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Scarlet fever


Your health expert: Dr Ade Adeniyi, Lead Physician, Bupa UK
Content editor review by Pippa Coulter, January 2023
Next review due January 2026

Scarlet fever is an infection that causes a rash and sore throat. It’s caused by a type of bacteria called group A streptococcus (or ‘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 it.

About scarlet fever

Anyone of any age can get scarlet fever. But it’s most common in children between the ages of two and eight. It’s much less common in adults. In the UK, most people usually get scarlet fever between December and May, and it tends to peak in March or April. It spreads very easily, so 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. And in 2022–2023, there was a steep rise in cases at the beginning of the normal scarlet fever season. 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 try and identify outbreaks and manage them.

Causes of scarlet fever

Scarlet fever is caused by a type of bacteria called group A streptococcus (‘Strep A’). It’s also known as Streptococcus pyogenes.

Scarlet fever spreads from person to person very easily. You can catch it by breathing in droplets from when an infected person coughs or sneezes. You can also catch it if you touch surfaces – like cups, taps and handles – that an infected person has touched.

Scarlet fever symptoms

The symptoms of scarlet fever begin about two to three days after you’ve been infected.

The first symptoms you may develop 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. This peels off after a couple of days, leaving your tongue looking bright red and swollen – 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 appear more like it’s sunburnt.

    Scarlet fever rash

    After around 12 to 48 hours, a rash appears on your abdomen (tummy) and chest. This quickly spreads to the rest of your body.

    The rash consists of small red pinpricks and has a rough, sandpapery texture. You may notice it more in skin folds, like in your armpits, behind your knees and in your elbows or groin. It can be harder to spot on black or brown skin, but it will still feel rough, like sandpaper. The rash lasts for several days. Your skin may then start to peel, and this can continue for several weeks. The peeling is most noticeable on the tips of your fingers and toes, and 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.

Under 18 GP Appointments

We now offer GP appointments for children aged children under 18 via our remote video service (UK wide) and face to face appointments at selected centres. Please note that these appointments cannot be booked online so please call 0330 822 3072 for more information or to book. Lines are open Monday to Friday 8am to 8pm, Saturday and Sunday 9am to 5pm. We may record and monitor our calls. Available from £49.

To book or to make an enquiry, call us on 0343 253 8381

Scarlet fever treatment

Scarlet fever usually goes away on its own, with time. But it’s best to get treatment with antibiotics. Treatment with antibiotics can:

  • reduce your risk of developing complications
  • help you get better faster
  • mean you’re less likely to spread it

Self-help

Make sure you rest while you recover from the infection, and that you’re drinking enough fluids. You can take over-the-counter painkillers if you need to, such as paracetamol, to manage symptoms like sore throat, headache and fever.

Medicines

Your GP will prescribe antibiotics for you. This will normally be penicillin. They may prescribe an alternative if you’re allergic to penicillin or if it isn’t available. You will usually need to take your antibiotics for 10 days.

Your symptoms will usually start to improve within seven days of starting antibiotics. But make sure you still take the full course 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 a week, 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.
  • Avoid contact with people who are at greater risk of complications. This includes very young and older people. It also includes people with a weak immune system, and those with conditions such as diabetes.

Hospital care

Some people with scarlet fever need to be admitted to hospital for treatment. This may be the case if you have very severe symptoms, a serious complication, or you’re at high risk of developing complications. Your GP will tell you if you need to go to hospital.

Your GP may also refer you for treatment in hospital if your symptoms haven’t improved after taking antibiotics.

If you or your child become very unwell, you should go to A&E or call an ambulance. See the complications section below for more information.

Complications of scarlet fever

It’s rare to get serious complications from scarlet fever. 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 have recovered from scarlet fever. This is more likely if you don’t receive treatment, and can happen if the infection spreads to other parts of your body. They include:

  • liver damage
  • osteomyelitis – infection of your bones
  • rheumatic fever – a fever linked to problems with your heart and joints
  • kidney damage – symptoms include having 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). You may hear it called ‘invasive strep A’ or just ‘invasive strep’. Invasive strep A can be very dangerous, especially for older or younger people, or those with other health problems. 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. Most people who have scarlet fever won’t develop this. But if your child has had symptoms of scarlet fever, it’s important to get treatment quickly to reduce the risk of developing it. If your child is getting worse after being diagnosed with scarlet fever or becomes very unwell, seek urgent medical attention. This may mean calling 999 or going to A&E.

Yes, scarlet fever spreads very easily. You can catch it when an infected person coughs or sneezes, or by touching surfaces that they have touched. If you have scarlet fever, you’ll need to stay away from nursery, school or work for at least 24 hours after starting antibiotics. See our causes section to find out more.

Scarlet fever is usually a mild illness. It doesn’t cause serious complications for most people. It’s still important to get treatment promptly though. This helps to stop the spread and reduces the risk of developing complications. Very rarely, the bacteria that causes scarlet fever can get into your bloodstream and cause a more dangerous illness, called invasive strep A. See our complications section for more information.

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. About a day or two later, you also start to develop a rash on your body. See our symptoms section for more information.

Yes, you can get scarlet fever as an adult, but it's more common in children. It’s most common in children aged between two and eight. It spreads very easily, so can cause outbreaks in nurseries and schools.

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