Scarlet fever

Overview

Scarlet fever is a bacterial infection that usually affects children. It causes a sore throat, fever, and a distinctive pink-red rash that feels like sandpaper. The infection is caused by group A streptococcus bacteria.

Scarlet fever used to be very common but became much rarer after antibiotics were introduced. However, cases have increased in some countries in recent years, especially among children aged 5 to 15.

Scarlet fever mainly affects children between 5 and 15 years old. It can also occur in younger children and adults, but this is less common.

Symptoms

Common symptoms

• Sore throat
• High fever (38°C or higher)
• Swollen neck glands
• A distinctive pink-red rash that feels like sandpaper (often starting on the chest and stomach)
• Flushed face with pale skin around the mouth
• Red and bumpy tongue (strawberry tongue)

Symptoms in children

• All the common symptoms listed above
• Nausea or vomiting
• Abdominal pain

Symptoms in older adults

• High fever that may be more severe
• More intense or widespread rash
• Severe sore throat with difficulty swallowing

Causes

Main causes

• Scarlet fever is caused by group A streptococcus bacteria.
• The bacteria release a toxin that causes the rash and other symptoms.

Risk factors

• Being in close contact with someone who has scarlet fever or a strep throat infection
• Living or working in crowded settings such as schools, nurseries, or military barracks
• Being between the ages of 5 and 15
• Having a weakened immune system

When to see a doctor

See a doctor urgently if:

• If you or your child has a sore throat, fever, and a sandpaper‑like rash
• If symptoms are severe or getting worse quickly

Book a routine appointment if:

• If you have mild symptoms but are worried it could be scarlet fever

Diagnosis

A doctor will ask about symptoms and check for the characteristic rash, sore throat, and strawberry tongue. They may also take a throat swab to confirm the bacteria.

Tests that may be done

• Throat swab test (a sterile cotton swab is gently rubbed on the back of the throat to collect a sample)
• Rapid strep test (gives results within minutes)
• Throat culture (takes a day or two to get results)

What to expect at your appointment

The doctor will examine your child’s throat, feel the neck for swollen glands, and look at the rash. A throat swab is quick and may feel a little uncomfortable but is not painful.

Treatment

Scarlet fever is treated with antibiotics to kill the bacteria, reduce symptoms quickly, and prevent complications. Treatment usually lasts 10 days, and it is important to finish all the medicine even if you feel better.

Self-care at home

• Get plenty of rest.
• Drink lots of fluids to stay hydrated – cool drinks or ice lollies can soothe a sore throat.
• Eat soft, easy‑to‑swallow foods such as soup, yoghurt, or mashed potatoes.
• Use over‑the‑counter pain relief (like paracetamol or ibuprofen) to lower fever and ease discomfort – ask your pharmacist for the right dose for your child.

Medical treatments

Doctors usually prescribe an antibiotic, such as penicillin or an alternative for those allergic to penicillin. It may be given as a liquid, tablets, or a one‑time injection. The full course must be completed.

When is surgery considered?

Surgery is not needed for scarlet fever.

Living with this condition

While on antibiotics, keep your child home from school or nursery for at least 24 hours after starting treatment (or until the fever has gone and they feel well). Wash hands often and avoid sharing cups, towels, or utensils.

Lifestyle tips

• Encourage regular handwashing with soap and water.
• Cover coughs and sneezes with a tissue or elbow.
• Keep surfaces and toys clean to reduce the spread to others.

Diet and exercise

A soft, cool diet is easier on a sore throat. Offer plenty of fluids like water, clear soups, or diluted fruit juice. Rest until the fever and sore throat have gone, then return to normal activities gradually.

Mental health and emotional wellbeing

Being ill can be worrying for both children and parents. Reassure your child that the medicine will help them feel better soon. Talk to your doctor if you or your child feel very anxious.

Prevention

There is no vaccine for scarlet fever. The best way to prevent it is by practicing good hygiene: washing hands regularly, covering your mouth when coughing or sneezing, and not sharing personal items like cups or towels.

Vaccines

There is currently no vaccine for scarlet fever.

Screening programmes

No routine screening is done for scarlet fever.

Complications

If left untreated

• Rheumatic fever – an inflammatory condition that can damage the heart valves, joints, and brain
• Kidney inflammation (glomerulonephritis) – can cause blood in the urine and swelling
• Ear infections
• Sinusitis
• Pneumonia

Long-term outlook

With antibiotic treatment, almost everyone recovers fully from scarlet fever without any lasting problems. The rash fades and symptoms usually improve within a few days. Serious complications are rare today because antibiotics are widely available.

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