Strep throat is a common bacterial infection caused by Streptococcus pyogenes, also known as Group A Streptococcus (GAS). This organism infects the throat and tonsils, leading to a painful illness. While acute symptoms may eventually fade on their own, medical consensus strongly advises against forgoing treatment. Ignoring a confirmed strep infection carries a serious risk of developing severe, non-throat-related complications.
Symptoms and the Likelihood of Self-Resolution
Strep throat typically presents with a sudden onset of symptoms, including a sore throat, fever, pain when swallowing, and visibly red or swollen tonsils. White patches or streaks of pus may also be present. Unlike a common cold, strep usually lacks symptoms such as a cough or runny nose. Without antibiotic intervention, uncomfortable symptoms generally persist for seven to ten days. Although fever and intense pain may subside, the spontaneous resolution of symptoms does not guarantee the bacteria have been fully eradicated, and the Group A Strep can linger.
Identifying Strep vs. Other Sore Throats
Accurate diagnosis is necessary because most sore throats are caused by viruses, which do not respond to antibiotics. Healthcare providers often use clinical scoring tools to assess the probability of a bacterial infection before testing. These tools evaluate factors like tonsillar exudates, swollen neck lymph nodes, fever, and the absence of a cough. Diagnosis relies on laboratory tests, typically starting with a Rapid Strep Test (RST) performed on a throat swab. If the RST is negative, a throat culture may still be performed, particularly for children, as it is more sensitive and can detect bacteria missed by the rapid test.
Critical Risks of Untreated Strep
Treatment is driven by the prevention of systemic complications that follow an untreated GAS infection. The most concerning is Acute Rheumatic Fever (ARF), an autoimmune condition developing two to three weeks after the initial strep episode. ARF is triggered when the immune system creates antibodies to fight the bacteria, which then mistakenly attack similar proteins in the body’s own tissues, especially the heart valves. This attack can lead to permanent heart damage, known as Rheumatic Heart Disease (RHD). Other immune-mediated complications include Post-Streptococcal Glomerulonephritis (PSGN), which causes kidney inflammation, and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). Leaving the infection untreated also increases the risk of localized complications, such as peritonsillar and retropharyngeal abscesses.
The Role of Antibiotics in Treatment
Antibiotic treatment serves two purposes: to relieve immediate symptoms and to prevent severe complications. While antibiotics typically shorten acute symptoms by only about 16 hours, the primary benefit is complication prevention. Penicillin and amoxicillin are the standard antibiotics due to their effectiveness, low cost, and lack of resistance in Group A Strep. Patients must complete the full course of medication, typically ten days, even if symptoms improve sooner. Stopping treatment prematurely allows bacteria to survive and potentially trigger post-streptococcal complications, though timely treatment ensures the patient is no longer contagious after 24 hours.