Streptococcal Disease (Group A)

What is group A streptococcal (group A strep) disease?

Group A Streptococcus (group A strep) is a type of bacterium (germ) that can be found in the nose and throat and on the skin. These bacteria might be present and not cause any illness, or they can infect different parts of the body and cause disease that can range from mild to severe. The most common infections caused by group A strep are strep throat and skin infections, such as impetigo. Serious disease can result when the bacteria invade internal parts of the body, such as the bloodstream, which is called invasive group A strep disease. In Virginia, about 200 cases of invasive group A strep disease are reported each year.

Who gets group A strep disease?

Anyone can get a group A strep infection. Strep throat is particularly common in children. Few people who come in contact with the bacteria will develop invasive group A strep disease. Although healthy people can get invasive group A strep disease, people with chronic illnesses like cancer, diabetes, and chronic heart or lung disease, and those who use medications such as steroids have a higher risk. People with skin lesions (such as cuts, chickenpox, and surgical wounds), people aged 65 years or older, and adults with a history of alcohol abuse or injection drug use also have a higher risk for invasive group A strep disease.

How are group A strep bacteria spread?

Group A strep bacteria are spread by direct contact with body fluids, such as secretions from the nose and throat or wound drainage from an infected person. Casual contact (as in work and school) and household items (like toys) rarely play any role in spreading the bacteria. The risk of spread of group A strep is greatest when an individual is ill; people who carry the bacteria but have no symptoms are much less contagious. Antibiotics are used to treat group A strep infections, and reduce the risk of spreading the infection to others.

What are the symptoms of group A strep disease?

Group A strep can result in no illness at all, mild illness (strep throat or a skin infection such as impetigo) or severe disease (necrotizing fasciitis or streptococcal toxic shock syndrome). Necrotizing fasciitis (occasionally described as "the flesh-eating bacteria") destroys muscles, fat, and skin tissue. Streptococcal toxic shock syndrome (STSS) causes blood pressure to drop rapidly and organs (e.g., kidney, liver, lungs) to fail. STSS is not the same as the "toxic shock syndrome" sometimes associated with tampon usage.

How soon after exposure do symptoms appear?

Symptoms usually appear within 1–3 days after exposure to the bacteria.

How is group A strep infection diagnosed?

Group A strep infections are diagnosed by laboratory tests that confirm that the bacteria are present in specimens taken from the site of infection (e.g., throat, wound, blood). Rapid tests to identify strep throat also exist.

What is the treatment for group A strep infection or invasive disease?

Group A strep infections can be treated with antibiotics. In addition, treatment in an intensive care unit and sometimes surgeries are often necessary for invasive disease. Early treatment might reduce the risk of death, but it is not always possible to prevent death in every case.

Should contacts of individuals with invasive group A strep disease be tested and treated?

There is no evidence that casual contacts, such as co-workers or school and daycare classmates, are at risk of developing invasive group A strep disease following contact with a person who has an invasive group A strep disease. Household contacts have rarely developed severe disease. Local health departments evaluate households when invasive group A strep disease is reported; antibiotics might be recommended for individuals in households where someone has a condition that puts them at risk of a severe group A strep disease. People who have been in contact with someone with a group A strep disease should seek medical care if they develop similar symptoms of illness.

How can group A strep infection be prevented?

The spread of group A strep can be reduced by good hand washing, especially after coughing and sneezing, before and after caring for an ill person, and before preparing foods and before eating. People with non-invasive group A strep infections (such as strep throat) should stay home from work, school, or daycare until they have taken antibiotics for at least 12 hours AND they no longer have a fever without the use of fever-reducing medication (such as acetaminophen or ibuprofen). People with wound infections should keep all wounds clean and watch for signs of infection (e.g., redness, swelling, pain, pus). If a wound looks infected, especially in a person who also has a fever, consult a healthcare professional immediately.

How can I get more information about group A strep disease?

January 2023

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