Scarlet fever

About scarlet fever

Scarlet fever is most common in children between the ages of two and eight, with children more likely to catch it around age four.

Between 2,000 and 4,000 people are diagnosed with scarlet fever each year in the UK. Now that antibiotics are available to treat the infection, most people only have a mild illness and recover quickly.

In most people, scarlet fever develops after a streptococcal throat infection, known as a ‘strep throat’. However, this happens in fewer than one in 10 people who have had a strep throat. In some people, scarlet fever can also occur after streptococcal infection in wounds, burns or following giving birth.

Symptoms of scarlet fever

The symptoms of scarlet fever begin about one to four days after you have been infected.

The first symptoms to show include:

  • having a sore throat
  • a fever (having a temperature higher than 38.5°C)
  • having a headache
  • tiredness
  • feeling sick and vomiting

You may also find that your tongue has a white coating with red spots. This coating goes away after about four days, leaving your tongue looking bright red, with red spots – commonly called a ’strawberry tongue’ because it looks like a strawberry. Your face may look red, but with paleness around your mouth.

Next, a rash appears on your abdomen (tummy) and chest between 12 and 48 hours after the first symptoms begin. This rash spreads to the rest of your body.

The rash looks like small red pinpricks and has a rough, sandpapery texture, which goes white if you press on it. The outer layer of your skin covered by the rash will likely peel after about one week. This peeling can last for up to six weeks after you have recovered. The peeling is most noticeable on your palms and soles of your feet.

If you or your child has any of these symptoms, see your GP.

Complications of scarlet fever

It’s rare to get complications of scarlet fever. However, if the infection is left untreated and spreads to other areas of your body, you can get complications, which include:

  • ear infection
  • throat infection and abscess
  • sinus infection

Other more serious complications are shown below. These are very rare, but can 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

Lastly, there are rare complications that can occur many weeks after you have recovered from the scarlet fever infection. These include:

  • liver damage
  • osteomyelitis – infection of your bones
  • rheumatic fever – a fever with painful, swollen or stiff joints
  • kidney damage – symptoms include having blood in your urine, producing less urine than is usual and having swelling of your face, hands and feet

Causes of scarlet fever

The bacteria Streptococcus pyogenes cause scarlet fever. You catch it from contact with infected saliva or mucus, which you may be exposed to in the air when someone who is ill coughs or sneezes. You can also pick it up by sharing plates, cutlery and cups with an infected person.

Diagnosis of scarlet fever

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

You will rarely need to have further tests, such as throat swabs, because your GP can diagnose scarlet fever from the symptoms that you have.

Treatment of scarlet fever

Self-help

You will need to rest and drink enough fluids.

Medicines

Your GP will prescribe antibiotics for you. This will normally be penicillin; however, if you’re allergic to penicillin, your GP will prescribe an alternative antibiotic for you. You will usually need to take the course of antibiotics for 10 days. Make sure you 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.

Resistance can start when the bacteria causing an infection aren't completely killed off by an antibiotic. Some bacteria survive because they have a genetic mutation that helps them resist the treatment. The few bacteria that survive can then reproduce, causing an infection that is resistant to that particular antibiotic.

It’s recommended that you take at least 24 hours off from school or work after you have started the antibiotics. This helps to prevent you passing the infection on to anyone else.

If you have pain or a fever, taking over-the-counter painkillers, such as paracetamol, can help.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Can I get scarlet fever as an adult?

Answer

Yes, you can get scarlet fever as an adult, but it's more common in children.

Explanation

Scarlet fever is mainly a childhood disease. Around eight in 10 people who are diagnosed with scarlet fever are under 10 years old. It’s most common in children aged between two and eight, and four-year-olds are most likely get the disease. Adults can catch scarlet fever, but this is much less common. Also, it’s rarely seen in children under two because they still have antibodies from their mothers to protect them.

Is there a vaccine available for scarlet fever?

Answer

No, there currently isn’t a vaccine that can protect you against scarlet fever. Unlike many childhood diseases that can be prevented by vaccination, the spread of scarlet fever can only be prevented by good hygiene and prompt treatment.

Explanation

The best way to protect yourself and other people from getting scarlet fever (and many other infections) is by practising good hygiene. Some examples are listed below.

  • Wash your hands often, especially after using the toilet and before touching food.
  • Don’t share cutlery, plates, cups, clothes, bedding or towels with an infected person.
  • Wash handkerchiefs and throw away tissues that have been used.

If you have scarlet fever, you can also prevent it spreading to other people by doing the following.

  • Take the full course of antibiotics prescribed for you by your GP.
  • Stay at home, away from school or work for at least 24 hours after starting the antibiotics.

What is rheumatic fever and how can it affect me?

Answer

Rheumatic fever is an inflammatory condition that affects many different parts of your body. It can affect your heart valves and lead to heart problems in later life. However, treating scarlet fever with antibiotics prevents most people from developing rheumatic fever. People between the ages of five and 15 are more likely to develop rheumatic fever, but in the UK, the illness is rare.

Explanation

If you don’t get treatment for scarlet fever, there is a higher chance that you may develop rheumatic fever many weeks later. The bacteria that cause scarlet fever don’t directly cause rheumatic fever. Instead, it’s your body’s immune response working too hard and attacking your tissues after the scarlet fever infection has gone that causes the problem. You can also get rheumatic fever after a throat infection with Streptococcus bacteria.

Symptoms of rheumatic fever are wide-ranging, but commonly include:

  • a high temperature over 39oC
  • severe pain in your joints, which moves from joint to joint and especially affects your ankles, knees, elbows and wrists
  • problems with your heart that may lead to breathlessness and chest pain
  • a rash on your skin or small lumps under your skin
  • uncontrolled movements of your upper body and face (this is called chorea)


If you have rheumatic fever you may need hospital treatment and antibiotics to clear up the bacterial infection. You may also be given aspirin and corticosteroids to help bring down your temperature and ease the pain in your joints. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.