae infections can be treated with antibiotics, but the pneumonia vaccine is the best way to prevent pneumococcal disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762904c69ff9-2283-4b5b-bc8f-d8b2b57a0446 The CDC recommends pneumococcal vaccination for: All children younger than 5 years old People 5 through 49 years old with certain risk conditions Adults 50 years or older
Groups C and G Streptococci C and G Groups C and G streptococci are much less well-understood than strep A and B because the diseases caused by these bacteria are far less common. Groups C and G strep most commonly live in animals such as horses and cattle and can spread to humans through raw milk or contact with these animals.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fa30388e-cd4e-42ff-bc7a-79353b7de1cf In humans, the bacteria generally live in places like the respiratory tract and gastrointestinal tract. They’re usually linked to underlying conditions, such as diabetes, chronic skin conditions, and cardiovascular diseases.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fa30388e-cd4e-42ff-bc7a-79353b7de1cf Infections can be treated with antibiotics, but severe infections can be fatal, especially when they have entered the bloodstream.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e35b9bed-ae81-40ea-af72-04234fb19999
Prevention and Treatment of Strep Infections Treatment and Prevention The best way to prevent common strep infections is through good hygiene — regular handwashing , covering coughs and sneezes, and avoiding close contact with people who have strep, says Sokol. Most strep infections can be treated with antibiotics , which help reduce symptoms, prevent complications, and lower the risk of spreading the infection to others. Prompt treatment is especially important for more serious cases, and taking the full course of antibiotics as prescribed is essential.
The Takeaway There are several different types of streptococcus bacteria. Groups A and B are the most common types. Group A strep is responsible for strep throat, scarlet fever, impetigo, and a few rare but potentially life-threatening infections. Group B most commonly affects newborns during birth. Prevention measures include good hand hygiene and avoiding sharing drinking glasses and utensils with others.
Resources We Trust Mayo Clinic: Know the Signs of Strep Throat in Children Cleveland Clinic: Group A Streptococcal Infections American Academy of Family Physicians: Strep Throat Centers for Disease Control and Prevention: About Group B Strep Disease MedlinePlus: Streptococcal Infections
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