Scarlet fever

Dear Alice,

I have a case of scarlet fever and was wondering how contagious it is and for how long. Am I putting people at risk by being around them?

Dear Reader,

It's very responsible of you to consider that it’s contagious! Scarlet fever caused by a bacteria that is spread by inhaling the droplets of an infected person (released for example, during coughing), by sharing utensils or other personal items, or by direct contact with an infected person. Effective hand washing is a great prevention tool. It’s worth noting that your level of contagiousness drops considerably after being on antibiotics for 24 hours and you no longer have a fever. At that time, it’s unlikely that you would spread the infection to another.

Here’s some background: scarlet fever is an infection caused by group A streptococcus (group A strep) — the same bug responsible for strep throat. Scarlet fever usually occurs in children ages 5 to 15 years old. Symptoms generally develop within two days of becoming infected and may include: 

  • A reddish-pink rash that spreads from the neck and face to the rest of the body (often described as having a rough, sandpapery feel and peels as it begins to fade)
  • "Strawberry tongue" that's red, swollen, and has a white coating early on
  • Bright red lines in the skin of the underarms and groin and around the mouth
  • A very red and sore throat
  • Difficulty swallowing
  • Fever and chills
  • Abdominal pain
  • Vomiting
  • General body aches
  • Headaches

List adapted from Mayo Clinic.

Your health care provider can diagnose scarlet fever during a physical exam (the rough rash is a dead giveaway) and via a throat culture. If left untreated, the bacteria can spread to other parts of the body, including the lungs, kidneys, tonsils, blood, and middle ear. In rare cases, it can also develop into rheumatic fever.

A variety of different antibiotics can treat group A strep and the illness subsides rather quickly once treatment begins, though the rash can hang around for seven days or longer after a person begins antibiotics. Even if you’re feeling better, taking the full course of antibiotics to prevent any resistant bacteria from proliferating is strongly advised. While it’s good to be cautious about potential transmission, you can likely lift the quarantine 24 hours after beginning your antibiotic treatment and your fever breaks unless your health care provider instructs you otherwise.

In order to prevent the spread of it to others, there are a few steps you can take beyond seeking treatment. First, be sure to wash your hands and any utensils and dishes you use thoroughly with warm water and soap. Additionally, be sure not to share food or drinks with others. This includes sharing utensils such as forks and spoons or straws that may be in a drink. Another way to ensure germs aren’t spread is to be sure to cover your mouth when you cough or sneeze.

Here’s to feeling better soon,

Last updated Mar 23, 2018
Originally published Dec 14, 2001

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