Yes, strep throat is actively circulating in the United States, and cases have been running higher than pre-pandemic levels. The CDC reports that both minor and serious Group A Strep infections during peak season now exceed what was typical before 2020, continuing a decade-long upward trend. Preliminary 2023 data showed serious strep infections hitting a 20-year high, and that elevated pattern has persisted into subsequent seasons.
Why Cases Are Higher Than Usual
Strep throat follows a predictable seasonal rhythm, peaking in late winter and early spring when people spend more time indoors and kids are packed into classrooms. But the numbers in recent years have been notably above the historical baseline. The CDC estimates between 20,000 and 27,000 cases of invasive (serious) Group A Strep infections occur each year in the U.S., causing 1,800 to 2,400 deaths annually. Those figures reflect only the most severe infections. Garden-variety strep throat, the painful but treatable kind, is far more common and isn’t tracked with the same precision, but it follows the same upward curve.
Several factors likely explain the surge. Reduced exposure to common bacteria during pandemic-era distancing left immune systems, particularly children’s, less primed to fight off Group A Strep when normal mixing resumed. That “immunity gap” created larger pools of susceptible people, and the bacteria took advantage.
How to Tell Strep Apart From a Regular Sore Throat
Most sore throats are caused by viruses, and they don’t need antibiotics. The distinction matters because strep requires treatment while viral sore throats just need time. A few hallmarks point toward strep rather than a virus:
- No cough. If you have a cough, runny nose, hoarseness, or pink eye, a virus is the more likely culprit.
- Fever above 100.4°F. Strep tends to bring a noticeable fever, while many viral sore throats don’t.
- Swollen, coated tonsils. White patches or streaks on the tonsils suggest strep.
- Tender lymph nodes. Swollen glands at the front of the neck, just below the jaw, are a classic strep sign.
Doctors use a simple checklist to estimate the likelihood that a sore throat is strep. A person with all four signs above (no cough, fever, swollen tonsils, tender lymph nodes) has roughly a 50/50 chance of testing positive. Someone with none of those features has only about a 1 to 2.5% chance. Children between ages 3 and 14 are at highest risk; adults over 45 are least likely to have strep as the cause of a sore throat.
The takeaway: if your sore throat came with a runny nose and cough, it’s probably not strep. If it came on suddenly with a high fever and painful swallowing but no cold symptoms, get tested.
How Testing Works
The rapid strep test (a quick throat swab done in the office) gives results in minutes. It’s highly reliable when it comes back positive, with a specificity around 96%, meaning false positives are rare. The catch is that rapid tests can miss some true cases. For children, many providers will send a backup throat culture if the rapid test is negative, since the stakes of missing strep are higher in younger patients. Throat cultures take one to two days but are considered the gold standard. Adults with a negative rapid test generally don’t need the follow-up culture because strep complications are less common in that age group.
Treatment and Getting Back to Normal
Strep throat is treated with a 10-day course of antibiotics, typically penicillin or amoxicillin. These remain fully effective. Group A Strep bacteria have not developed resistance to either drug, which is unusual in an era of growing antibiotic resistance across many other infections.
That said, about one in three serious Group A Strep infections now involve bacteria resistant to erythromycin and clindamycin, the backup antibiotics sometimes used for people with penicillin allergies. If you have a penicillin allergy, it’s worth mentioning this resistance trend to your provider so they can choose the most effective alternative.
Most people start feeling significantly better within 24 to 48 hours of starting antibiotics. The standard guideline is that you (or your child) can return to school or work after at least 12 to 24 hours on antibiotics and once fever has resolved. Finishing the full 10-day course matters even after symptoms disappear, because stopping early increases the risk of the infection bouncing back and of complications developing.
Why Treatment Matters Beyond the Sore Throat
Strep throat itself is uncomfortable but not dangerous. The real concern is what can happen if it goes untreated. Rheumatic fever, an inflammatory condition that can damage the heart valves, develops one to five weeks after an untreated strep infection. Severe cases of rheumatic heart disease can require surgery and can be fatal. This complication is the primary reason strep throat, unlike a viral sore throat, warrants antibiotics.
Untreated strep can also trigger kidney inflammation (a condition where the immune system mistakenly attacks the kidneys’ filtering units), though this is less common. Both complications are largely preventable with a straightforward course of antibiotics started within the first few days of symptoms.
Reducing Spread at Home and School
Strep spreads through respiratory droplets, so coughing, sneezing, and sharing cups or utensils are the main transmission routes. If someone in your household tests positive, a few practical steps cut the risk of it sweeping through the whole family:
- Replace toothbrushes once the infected person has been on antibiotics for 24 hours.
- Don’t share drinking glasses, utensils, or towels until treatment is well underway.
- Wash hands frequently, especially after coughing or sneezing and before meals.
- Keep sick kids home until they’ve had at least 12 to 24 hours of antibiotics and their fever is gone.
Strep can bounce around a household for weeks if each family member catches it in sequence, so prompt testing for anyone who develops symptoms helps break the chain. Carriers (people who harbor the bacteria without symptoms) exist but are much less likely to spread the infection or develop complications.