Strep Throat Signs and Symptoms Without a Fever
Although fever is common with strep throat, it is not always present. Other common signs and symptoms include throat discomfort, painful swallowing and swollen neck lymph nodes, among others.
Strep throat is a common infection caused by group A strep bacteria. This contagious illness occurs most commonly in children aged 5 and 15, notes the Centers for Disease Control and Prevention. Parents, teachers and other adults who spend time with school-aged children are also at increased risk for strep throat. Even among at-risk children and adults, however, the majority of sore throats are due to a viral infection rather than group A strep. Although fever often accompanies strep throat, you can have a group A strep throat infection without a fever. Other symptoms may suggest strep throat but laboratory testing is often necessary to distinguish between viral and strep sore throat because the symptoms of these ailments overlap.
Throat Discomfort and Painful Swallowing
A sore throat is the hallmark symptom experienced by people with strep throat. The pain typically develops suddenly, is moderate to severe in intensity and often causes difficulty swallowing because of the discomfort. Despite the throat pain, hoarseness rarely occurs with strep throat and strongly suggests a viral infection rather than a group A strep infection.
Mouth and Throat Signs
People with strep throat typically exhibit increased redness of the tonsils and lining tissue at the back of the throat. The uvula -- the piece of tissue hanging from the palate at the back of the throat -- also often appears a beefy red color. The tonsils are often enlarged and might show a white or yellow pus-like coating. Tiny purple spots called petechiae might also be present on the roof of the mouth toward the throat.
Swollen Glands
Swollen glands in the neck frequently develop with strep throat, although they do not confirm this diagnosis. The swollen glands represent enlarged lymph nodes that swell and become tender as they help fight the throat infection. The nodes likely to swell with strep throat reside along the large strap-like muscles at the front of the neck. The swelling is usually not significant enough to cause noticable lumps in the neck but are rather felt beneath the skin.
Headache, Nausea and Vomiting
Headache, abdominal discomfort, nausea and vomiting can occur with strep throat -- especially in young children. These symptoms are relatively uncommon in adults with strep throat. Notably, diarrhea rarely occurs with a group A strep throat infection and suggests a viral infection or another cause for the throat discomfort.
Scarlet Fever Rash
Children with strep throat sometimes develop scarlet fever, a skin rash associated with the infection. The rash typically begins within 1 to 2 days of the throat pain and other symptoms. This fine, red rash has a sandpaper-like feel and begins on the neck and face before spreading to the child's trunk, arms and legs. The scarlet fever rash characteristically spares the area around the mouth, the palms and the soles of the feet.
Other Considerations and Next Steps
A sore throat accompanied by nasal stuffiness, a runny nose, irritated eyes, a cough, diarrhea, mouth sores and/or hoarseness strongly suggests a viral infection rather than strep throat. If you're unsure whether you or your child might have strep throat, see your doctor as soon as possible. A rapid test -- usually performed in the office while you wait -- is frequently used to confirm or rule out a group A strep infection. If strep throat is diagnosed, a short course of antibiotics is recommended to clear the infection and prevent possible complications. If your healthcare provider diagnoses a viral infection, antibiotics are not recommended because they are ineffective against viruses and can cause harmful side effects.
Reviewed and revised by: Tina M. St. John, M.D.