Group A Streptococcus (GAS, or Streptococcus pyogenes) is a bacterium that frequently causes infections in children, especially at school age.
The best known is strep throat (streptococcal pharyngitis), while the same bacterium can cause scarlet fever and certain skin infections, such as impetigo. In the vast majority of cases the infections are treated effectively. Much more rarely, streptococcus can cause a serious, invasive infection. National Public Health Organization (EODY)
For parents, then, the important thing is not to fear every sore throat, but to know when a child needs to be examined and when their general condition requires urgent assessment.
What symptoms can it cause?
Strep throat may present with a sudden sore throat, pain on swallowing, fever, swollen lymph nodes in the neck and redness or exudate on the tonsils.
Some children also have a headache, abdominal pain, nausea or vomiting.
When the infection is accompanied by the characteristic fine, sandpaper-like rash, it may be scarlet fever.
In contrast, symptoms such as cough, runny nose, hoarseness or conjunctivitis point more towards a viral infection than typical strep throat. CDC
Is every sore throat strep?
No. In fact, many sore throats in children are caused by viruses and do not need an antibiotic.
When there are no clear symptoms of a viral infection, the clinical picture alone is not always enough to distinguish viral from streptococcal pharyngitis with certainty. Depending on the child’s age and symptoms, the pediatrician may decide that a
rapid strep test or throat culture is needed.
CDC
Especially in children and teenagers, when a rapid test is negative but clinical suspicion remains, confirmation with a culture may be needed. CDC
When is an antibiotic needed?
When strep throat is confirmed, appropriate antibiotic treatment is given.
Treatment shortens the duration of symptoms, limits the spread of the bacterium and reduces the risk of certain complications. It is important that the antibiotic is taken at the right dose and for as long as the doctor has recommended. CDC
On the other hand, antibiotics should not be given “preventively” to every child with a sore throat, nor because another child in the class was diagnosed with strep.
Using antibiotics properly protects both the individual child and public health.
How does it spread?
Group A streptococcus spreads mainly from person to person through respiratory droplets and direct contact with secretions. It can also spread through contact with infected skin sores. CDC
Close contact makes transmission easier, which is why infections are more common in settings where many children are together, such as schools and nurseries. CDC
Simple measures can limit the spread: good handwashing, covering coughs and sneezes, and not sharing cups, cutlery and food with someone who is ill.
CDC
When can my child return to school?
Once appropriate antibiotic treatment has started, contagiousness drops considerably.
Current CDC guidance states that a child with strep throat can return to school or nursery when they
have no fever and at least 12–24 hours have passed since starting appropriate antibiotic treatment. The child should, of course, feel well enough to take part in their activities. CDC
The pediatrician can give more specific advice depending on the clinical picture and the circumstances at the school or nursery.
Do other family members need antibiotics?
Usually not.
Close contacts of a child with an ordinary strep infection do not, as a rule, receive preventive antibiotics simply because they were exposed to streptococcus. If they develop symptoms, they need to be assessed. CDC
Different management may be needed in special cases of severe invasive disease, or when there are people with specific high-risk factors in the close environment. In these cases, advice is given individually by the treating doctors and the relevant public health services. CDC
What is invasive strep (iGAS)?
Very rarely, group A streptococcus can reach parts of the body where bacteria are not normally present and cause
invasive infection (invasive Group A Streptococcal disease – iGAS).
This is a different condition from ordinary strep throat. It can present as serious infections such as bacteraemia/sepsis, pneumonia, necrotising soft-tissue infection or streptococcal toxic shock syndrome. These conditions are
rare but serious and require urgent hospital treatment. CDC
The fact that a child has ordinary strep throat
does not mean they are going to develop invasive disease.
Which symptoms should worry parents?
More than a specific temperature reading, what matters is the
child’s overall condition.
Urgent medical assessment is needed when a child shows a significant deterioration in their general condition, difficulty breathing, unusual sleepiness or difficulty waking, inability to take fluids, severe or rapidly worsening pain, or rapid worsening of a skin infection.
Also, if a child taking antibiotics for confirmed strep infection does not improve or gets worse, contact the pediatrician again. The CDC recommends contacting a healthcare professional if the child does not feel better after 48 hours of antibiotic treatment. CDC
Is there a vaccine against strep?
Currently there is no approved vaccine available against group A streptococcus. Vaccine development is an active field of research, and the World Health Organization has made the development of GAS vaccines one of its related research priorities. World Health Organization
Until an effective vaccine is available, prevention relies mainly on good hygiene, early recognition of symptoms and correct diagnosis and treatment of streptococcal infections. CDC
What parents should remember
Strep is common in children and in most cases is treated effectively. Not every sore throat needs an antibiotic, and not every contact with a case should cause worry or lead to preventive treatment.
What matters is a proper assessment of the child, confirming the diagnosis when appropriate and prompt treatment when it really is a streptococcal infection.
But when a child seems much more unwell than we would expect from an ordinary infection, or their condition worsens quickly, we don’t wait — we seek medical assessment straight away.
For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.