Scarlet fever
- Dr Ade Adeniyi, Lead physician, Bupa
Scarlet fever is an infection that causes a rash and sore throat. It’s caused by a type of bacteria called group A streptococcus (Strep A). Scarlet fever is usually mild. But you’ll need treatment with antibiotics to reduce the risk of complications. Seek medical advice if you think you or your child has scarlet fever.
About scarlet fever
Scarlet fever can affect you at any age. But it’s most common in children aged between two and eight years. The infection is much less common in adults. In the UK, most people get scarlet fever between December and May. Infections tend to be most common in March or April. Scarlet fever spreads very easily, so it can cause outbreaks in nurseries, schools, and other places where people are in close contact.
Scarlet fever is much less common today than it used to be. But cases have been increasing over the past 10 years. Scarlet fever is a notifiable disease. This means if you’re diagnosed with it, your doctor must report it to health authorities. This is to help identify and manage outbreaks.
Causes of scarlet fever
Scarlet fever is caused by a type of bacteria called group A streptococcus (Strep A). The bacteria are also known as Streptococcus pyogenes.
Scarlet fever spreads very easily from person to person. You can catch it by:
- breathing in droplets from an infected person’s coughs or sneezes
- touching surfaces – such as cups, taps and handles – that an infected person has touched
Scarlet fever symptoms
Scarlet fever symptoms begin about two to three days after you’ve been infected.
The first signs of scarlet fever include:
- a sore throat
- a fever (having a temperature higher than 38.3°C)
- a headache
- tiredness
- feeling sick and vomiting
Scarlet fever tongue
Your tongue may develop a white coating with red spots. The coating peels off after a couple of days, leaving your tongue looking bright red and swollen. This is commonly called a ‘strawberry tongue’. If you have white skin, your face may look flushed but pale around your mouth. If you have black or brown skin, your face may look more like it’s sunburnt.
Scarlet fever rash
After around 12 to 48 hours, a rash appears on your tummy and chest. This quickly spreads to the rest of your body.
The scarlet fever rash looks like small red pinpricks and has a rough, sandpapery texture. It can be harder to see on black or brown skin, but it will still feel rough, like sandpaper. You may notice it more in skin folds, for example:
- in your armpits
- behind your knees
- in your elbows or groin
The rash lasts for several days. Your skin may then start to peel. This can carry on for several weeks. The peeling is most noticeable on:
- the tips of your fingers and toes
- your groin area
If you or your child has any of these symptoms, see your GP or contact NHS 111 as soon as possible.
Diagnosis of scarlet fever
Your GP will ask about your symptoms and examine you. They may also ask you about your medical history.
Your GP will usually be able to diagnose scarlet fever from your symptoms alone. Occasionally, you may need to have a throat swab or blood test to confirm the diagnosis.
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Scarlet fever treatment
Scarlet fever usually goes away on its own in about a week. But it’s best to take antibiotics as soon as possible. Treatment with antibiotics can:
- reduce your risk of developing complications
- help you get better faster
- mean you’re less likely to spread the infection
Self-help
While you’re recovering from the infection, it’s important to:
- rest as much as you can
- drink plenty of fluids
- take over-the-counter painkillers – for example, paracetamol – to ease symptoms such as a sore throat, headache and fever
Medicines
Your GP will prescribe an antibiotic. This will normally be penicillin. But they may prescribe a different antibiotic if you’re allergic to penicillin or if penicillin isn’t available. You’ll usually need to take your antibiotics for 10 days.
Even if your symptoms seem to be getting better, make sure you take the full course of antibiotics as prescribed by your GP. This helps to prevent the bacteria becoming resistant to the antibiotics and reduces the chance of complications.
If your symptoms don’t improve after 48 to 72 hours or they’re getting worse, contact your GP.
Preventing spread
You’ll need to take at least 24 hours off from nursery, school or work after you’ve started the antibiotics. This helps to prevent you passing the infection on to anyone else. You should also take the following measures to avoid spreading the infection.
- Wash your hands often, especially after using the toilet and before touching food.
- Don’t share cutlery, plates, cups, clothes, bedding or towels.
- Throw away used tissues promptly, and wash your hands afterwards.
It’s important to avoid contact with people who are at greater risk of complications. This includes:
- very young babies
- people aged 75 and over
- people with a weak immune system
- people with long-term conditions such as diabetes or heart disease
Hospital care
Some people with scarlet fever need to be admitted to hospital for treatment. This may be because they:
- have very severe symptoms
- have a serious complication
- may be at high risk of developing complications
- haven’t improved after taking antibiotics
If you or your child become very unwell, you should go to A&E or call an ambulance.
Complications of scarlet fever
It’s rare to get serious complications from scarlet fever. But your risk of developing complications is greater if you don’t get prompt treatment.
You may develop complications related to the initial infection. These can include:
- ear infection
- throat abscess – a collection of pus near one of your tonsils
- sinusitis – infection of your sinuses
It’s also possible to develop complications many weeks after you’ve recovered from scarlet fever. This can happen if the infection spreads to other parts of your body. It’s more likely to happen if you don’t take antibiotics for scarlet fever. Later complications include:
- liver damage
- osteomyelitis – infection of your bones
- rheumatic fever – a fever linked to problems with your heart and joints
- kidney damage – the symptoms include blood in your urine, producing less urine than usual, and swelling of your face, hands and feet
Invasive strep A
Very rarely, the bacteria that causes scarlet fever may get into your bloodstream. This is called invasive group A strep (iGAS) but is also referred to as invasive strep A or just invasive strep. Invasive strep A can be very dangerous, especially for older or younger people and those with other health problems, including problems with their immune system. Complications associated with invasive strep A include:
- pneumonia – inflammation of your lungs
- meningitis – an infection of the membranes that cover your brain and spinal cord
- endocarditis – inflammation of your heart’s inner lining
- sepsis – a life-threatening reaction to infection
Invasive strep A can be life-threatening. But most people who have scarlet fever won’t develop this. It’s most likely to affect people who haven’t taken antibiotics to treat scarlet fever.
If you or your child has had symptoms of scarlet fever, it’s important to get treatment quickly to reduce the risk of developing invasive strep A. If the symptoms are getting worse after being diagnosed with scarlet fever or you or your child feel very unwell, seek urgent medical attention. This may mean calling 999 or going to A&E.
Scarlet fever is very contagious at first. If you don’t take antibiotics to treat it, you can pass on the infection for two to three weeks after your symptoms first appear. Once you’ve started antibiotics, you should stay away from nursery, school or work for at least 24 hours. For more information, see our section on scarlet fever treatment.
Scarlet fever is usually a mild illness. But it’s still important to get treatment straightaway. This helps to stop the spread of the illness and reduces the risk of complications. Very rarely, the infection can pass to other parts of your body or the bacteria can get into your bloodstream. This can be life-threatening.
For more information, see our section on complications of scarlet fever.
The first symptoms of scarlet fever are usually a sore throat and fever (high temperature). You may also have a headache, feel very tired and feel sick or vomit. You may develop a white coating on your tongue followed by a rash on your body.
For more information, see our section on scarlet fever symptoms.
Scarlet fever can go away on its own in about a week. But taking antibiotics to treat it is important. This is because you’ll:
- get better more quickly
- be less likely to spread the infection to others
- be less likely to develop complications
For more information, see our section on scarlet fever treatment.
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This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
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- Scarlet fever. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2024
- Guidelines for the public health management of scarlet fever outbreaks in school, nurseries and other childcare settings. UK Health Security Agency. www.gov.uk, published January 2023
- Scarlet fever: symptoms, diagnosis and treatment. UK Health Security Agency. www.gov.uk, updated March 2019
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- Personal communication from Dr Ade Adeniyi, Lead Physician, Bupa UK, May 2025
- Victoria Goldman, Freelance Health Editor
