Is Coughing a Symptom of Strep Throat?

Expert Q&A

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Q. My son was recently diagnosed with strep throat. It has been 5 days now, he has developed a very bad cough. It's not a continuous cough all day but when he gets these cough spells his face turns red from coughing so hard. Is this because of his strep throat? I wasn't aware that you could develop a cough after a couple of days with strep. Is this just another symptom of having strep? He is taking antibiotics. Should I call his doctor or will this clear up along with his strep throat?

A. Coughing isn't a usual symptom of strep throat.

Strep Throat Symptoms

Strep more typically causes kids to have symptoms that can include a:

Other strep throat symptoms sometimes include vomiting, abdominal pain, a headache, and a classic rash (scarlet fever).

Understanding Strep Throat

Caused by an infection with the group A Streptococcus bacteria, to really understand strep throat, it is also important to know what this common bacteria doesn't do.

Strep doesn't usually cause a cough, sneezing, or a runny nose, so if you have a sore throat and a cough and runny nose, then you are much more likely to have a viral illness than strep throat. Ulcers or vesicles in the throat and pink eye also point away from a diagnosis of strep throat.

Children under age three don't typically get strep throat either and they even more rarely get rheumatic fever, so it is generally not even recommended that younger infants and toddlers be tested.

And most importantly, remember that strep throat usually responds very quickly to antibiotics, and many children feel much better within a day or two.

Strep That Isn't Getting Better

So why isn't your child with strep throat getting better?

Does he need a stronger antibiotic?

One possibility is that it isn't strep causing the cough and that it is possible that he caught a cold virus on top of the strep infection.

Or if he has allergies or asthma, then maybe something triggered an attack.

Another possibility is that he never had strep at all and his symptoms are all from a virus, which would explain why he wouldn't be getting better after 5 days of antibiotics. This is especially likely if he didn't have a strep test and he was simply diagnosed because it 'looked' like strep.

Strep Throat Carriers

However, even if he had a positive strep test, many children are carriers for strep, which means that the strep bacteria lives in their throat, but isn't causing problems. Strep carriers will be positive when tested for strep, even when the strep bacteria isn't causing their symptoms. This might be likely if he always tests positive for strep, even when he doesn't have typical symptoms or isn't around anyone else with strep. Keep in mind that strep carriers aren't thought to be contagious and many pediatricians will treat these children with a stronger antibiotic, not to treat their strep infection, but to stop them from being carriers.

That leaves us without an easy or definite answer, but since your child isn't getting better and is already being treated by his doctor, you should call to give him or her an update and get further advice.

To help minimize these kinds of situations, it is recommended that only children with classic strep symptoms be tested for strep, especially avoiding those with obvious viral symptoms, like a cough, runny nose, congestion, and diarrhea, etc.


CDC. Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic — Wyoming, March 2015. MMWR. January 1, 2016 / 64(50);1383-5

Hersh AL, Jackson MA, Hicks LA, et al. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics. 2013;132(6):1146-54.

IDSA Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America

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