Group A streptococcus (GAS) – Strep A Guidance

Group A streptococcus (GAS), also referred to as Strep A is a common bacterium. Lots of us carry it in our throats and on our skin and it doesn’t always result in illness. However, GAS does cause a number of infections, some mild and some more serious.

Milder infections caused by GAS include scarlet fever, impetigo, cellulitis and pharyngitis. These can be easily treated with antibiotics. Even without antibiotics, most mild GAS infections would clear up on their own.  

Often symptoms that look like GAS infections, like sore throats, are more commonly caused by viruses than GAS bacteria. If you or your child has a runny nose with their sore throat, it’s more likely to be a virus infection. Children without fever are very unlikely to need antibiotics. Sore throats caused by viruses do not need to be treated with antibiotics unless there are concerns about complications.

Strep A symptoms can range from:

• flu-like symptoms, such as a high temperature, swollen glands or an aching body.
• sore throat (strep throat or tonsillitis)
• a rash that feels rough, like sandpaper (scarlet fever)
• scabs and sores (impetigo)
• pain and swelling (cellulitis)
• severe muscle aches.
• nausea and vomiting.

While the vast majority of GAS cases are mild, sometimes GAS can cause more serious illness, called invasive Group A strep (iGAS). This is very rare.

When the immune system is compromised, a person is more vulnerable to invasive disease. Children who have chicken pox and the very elderly are also more at risk.

• wash your hands often with soap and water
• cover your mouth and nose with a tissue when you cough or sneeze
• bin used tissues as quickly as possible

There are a number of routes to go down to look after your child if they are displaying Strep A symptoms. Please consider points 1 – 3 as this will help your child get the right type of treatment without relying on A&E.

1. Pharmacy first / Self-care – for the vast majority of symptoms, your pharmacy can provide over the counter medication as well as advice. Please See NHS Inform for self-care advice.

2. GP – If your pharmacist recommends you speak to a GP, please phone and make an appointment for a telephone consultation and if appropriate, your GP can write you a prescription for antibiotics. You should see your GP or Nurse Specialist if your child has any of the following:

• Is finding it hard to breathe
• Seems dehydrated (sunken eyes, drowsy or no urine passed for 12 hours)
• Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) – especially if they remain drowsy or irritable despite their fever coming down
• Has extreme shivering or complains of muscle pain
• Has had chickenpox in the past few days and is now getting more unwell with a high fever and spreading red rash
• Swelling of a limb or joint
• Too painful for your child to stand
• Has a swollen eye
• Continues to have a fever of 38.0°C or above for more than 5 days
• Seems to be getting worse or if you are worried

3. GP Out of Hours – If you think you need to speak to a GP and your normal practice is closed, you can access GP Out of Hours. This service is strictly appointment only, and you can call NHS24 on 111 for advice and to make an appointment if necessary.

4. When to visit A&E – A&E is for very urgent or life-threatening injuries or illnesses. You should visit A&E if:

• there are pauses when you or your child breathes
• you or your child’s skin, tongue or lips are blue
  • Becomes pale, mottled and feels abnormally cold to touch
  • Severe breathing difficulty – too breathless to talk / eat or drink
  • Has a fit / seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (see the ‘Glass Test’ overleaf)
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)