Symptoms of Strep Throat – What are the Signs?

Strep throat is a bacterial infection that causes severe inflammation and a sore throat. The main symptoms of strep throat include throat pain that usually comes on quickly, painful swallowing, red and swollen tonsils with white patches or pus, tiny red spots on the soft palate, swollen and tender lymph nodes in the neck, fever, headache, rash, nausea or vomiting, and body aches.1 Strep throat is most common in children and teens, but anyone can get it, especially those who come into frequent contact with children or live or work in crowded places.1 It’s important to see a doctor if you or your child has symptoms of strep throat, as it can lead to serious complications if left untreated.

Key Takeaways

  • Strep throat is a bacterial infection that causes a severe sore throat and other distinctive symptoms.
  • The main symptoms include throat pain, difficulty swallowing, fever, swollen tonsils, and tender lymph nodes.
  • Strep throat is most common in children and teens, but can affect people of all ages.
  • Prompt medical attention is crucial to prevent serious complications from untreated strep throat.
  • Good hygiene practices like handwashing can help prevent the spread of strep throat.

Overview of Strep Throat

Strep throat is an infection of the throat and tonsils caused by a bacteria called group A streptococcus, also known as2 Streptococcus pyogenes.2 This bacteria lives in the nose and throat and can be spread through close contact, such as coughing, sneezing, or sharing personal items.3 Strep throat is highly contagious and can lead to serious complications if left untreated, including scarlet fever, kidney inflammation, and rheumatic fever.2

What is Strep Throat?

4 Strep throat is a bacterial infection that causes severe inflammation and a sore throat. It is most common in children, but it affects people of all ages.2 Strep throat tends to circulate in the winter and early spring, and young age is a significant risk factor for strep throat infection.2

Causes of Strep Throat

4 The Streptococcus pyogenes (Strep A) bacteria are the primary cause of strep throat and related illnesses.4 These bacteria can cause a variety of conditions, including impetigo, scarlet fever, cellulitis, necrotizing fasciitis, toxic shock syndrome, and invasive group A streptococcus (iGAS) infections.4 During the winter of 2022 – 2023, the CDC observed an increase in iGAS infections, particularly in children.

Common Signs and Symptoms

The most common signs and symptoms of strep throat include a sore throat that usually comes on quickly, difficulty swallowing, red and swollen tonsils, swollen and tender lymph nodes in the neck, fever, and headache.2 These symptoms are typically more severe than those associated with a viral sore throat.3 Strep throat can also cause nausea, vomiting, body aches, and a loss of appetite.

Throat Pain and Difficulty Swallowing

One of the hallmark signs of strep throat is a severe, painful sore throat that makes swallowing difficult.3 The throat pain is often more intense than what is experienced with a typical viral sore throat.

Swollen Tonsils and Lymph Nodes

Strep throat commonly causes the tonsils to become red, swollen, and may even develop white patches or pus.3 Individuals with strep throat also often experience swollen and tender lymph nodes in the neck as the body tries to fight the infection.3

Fever and Headache

Fever, often 101°F or higher, is another common symptom of strep throat.3 Individuals may also experience a headache as the body reacts to the bacterial infection.3

Distinguishing Strep Throat Symptoms

One of the key ways to distinguish strep throat from a viral sore throat is the presence of certain physical symptoms. Strep throat often causes the tonsils to become red and swollen2, and may also lead to the development of white patches or streaks of pus on the tonsils.2 Another distinguishing symptom is the presence of tiny red spots, called petechiae, on the soft palate at the back of the throat.2 These physical signs can help healthcare providers identify strep throat and differentiate it from other types of sore throat.

Red and Swollen Tonsils

One of the hallmark symptoms of strep throat is the development of red and swollen tonsils.2 This inflammation is a result of the streptococcal bacteria infecting the throat and tonsils.

White Patches or Pus on Tonsils

In addition to the redness and swelling, strep throat can also cause the formation of white patches or streaks of pus on the tonsils.2 This is another distinguishing physical sign that can help differentiate strep throat from other types of sore throats.

Tiny Red Spots on the Soft Palate

Another key symptom of strep throat is the presence of tiny red spots, known as petechiae, on the soft palate at the back of the throat.2 These small red dots are a unique physical manifestation of the streptococcal infection.

Distinguishing symptoms of strep throat

Other Potential Symptoms

In addition to the more common symptoms of strep throat, such as a sore throat and fever, some individuals may also experience nausea, vomiting, body aches, and a rash. Nausea and vomiting are more common in younger children with strep throat.3 Body aches and a red, sandpaper-like rash known as scarlet fever can also sometimes occur as a result of the streptococcal infection.3,4 These additional symptoms can help healthcare providers diagnose and differentiate strep throat from other types of sore throat.

Nausea or Vomiting

Nausea and vomiting are more common in younger children with strep throat.3 These symptoms can be an indication of the severity of the streptococcal infection and may require prompt medical attention.

Body Aches

Body aches can sometimes occur as a result of the streptococcal infection that causes strep throat.3,4 These aches may be a sign of the body’s inflammatory response to the bacteria.

Rash

A red, sandpaper-like rash known as scarlet fever can also sometimes develop as a complication of strep throat.3,4 This rash is caused by the streptococcal toxins and can spread to various parts of the body.

When to See a Doctor

It’s important to see a doctor if you or your child has symptoms of2 [when to see a doctor for strep throat], including a sore throat accompanied by tender, swollen lymph glands, a sore throat lasting longer than 48 hours, a fever, a sore throat with a rash, or difficulties with breathing or swallowing.5 You should also see a doctor if strep throat has been diagnosed but you’re not seeing improvement after 48 hours of taking antibiotics. Prompt medical attention is crucial to prevent serious complications from untreated2 [strep throat].

When to see a doctor for strep throat

What are the symptoms of strep throat?

The primary symptoms of strep throat include a sore, scratchy throat and pain when swallowing.2 Individuals with strep throat often develop a fever and experience swollen, tender lymph nodes in the neck.3 Difficulty swallowing due to the throat pain is another common symptom.3 These symptoms typically come on quickly and are more severe than those associated with a typical viral sore throat.2 Strep throat can also cause other symptoms like nausea, vomiting, body aches, and a rash in some cases.

Sore Throat and Pain

One of the primary indicators of strep throat is a sore, scratchy throat accompanied by pain when swallowing.2 This throat discomfort is usually more severe than what is experienced with a typical viral sore throat.

Fever and Swollen Lymph Nodes

Individuals with strep throat often develop a fever,3 as well as swollen and tender lymph nodes in the neck.3 These physical signs can help differentiate strep throat from other types of sore throat.

Difficulty Swallowing

Due to the inflammation and pain in the throat, difficulty swallowing is a common symptom of strep throat.3 This can make it challenging to eat or drink, especially for young children.

Diagnosis and Testing

The only way to definitively diagnose strep throat is through a medical test. Healthcare providers typically use either a rapid strep test or a throat culture to confirm the presence of group A streptococcus bacteria.6

Rapid Strep Test

A rapid strep test can provide results in just 20 minutes, allowing for quick diagnosis and treatment.6

Throat Culture

In contrast, a throat culture takes about 2 days to process, but it can provide more conclusive results. If the rapid test is negative but the provider still suspects strep, they may order a throat culture for more definitive identification.6

These diagnostic tests are important to distinguish strep throat from other types of sore throat and determine the appropriate treatment.62

Treatment Options

The standard treatment for [treatment for strep throat] is a course of antibiotics, usually penicillin or amoxicillin. Antibiotics can help reduce the severity of symptoms, limit contagiousness, and prevent complications.7 Most antibiotic treatments for strep throat last about 10 days.7 Antibiotics like penicillin and amoxicillin are commonly prescribed for [antibiotics for strep throat] due to their effectiveness and safety.7 Antibiotics can help you start feeling better in a day or two.7 Antibiotics can reduce the risk of spreading strep to others.7

Home Remedies for Symptom Relief

In addition to antibiotics, there are some [home remedies for strep throat] that can provide relief for the symptoms of strep throat, such as gargling with salt water, sucking on lozenges or hard candy, drinking warm liquids, and getting plenty of rest.7 Home treatments such as rest, gargling with saltwater, and using a humidifier can help ease strep throat symptoms.7 Over-the-counter pain relievers like ibuprofen or acetaminophen can also help manage fever and discomfort.7 It’s important to take the full course of antibiotics as prescribed to fully clear the infection.

Complications of Untreated Strep Throat

If left untreated, strep throat can lead to serious complications. The infection can spread to other parts of the body, causing tonsil abscesses, sinus infections, skin infections, or even a blood infection.8 Strep throat can also trigger inflammatory conditions like scarlet fever, rheumatic fever, and kidney inflammation, which can damage the heart, joints, nervous system, and other organs.9 Prompt diagnosis and treatment with antibiotics is crucial to prevent these potentially severe complications associated with untreated strep throat.

Each year, about 13,000 people in the United States will experience severe strep throat infections that can lead to serious complications, including premature death.8 Strep throat is a highly contagious bacterial infection caused by group A streptococcus bacteria.8 If strep throat is left untreated, it can lead to complications such as pneumonia, meningitis, ear infections, throat abscess, toxic shock syndrome, and heart failure.8 Toxic shock syndrome is a rare but serious side effect of strep throat that can lead to organ failure.8 Heart failure can be a complication of recurrent strep throat infections, potentially resulting from rheumatic fever.8

Acute rheumatic fever is a serious complication of untreated strep throat, and appropriate antibiotic treatment can prevent it.9 Acute rheumatic fever is less common now than in the pre-antibiotic era.9 Post-streptococcal glomerulonephritis can occur in children under seven after strep throat and typically resolves spontaneously without leading to permanent kidney damage.9 Children under seven are at the highest risk of developing post-streptococcal glomerulonephritis after strep throat.9

Rapid strep tests are available to quickly identify an active strep infection, involving a minimally invasive swab of the throat to collect cell samples.8 Antibiotics are prescribed to clear the strep infection when the test is positive.8 Various complications of untreated strep throat necessitate prompt medical care and treatment to prevent serious health issues.8

https://www.youtube.com/watch?v=YXku3Ca1y7U

Prevention Strategies

The best way to prevent the spread of strep throat is through good hygiene practices. Proper and frequent handwashing with soap and water is the most effective way to stop the transmission of streptococcal bacteria.10 It is recommended to wash hands regularly throughout the day, especially before certain activities such as eating, touching the face, or interacting with an ill person.10 Using hand sanitizer with at least 60% alcohol content can be effective in killing germs when soap and water are not available, making it a good alternative for cleanliness on the go.10

Covering Coughs and Sneezes

It’s also important to cover your mouth and nose when coughing or sneezing to avoid spraying respiratory droplets into the air. This simple step can help prevent the spread of streptococcal bacteria that cause strep throat.

Avoiding Shared Personal Items

Avoiding sharing personal items like cups, utensils, toothbrushes, and towels with someone who is sick can also help prevent the spread of strep throat.6 Taking these preventive measures can help stop the infection from spreading to others.

Strep Throat in Children

Strep throat is most common in children, particularly those between the ages of 5 and 15.2 The symptoms in children are similar to adults, including a sore throat, fever, swollen lymph nodes, and difficulty swallowing.11 Children may also experience nausea, vomiting, and loss of appetite.11 Diagnosis and treatment are the same as for adults, typically involving a rapid strep test or throat culture and a course of antibiotics.11 It’s important for parents to be vigilant about strep throat in their children and seek medical attention promptly to prevent complications.

Strep throat is most common in school-age children, but anyone can get it.11 As many as 1 in 5 children are strep carriers.11 A positive rapid strep test or positive throat culture confirms the presence of strep throat caused by harmful bacteria.11 Children with strep throat should stay home from school or childcare until they have taken antibiotic medicine for 12 hours and have no fever.11

Strep throat is highly contagious and can spread through respiratory droplets, secretions, saliva, or shared items like utensils or drink containers.12 People with strep throat should stay home from work, school, daycare, or activities until they no longer have a fever and have taken antibiotics for at least 12 hours.12

Strep throat tends to circulate more in winter and early spring, indicating a seasonal trend in the occurrence of this condition.2 It typically takes 2-5 days for someone exposed to the group A streptococcus bacteria to develop strep throat symptoms.12 With proper diagnosis and treatment, most children can return to school and activities within a few days.12

Antibiotic treatment for strep throat reduces the risk of serious complications, emphasizing the importance of prompt medical intervention.2 Complications of strep throat may lead to inflammatory illnesses such as scarlet fever, poststreptococcal glomerulonephritis, rheumatic fever, and poststreptococcal reactive arthritis, indicating potential severe outcomes associated with this infection.2 Proper hand hygiene, including regular hand-washing and avoiding sharing personal items, is highlighted as essential preventive measures to reduce the risk of strep infection, pointing towards the importance of hygiene practices in mitigating the spread of the bacteria.2

Call the doctor if a child has a sore throat that lasts more than 3 days, starts drooling, cannot talk, or voice becomes muffled.11 Fever temperature ranges: younger than 3 months of age, 100.4° Fahrenheit (F) or 38° Celsius (C) or above; older than 3 months of age, 104° F (40° C) or above.11 Antibiotics can have side effects like diarrhea or rash.11

Recurring Strep Throat Infections

It’s possible to get strep throat more than once, as having the infection does not provide long-lasting immunity.13 Recurring strep throat infections can happen multiple times within one respiratory season, typically occurring in the fall and winter in the U.S.13 Recurrent strep throat infections can occur for a few reasons, such as antibiotic-resistant bacteria, poor adherence to the full antibiotic treatment, or being a strep throat “carrier” where the bacteria live in the throat without causing symptoms.13 Certain groups have a higher risk of developing strep throat, including children aged 5 to 15, parents of school-aged kids, adults who work with children, and individuals who attend or work in schools, daycare centers, or live in close, crowded quarters like military barracks.13 Individuals who experience repeated strep throat episodes may need to work closely with their healthcare provider to identify the underlying cause and develop an appropriate treatment plan to prevent future reinfections.

13 Research indicates that individuals with recurring strep throat infections have smaller germinal centers in lymph nodes, reduced antibacterial antibodies, and an inefficient immune response to GAS compared to those who resist reinfection.13 Antibiotics such as penicillin or amoxicillin are the standard treatment for true recurrent strep infections, and a tonsillectomy may be recommended in some cases.13 GAS carriers, individuals who test positive for strep bacteria but are asymptomatic, may not show typical strep symptoms, and their symptoms do not improve with antibiotics.13 Recurring strep throat infections can be prevented through good hygiene practices, especially important in school-age children, who are more prone to recurrent infections.13 Tonsillectomy is no longer the standard practice for recurring strep throat infections, with watchful waiting often recommended instead.

14 Recurring strep throat is generally defined as having three or more cases in a year for it to be considered recurrent.14 Strep throat is commonly seen in children and adolescents, and less commonly in children under 3 years old and adults.14 Strep throat can lead to complications involving the skin, heart, or kidneys if left untreated.14 Complications of untreated strep throat may include scarlet fever, rheumatic fever, heart tissue and valve damage, and potentially damage to other organs.14 Strep throat can develop into sepsis if not appropriately treated, which can be life-threatening.

14 Antibiotics like penicillin or amoxicillin are commonly prescribed to treat strep throat infections.14 Overuse of antibiotics can lead to bacteria becoming resistant to antibiotic treatment.14 Ways to reduce the risk of getting strep throat include thorough handwashing, minimizing contact with sick individuals, getting enough sleep, eating a nutritious diet, regular exercise, and reducing stress.14 Though a vaccine against Strep A is in development, no cure currently exists for the infection.14 Treatment options for recurring strep throat may include adjusting antibiotic dosages, changing medications, or long-term antibiotic therapy.14 Tonsillectomy, the surgical removal of tonsils, may be recommended in some cases of recurring strep throat.

Scarlet Fever and Strep Throat

A rare but serious complication of strep throat is the development of scarlet fever, a streptococcal infection characterized by a distinctive red, sandpaper-like rash. Scarlet fever mostly affects children between the ages of 5 and 15 years.15 The rash typically starts on the chest and neck and then spreads to other parts of the body.16 If left untreated, scarlet fever can lead to long-term health problems by damaging the heart, kidneys, or other organs.15 However, with prompt antibiotic treatment, scarlet fever is now easily managed and the prognosis is good.

The symptoms of scarlet fever include a red rash resembling sunburn, flushed face, strawberry tongue, and fever of 100.4 F (38.0 C) or higher.15 Children with scarlet fever may need emergency evaluation if they experience symptoms like chest pain, rapid breathing, or dehydration.15 The incubation period for scarlet fever after exposure is typically 2 to 4 days.15 Children aged 5 to 15 years are more likely to get scarlet fever, especially in close-contact environments like family settings or school.15

Complications of scarlet fever can affect various body parts, such as the tonsils, skin, blood, heart, and kidneys.15 Rare complications like rheumatic fever and a potential link to pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS) can also occur.15

Fever of 101°F or higher is a common symptom of scarlet fever.16 The rash from scarlet fever usually appears within one to two days after the illness begins and typically lasts around 7 days before fading.16 While complications from scarlet fever are not common, they can include arthritis, ear infections, pneumonia, and rheumatic fever.16 Treatment with antibiotics can prevent most health problems associated with scarlet fever.16

Strep Throat and Coughing

The presence of a cough is a key differentiating factor between4 strep throat and a viral sore throat. Individuals with strep throat typically do not experience significant coughing, as the infection is localized to the throat and tonsils.17 In contrast, a viral sore throat is more likely to be accompanied by a persistent cough. If you or your child has a sore throat along with a significant cough, it is more likely to be a viral infection rather than strep throat.4 This symptom can help healthcare providers make an accurate diagnosis.

SymptomStrep ThroatViral Sore Throat
CoughMinimalPersistent
FeverTypically presentMay be present
Sore ThroatSevere, sudden onsetMild to moderate
Swollen Lymph NodesCommonUncommon
HeadacheFrequentMay occur

The table above highlights the key differences between the symptoms of strep throat and a viral sore throat, including the presence or absence of coughing. This information can assist healthcare providers in making an accurate diagnosis and providing the appropriate treatment.

Strep Throat Without Tonsils

It is possible to develop strep throat even if you have had your tonsils removed (tonsillectomy).18 While the tonsils are a common site of streptococcal infection, the bacteria can still infect the throat and surrounding tissues.18 Individuals without tonsils may experience slightly milder symptoms of strep throat, but the infection can still cause a sore throat, fever, and other characteristic symptoms.18 Regular medical checkups and prompt treatment are still important for those without tonsils to prevent complications from strep throat.

Strep throat generally infects the structures of the throat and tonsils,18 and it is possible to get strep throat without tonsils, as removing the tonsils does not eliminate the risk of infection completely.18 The Centers for Disease Control and Prevention (CDC) state that it takes about 2–5 days to become infected after exposure to the Streptococcus bacteria.18 Individuals aged 5–15 years and adults in close contact with children are at a higher risk of strep throat.18

The standard treatment for strep throat involves antibiotics like penicillin or amoxicillin, with patients typically feeling better within 48 hours of starting the treatment.18 Antibiotic treatment reduces symptoms duration, likelihood of transmission, and complications.18 People with recurring strep throat infections may benefit from a tonsillectomy to decrease the severity and frequency of infections.18 Doctors use rapid strep tests involving throat swabs to diagnose strep throat accurately,18 and good hygiene practices, such as regular handwashing and covering the mouth when sneezing or coughing, are essential for preventing the spread of strep throat.18

Conclusion

In conclusion, the key symptoms of strep throat include a severe sore throat, difficulty swallowing, fever, swollen tonsils and lymph nodes, and potential additional symptoms like nausea, body aches, and a rash.19 Prompt diagnosis through a rapid strep test or throat culture is important, as strep throat requires prompt treatment with antibiotics to reduce symptom severity, limit contagiousness, and prevent serious complications.19 Good hygiene practices like handwashing and avoiding shared personal items can also help prevent the spread of this highly contagious bacterial infection.20 By recognizing the signs and seeking medical care when appropriate, individuals can manage strep throat and avoid potential long-term health issues.

Strep throat is more prevalent among children and adolescents compared to other age groups,21 and the infection is common in those between the ages of five to fifteen years.20 While adults can also develop strep throat, it is a relatively rare occurrence, with only about 1 in 10 adults with a sore throat actually having a strep infection.20 Nonetheless, it is crucial for individuals of all ages to be aware of the symptoms and seek prompt medical attention to prevent complications and limit the spread of this highly contagious disease.

By understanding the symptoms, seeking timely diagnosis, and following the prescribed treatment, individuals can effectively manage strep throat and avoid the potential long-term consequences of this bacterial infection.19 With a combination of medical care and personal hygiene practices, the impact of strep throat can be minimized, allowing for a swift recovery and the prevention of further health complications.

FAQ

What are the symptoms of strep throat?

The main symptoms of strep throat include a sore, scratchy throat, pain when swallowing, fever, swollen and tender lymph nodes in the neck, and difficulty swallowing.

What causes strep throat?

Strep throat is caused by a bacterial infection with group A streptococcus, also known as Streptococcus pyogenes. This bacteria lives in the nose and throat and can be easily spread through close contact with infected individuals.

How can I differentiate strep throat from a viral sore throat?

Key distinguishing symptoms of strep throat include red and swollen tonsils, white patches or pus on the tonsils, and tiny red spots on the soft palate. These physical signs help healthcare providers diagnose strep throat versus a typical viral sore throat.

Can strep throat cause other symptoms besides a sore throat?

Yes, in addition to a sore throat, strep throat can also cause fever, headache, nausea, vomiting, body aches, and a red, sandpaper-like rash known as scarlet fever.

When should I see a doctor for strep throat?

You should see a doctor if you have a sore throat lasting more than 48 hours, a fever, swollen lymph nodes, difficulty breathing or swallowing, or if your symptoms are not improving after 48 hours of taking antibiotics.

How is strep throat diagnosed?

Strep throat is diagnosed through either a rapid strep test or a throat culture. A rapid test can provide results in 20 minutes, while a throat culture takes about 2 days to process.

How is strep throat treated?

The standard treatment for strep throat is a course of antibiotics, usually penicillin or amoxicillin. Over-the-counter pain relievers and home remedies like gargling with salt water can also provide symptom relief.

What happens if strep throat is left untreated?

If left untreated, strep throat can lead to serious complications like tonsil abscesses, sinus infections, skin infections, blood infections, and inflammatory conditions like scarlet fever and rheumatic fever.

How can I prevent spreading strep throat to others?

The best prevention methods include proper and frequent handwashing, covering your mouth when coughing or sneezing, and avoiding sharing personal items like cups, utensils, and towels with someone who is sick.

Are children more susceptible to strep throat?

Yes, strep throat is most common in children between the ages of 5 and 15. The symptoms in children are similar to adults and require the same diagnosis and treatment.

Can you get strep throat more than once?

It is possible to get strep throat repeatedly, as previous infections do not provide long-lasting immunity. Recurrent strep throat may be due to antibiotic resistance, poor antibiotic adherence, or being a strep throat carrier.

Source Links

  1. https://www.cdc.gov/group-a-strep/about/strep-throat.html
  2. https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338
  3. https://www.webmd.com/oral-health/understanding-strep-throat-basics
  4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/strep-throat
  5. https://www.uclahealth.org/news/article/when-to-see-a-doctor-for-a-sore-throat
  6. https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344
  7. https://www.webmd.com/oral-health/understanding-strep-throat-treatment
  8. https://www.primarycarewalkinmedicalclinic.com/blog/6-potential-complications-of-untreated-strep-throat
  9. https://www.medicinenet.com/strep_throat_complications/views.htm
  10. https://www.healthline.com/health/strep-throat-prevention-and-treatments
  11. https://www.nationwidechildrens.org/conditions/strep-throat
  12. https://www.luriechildrens.org/en/blog/faq-what-to-know-about-strep-throat/
  13. https://www.verywellhealth.com/recurring-strep-throat-5271119
  14. https://www.bannerhealth.com/healthcareblog/teach-me/what-happens-if-you-get-strep-throat-a-lot
  15. https://www.mayoclinic.org/diseases-conditions/scarlet-fever/symptoms-causes/syc-20377406
  16. https://www.cdc.gov/group-a-strep/about/symptoms-of-scarlet-fever.html
  17. https://www.webmd.com/cold-and-flu/sore-throat-cold-strep-throat-tonsillitis
  18. https://www.medicalnewstoday.com/articles/can-you-get-strep-throat-without-tonsils
  19. https://neumed.com/strep-throat-causes-symptoms-diagnosis-and-treatment/
  20. https://pharmeasy.in/blog/home-remedies-for-strep-throat-by-dr-rajeev-singh/
  21. https://woombie.com/blog/post/identifying-the-telltale-signs-10-common-symptoms-of-strep-throat