Scarlet Fever: Symptoms, Rash & Treatment Guide

What Is Scarlet Fever?

Scarlet fever (also called scarlatina) is a bacterial infection caused by Group A Streptococcus (GAS) bacteria that produces a toxin leading to a characteristic red rash, high fever, sore throat, and strawberry tongue. It primarily affects children aged 5-15 years and is highly contagious but treatable with antibiotics.

Scarlet fever develops when Group A Streptococcus bacteria, the same bacteria that cause strep throat, produce a toxin called erythrogenic (rash-producing) toxin. Not everyone infected with strep bacteria develops scarlet fever - it only occurs in individuals who are susceptible to this particular toxin. This explains why some family members may develop strep throat while others develop the full scarlet fever syndrome with its distinctive rash.

The condition has been known for centuries and was once a major cause of childhood mortality. Before the advent of antibiotics in the 1940s, scarlet fever outbreaks could be devastating, with high mortality rates. Today, thanks to effective antibiotic treatment, scarlet fever is generally mild and complications are rare when properly treated. However, the disease remains important to recognize and treat promptly to prevent potential complications.

Epidemiologically, scarlet fever is most common in school-age children, with peak incidence between ages 5 and 15. Children under six months are typically protected by maternal antibodies passed during pregnancy. Older children and adults can develop scarlet fever, though they more commonly experience strep throat without the characteristic rash. The condition occurs year-round but peaks during late winter and early spring, corresponding to the school year when close contact facilitates transmission.

Why Does Scarlet Fever Occur?

The distinctive symptoms of scarlet fever result from the body's response to toxins produced by the streptococcal bacteria. When Group A Streptococcus bacteria colonize the throat, they can produce several types of pyrogenic exotoxins (streptococcal pyrogenic exotoxins A, B, and C). These toxins trigger an intense immune response, causing the widespread rash, fever, and other characteristic symptoms.

Once a person has been exposed to a particular toxin type and developed antibodies against it, they become immune to that specific toxin. This is why people generally only get scarlet fever once, though they can still develop strep throat from infections with bacteria producing different toxin types. This acquired immunity explains why the condition predominantly affects children who haven't yet developed these protective antibodies.

What Are the Symptoms of Scarlet Fever?

Scarlet fever symptoms appear 1-3 days after infection and include high fever (38-40°C/100.4-104°F), severe sore throat, red sandpaper-like rash starting in the groin and armpits, strawberry tongue, flushed face with pale area around the mouth, swollen lymph nodes, headache, nausea, and vomiting. Skin peeling on fingers and toes occurs 1-3 weeks later.

The symptom progression of scarlet fever follows a characteristic pattern that helps distinguish it from other childhood illnesses. Understanding this timeline is crucial for early recognition and prompt treatment. Symptoms typically begin 1 to 3 days after exposure to an infected person, with the illness developing in distinct phases.

The initial symptoms often appear suddenly and can be quite dramatic. Children may go from appearing well to being quite ill within a matter of hours. This rapid onset, combined with the high fever and sore throat, often alerts parents that something more significant than a common cold is occurring. The severity of initial symptoms can vary considerably between children, with some experiencing mild illness while others become quite unwell.

Initial Symptoms (Days 1-2)

The first signs of scarlet fever typically include a sudden onset of fever, which can range from moderate (38°C/100.4°F) to high (40°C/104°F or higher). This fever is often accompanied by severe sore throat that makes swallowing painful. Children frequently complain of headache, body aches, nausea, and may vomit. The tonsils become enlarged, red, and may develop white or yellow patches of pus on their surface. Lymph nodes in the neck often become swollen and tender to touch.

During this early phase, the tongue typically develops a thick white coating that can look quite alarming to parents. This coating covers the tongue's surface but the edges often remain red. The throat and soft palate may also show tiny red spots (petechiae). Children may refuse to eat due to throat pain and generally feel quite miserable with reduced energy and appetite.

The Characteristic Rash

The hallmark rash of scarlet fever typically appears 12 to 48 hours after the initial symptoms begin. It usually starts in the warm, moist areas of the body - the armpits, groin, and neck - before spreading to the trunk (chest, back, and abdomen) and eventually to the arms and legs. The rash has a distinctive sandpaper texture that is often described as feeling like rough goose bumps or very fine sandpaper when you run your hand over the skin.

On lighter skin, the rash appears as tiny red bumps that give the skin a diffuse red or pink flush. The individual bumps may be difficult to distinguish, but the rough texture is unmistakable. On darker skin tones, the redness may be more difficult to appreciate visually, but the characteristic sandpaper texture remains a reliable diagnostic feature. The rash typically blanches (turns white briefly) when pressed.

The rash concentrates particularly in skin folds - the elbows, armpits, groin, and behind the knees. In these creases, the rash may form red lines called Pastia's lines, which can persist even after the rash fades. These lines result from the fragility of small blood vessels in these areas and are a helpful diagnostic sign.

Facial Appearance

The face takes on a characteristic appearance in scarlet fever that helps differentiate it from other rash illnesses. The cheeks become flushed and red, while the area immediately around the mouth remains notably pale - a sign called circumoral pallor. This creates a distinctive look sometimes described as "slapped cheeks" with a pale mustache. The forehead may also appear flushed.

The eyes may appear slightly bloodshot, and children may complain of discomfort in bright light. However, significant eye involvement with discharge or crusting would suggest a different diagnosis and warrants medical evaluation. The facial flushing, combined with the high fever, can make children appear quite unwell.

Strawberry Tongue

One of the most distinctive features of scarlet fever is the evolution of the tongue's appearance. In the first few days, the tongue becomes covered with a thick white coating through which red, enlarged papillae (taste buds) can be seen - this is called a "white strawberry tongue." Over the following 4 to 5 days, this white coating peels off to reveal a bright red tongue with prominent, swollen papillae - the classic "red strawberry tongue" or "raspberry tongue."

This tongue appearance is caused by the bacterial toxins affecting the tongue's surface. The enlarged, red papillae against the red background truly do resemble the surface of a strawberry, making this a memorable and useful diagnostic feature. The strawberry tongue typically persists for about a week before gradually returning to normal.

Late Symptoms (1-3 Weeks After Onset)

As the acute illness resolves, several characteristic late features appear. The rash typically fades within 7 days, progressing from red to pink before disappearing. In its place, a distinctive peeling of the skin begins, usually appearing 1 to 3 weeks after the initial illness. This desquamation (skin peeling) is most prominent on the fingertips, toes, palms, and soles, where sheets of skin may peel off. More subtle peeling can occur on the trunk.

Some children may experience temporary joint pain, particularly in the larger joints like knees and elbows, in the weeks following scarlet fever. This transient arthralgia typically resolves within a week without treatment and should not be confused with the more serious rheumatic fever, which requires ongoing medical evaluation. If joint symptoms are severe, persistent, or accompanied by signs of heart involvement, prompt medical assessment is essential.

When Should You See a Doctor for Scarlet Fever?

Seek medical care if you suspect scarlet fever - a healthcare provider can perform a rapid strep test for diagnosis and prescribe antibiotics. Seek immediate care if the child has difficulty breathing or swallowing, drooling, severe throat pain, high fever not responding to medication, signs of dehydration, or symptoms worsen after starting antibiotics.

Early medical evaluation is important whenever scarlet fever is suspected. While the condition is generally not dangerous when properly treated, prompt diagnosis and antibiotic therapy can significantly reduce the duration of illness, limit contagiousness, and prevent potential complications. Healthcare providers can confirm the diagnosis through clinical examination and rapid strep testing, then prescribe appropriate antibiotic treatment.

Most children with scarlet fever can be safely managed at home with oral antibiotics and supportive care. However, certain situations require more urgent medical attention to ensure complications are not developing or the diagnosis is not something more serious requiring different treatment.

Routine Medical Evaluation

Contact your healthcare provider or schedule an appointment if your child develops a combination of sore throat with fever and a rash that feels rough or sandpaper-like. Even if you're not certain it's scarlet fever, any persistent sore throat with fever lasting more than 48 hours warrants evaluation, as strep infections benefit from antibiotic treatment regardless of whether the characteristic rash develops.

Seek Urgent Care If:

• Difficulty breathing: Any breathing difficulty, including rapid breathing, labored breathing, or the child using extra muscles to breathe (visible rib cage movements)
• Severe throat swelling: Difficulty swallowing saliva, drooling, or refusal to swallow that suggests significant throat or tonsillar swelling
• High fever not responding to treatment: Fever above 40°C (104°F) that doesn't improve with appropriate fever-reducing medication
• Signs of dehydration: Decreased urination, dry mouth, no tears when crying, or unusual drowsiness - particularly concerning in young children refusing fluids due to throat pain
• Worsening symptoms despite antibiotic treatment: If symptoms continue to worsen 48-72 hours after starting antibiotics, the child needs reassessment
• Neck swelling or stiffness: Significant swelling on one side of the neck or neck stiffness that could indicate abscess formation or other complications
• Widespread skin involvement: Rapidly spreading rash, blistering, skin peeling during the acute illness (not the normal late peeling), or signs of skin infection

How Does Scarlet Fever Spread?

Scarlet fever spreads through respiratory droplets when an infected person coughs, sneezes, or talks. It can also spread through direct contact with infected saliva or nasal secretions, or by touching contaminated objects like towels or toys. The infection is contagious from a few days before symptoms until 24-48 hours after starting antibiotics.

Understanding how scarlet fever spreads is essential for preventing transmission within families, schools, and communities. Group A Streptococcus bacteria are highly contagious and can spread easily in settings where people are in close contact. The primary mode of transmission is through respiratory droplets, but the bacteria can also survive on surfaces for varying periods, contributing to indirect spread.

When an infected person coughs, sneezes, or even talks, tiny droplets containing the bacteria are released into the air. These droplets can travel up to 6 feet (2 meters) and can be inhaled by people nearby or land on surfaces. The bacteria primarily colonize the nose and throat, so activities involving close face-to-face contact or sharing of items that contact the mouth carry the highest transmission risk.

Transmission Routes

Droplet transmission is the primary route of spread. When an infected person coughs, sneezes, laughs, or speaks, they release respiratory droplets containing bacteria. People who breathe in these droplets or who have them land on their nose, mouth, or eyes can become infected. This explains why outbreaks commonly occur in schools, daycare centers, and family households where people are in close proximity.

Direct contact transmission occurs through touching infected respiratory secretions. This includes activities like kissing, sharing food or drinks, or touching the face after contact with an infected person's saliva or nasal mucus. Children are particularly prone to this type of transmission through normal play activities.

Indirect contact transmission can occur through contaminated objects (fomites). Bacteria can survive on surfaces like door handles, toys, eating utensils, and towels. When a person touches a contaminated surface and then touches their face, they can transfer bacteria to their nose or throat. However, this is less efficient than direct droplet transmission.

Contagious Period

Individuals with scarlet fever are most contagious during the acute phase of illness when symptoms are worst. They can actually begin spreading the bacteria a few days before symptoms develop, which contributes to the difficulty in preventing spread. Without antibiotic treatment, an infected person may remain contagious for 2-3 weeks after symptoms begin.

With appropriate antibiotic treatment, most people are no longer contagious after 24 to 48 hours of therapy. This is why healthcare guidelines typically recommend that children stay home from school or daycare for at least 24-48 hours after starting antibiotics. However, they should also be fever-free for 24 hours without fever-reducing medication and feel well enough to participate in normal activities before returning.

Carrier State

An important consideration in scarlet fever transmission is the existence of asymptomatic carriers. Up to 15-20% of school-age children may carry Group A Streptococcus bacteria in their throat without having any symptoms. During outbreaks, this carrier rate can increase significantly - sometimes up to 50% of children in an affected classroom may be carriers. These carriers can potentially transmit the bacteria to others, though they are generally less infectious than people with active symptoms.

How Can You Prevent Scarlet Fever?

Prevent scarlet fever by practicing good hand hygiene, avoiding sharing personal items, covering coughs and sneezes, keeping sick children home from school, and ensuring adequate ventilation. There is no vaccine available. Good hygiene practices are the most effective prevention strategy.

While there is currently no vaccine to prevent scarlet fever, simple hygiene measures can significantly reduce the risk of transmission. These preventive strategies focus on interrupting the transmission pathways - respiratory droplets, direct contact, and contaminated surfaces. Implementing these measures consistently is particularly important in households where someone has been diagnosed with scarlet fever and in childcare or school settings during outbreaks.

Hand Hygiene

Proper hand washing is one of the most effective measures for preventing the spread of streptococcal infections. Hands should be washed thoroughly with soap and water for at least 20 seconds, particularly after coughing or sneezing, before eating or preparing food, after contact with a sick person, and after using the bathroom. When soap and water aren't available, alcohol-based hand sanitizers containing at least 60% alcohol can be used, though they are less effective against some bacteria.

Teaching children proper handwashing technique is essential. This includes wetting hands, applying soap, lathering all surfaces including between fingers and under nails, scrubbing for 20 seconds (about the time to sing "Happy Birthday" twice), rinsing thoroughly, and drying with a clean towel. Using visual aids or songs can help children learn and remember these steps.

Respiratory Hygiene

Covering coughs and sneezes effectively reduces the release of infectious droplets into the air. The preferred technique is to cough or sneeze into a tissue, dispose of the tissue immediately, and then wash hands. If a tissue isn't available, coughing or sneezing into the elbow (not the hands) is recommended, as this prevents contaminating surfaces that are frequently touched.

Environmental Measures

Improving ventilation in indoor spaces helps reduce the concentration of respiratory droplets in the air. Opening windows, using fans to increase air circulation, or ensuring HVAC systems are functioning properly can all contribute to reduced transmission risk. During outbreaks, increased attention to cleaning frequently touched surfaces with appropriate disinfectants can help reduce indirect transmission.

Keeping Sick Children Home

Children diagnosed with scarlet fever should remain home from school, daycare, and other group activities until they have completed at least 24-48 hours of antibiotic treatment AND have been fever-free for 24 hours without fever-reducing medication. They should also feel well enough to participate in normal activities. Sending a child back too early increases the risk of spreading infection to others.

How Is Scarlet Fever Diagnosed?

Scarlet fever is diagnosed through clinical examination of the characteristic rash, throat appearance, and strawberry tongue, combined with a rapid strep test or throat culture to confirm Group A Streptococcus infection. The rapid test provides results in minutes, while a throat culture takes 24-48 hours but is more accurate.

Diagnosing scarlet fever involves a combination of clinical assessment and laboratory confirmation. An experienced healthcare provider can often suspect scarlet fever based on the constellation of characteristic signs and symptoms - the sandpaper rash, strawberry tongue, flushed cheeks with circumoral pallor, and associated sore throat and fever. However, laboratory confirmation of streptococcal infection is important to guide treatment decisions and exclude other conditions that may mimic scarlet fever.

Clinical Examination

During the physical examination, the healthcare provider will thoroughly assess the throat, tonsils, lymph nodes, tongue, and skin. They will look for the characteristic features of scarlet fever: enlarged, red tonsils possibly with white or yellow patches; swollen, tender lymph nodes in the neck; the distinctive sandpaper-textured rash; Pastia's lines in skin creases; and the strawberry tongue. The provider may run their hand over the rash to appreciate its characteristic texture.

The clinical examination also helps rule out other conditions that can cause similar symptoms. Various viral infections, drug reactions, and other bacterial infections can cause fever with rash in children. The specific combination of features in scarlet fever - particularly the sandpaper rash, strawberry tongue, and strep-positive throat - helps distinguish it from these other conditions.

Rapid Strep Test

The rapid antigen detection test (RADT), commonly called a "rapid strep test," is usually the first-line diagnostic test. The healthcare provider swabs the back of the throat and tonsils with a sterile cotton swab, then the sample is tested for Group A Streptococcus antigens. Results are typically available within 5-15 minutes, allowing for immediate treatment decisions.

The rapid strep test is highly specific, meaning a positive result reliably indicates streptococcal infection. However, it is not 100% sensitive - meaning some true strep infections may be missed (false negatives). If the rapid test is negative but clinical suspicion remains high, a throat culture may be performed for confirmation.

Throat Culture

A throat culture involves taking a swab sample and growing any bacteria present in a laboratory setting. This test is the gold standard for diagnosing streptococcal infection because it is both highly sensitive and specific. The main disadvantage is time - results typically take 24-48 hours. Some healthcare providers routinely send a throat culture when the rapid test is negative, while others may base this decision on the clinical presentation and local strep prevalence.

When Additional Testing May Be Needed

In most cases, clinical examination combined with a rapid strep test or throat culture is sufficient to diagnose scarlet fever. However, in certain situations, additional testing may be warranted. If complications are suspected - such as kidney involvement or evidence of invasive infection - blood tests, urinalysis, or other investigations may be performed. Children who don't respond appropriately to treatment may need reassessment and potentially additional testing to evaluate for complications or alternative diagnoses.

How Is Scarlet Fever Treated?

Scarlet fever is treated with antibiotics, typically penicillin V or amoxicillin for 10 days. For penicillin-allergic patients, alternatives include azithromycin, clarithromycin, or cephalosporins. It is crucial to complete the full antibiotic course even if symptoms improve to prevent complications. Supportive care includes rest, fluids, and fever-reducing medications like paracetamol (acetaminophen) or ibuprofen.

Treatment for scarlet fever focuses on two main goals: eliminating the bacterial infection with antibiotics and providing supportive care to manage symptoms while the child recovers. Prompt antibiotic treatment is important not only to help the child feel better faster but also to reduce the risk of complications and limit the spread of infection to others.

With appropriate treatment, most children begin to feel significantly better within 24-48 hours of starting antibiotics, though the rash and other symptoms may take longer to fully resolve. Complete recovery typically occurs within 1-2 weeks. However, even when symptoms improve quickly, it is essential to complete the full course of antibiotics as prescribed.

Antibiotic Treatment

Group A Streptococcus bacteria remain highly susceptible to penicillin, making penicillin-based antibiotics the first-line treatment for scarlet fever. The most commonly prescribed options are penicillin V (taken orally two to three times daily) or amoxicillin (which can be given once or twice daily and is often preferred for children due to its pleasant taste). The standard treatment course is 10 days, though newer research suggests shorter courses may be effective in some cases - follow your healthcare provider's specific recommendations.

For children allergic to penicillin, alternative antibiotics include azithromycin (typically a 5-day course), cephalosporins (such as cephalexin, for those without severe penicillin allergy), or clindamycin. Your healthcare provider will choose the most appropriate alternative based on the type and severity of penicillin allergy and local antibiotic resistance patterns.

Fever and Pain Management

Over-the-counter pain relievers can help manage fever and throat pain while antibiotics take effect. Paracetamol (acetaminophen) is safe for children from 3 months of age and provides effective relief of fever and pain. Ibuprofen can be used in children from 6 months of age and may provide longer-lasting relief. Always follow age-appropriate dosing instructions on the packaging or as directed by your healthcare provider.

These medications are available in child-friendly formulations including liquid suspensions, chewable tablets, and melt-in-mouth tablets. If you're unsure which formulation or dose is appropriate for your child, consult your pharmacist or healthcare provider. Do not give aspirin or aspirin-containing products to children or teenagers with viral or bacterial infections due to the risk of Reye's syndrome.

Supportive Care

Beyond medications, several supportive measures can help your child feel more comfortable during recovery:

• Rest: Adequate rest helps the body fight infection and recover. Let your child rest as much as they need, especially during the first few days when symptoms are most severe.
• Fluids: Ensure adequate fluid intake to prevent dehydration, especially if fever is high. Cold drinks, popsicles, and ice cream may be soothing for a sore throat and encourage fluid intake.
• Soft foods: If swallowing is painful, offer soft, cool foods that are easy to swallow, such as soup, yogurt, smoothies, and mashed foods.
• Throat comfort: Warm salt water gargles (for older children who can gargle safely), throat lozenges or sprays (for age-appropriate children), and honey (for children over 1 year) may provide additional throat comfort.
• Humidification: Using a cool-mist humidifier in the child's room can help keep throat tissues moist and may ease discomfort.

What Are the Possible Complications of Scarlet Fever?

While most children recover fully with antibiotic treatment, potential complications include peritonsillar abscess (severe throat infection), acute post-streptococcal glomerulonephritis (kidney inflammation), and rarely, rheumatic fever (which can affect the heart, joints, and nervous system). Prompt antibiotic treatment significantly reduces the risk of complications.

Modern antibiotic treatment has made serious complications from scarlet fever relatively rare. However, it's important for parents and caregivers to understand the potential complications so they can recognize warning signs and seek appropriate care. Complications can be broadly categorized as suppurative (pus-forming, resulting from local spread of infection) or non-suppurative (immune-mediated, resulting from the body's response to the infection).

Peritonsillar Abscess

A peritonsillar abscess (quinsy) occurs when the infection spreads beyond the tonsils to form a collection of pus in the tissues beside the tonsil. This complication typically causes increasingly severe sore throat, often worse on one side, difficulty swallowing or opening the mouth, drooling, muffled "hot potato" voice, and fever that may return after initial improvement. The affected tonsil may appear pushed toward the midline.

Peritonsillar abscess requires prompt medical treatment, typically involving antibiotics and drainage of the abscess. If you notice increasing one-sided throat pain, difficulty swallowing, or worsening symptoms despite antibiotic treatment, seek medical evaluation promptly.

Acute Post-Streptococcal Glomerulonephritis

This kidney complication can occur 1-3 weeks after a streptococcal infection. It results from immune complexes (antibody-antigen combinations) depositing in the kidneys, causing inflammation. Symptoms include dark or cola-colored urine, decreased urine output, swelling (especially around the eyes and in the legs/feet), mild fever, and sometimes high blood pressure or headaches.

Post-streptococcal glomerulonephritis typically resolves on its own over several weeks, though supportive care and monitoring are important. Most children recover completely with normal kidney function. If you notice changes in your child's urine or swelling in the weeks following scarlet fever, contact your healthcare provider for evaluation.

Rheumatic Fever

Rheumatic fever is an inflammatory condition that can develop 2-4 weeks after untreated or inadequately treated streptococcal infection. It can affect multiple organ systems, including the heart (carditis), joints (arthritis), nervous system (chorea - involuntary movements), and skin. The heart involvement is of greatest concern, as it can lead to permanent damage to heart valves.

Symptoms of rheumatic fever may include joint pain and swelling (typically affecting multiple large joints), fever, fatigue, chest pain or shortness of breath, unusual movements, and skin rash or nodules. Rheumatic fever requires hospitalization, anti-inflammatory treatment, and ongoing follow-up. Prompt and complete antibiotic treatment of strep infections is the key preventive measure.

While rheumatic fever was historically a major concern, it has become rare in developed countries due to widespread antibiotic treatment. However, it remains more common in developing nations and in areas with limited healthcare access.

What Happens in the Body During Scarlet Fever?

When Group A Streptococcus bacteria infect the throat, they produce toxins (streptococcal pyrogenic exotoxins) that spread through the bloodstream, triggering an immune response that causes the characteristic rash, fever, and strawberry tongue. Once the body develops antibodies to the toxin, immunity to the rash-producing effect is lifelong, though strep throat can still occur.

Understanding the pathophysiology of scarlet fever helps explain why the symptoms develop as they do and why certain individuals develop the full syndrome while others with strep infections only experience throat symptoms. The key to scarlet fever lies in the specific toxins produced by certain strains of Group A Streptococcus and the individual's immune response to these toxins.

The Infection Process

Group A Streptococcus bacteria enter the body through the respiratory tract, typically by inhaling contaminated droplets or transferring bacteria from hands to the mouth or nose. The bacteria colonize the pharynx (throat) and tonsils, where they adhere to the mucosal cells and begin to multiply. This local infection causes the sore throat, tonsil inflammation, and swollen lymph nodes that are common to both strep throat and scarlet fever.

As the bacteria multiply, they produce various proteins and enzymes that help them evade the immune system, obtain nutrients, and spread. The bacteria can also release exotoxins - proteins that are secreted into the surrounding tissues and bloodstream, where they can have effects throughout the body.

The Role of Bacterial Toxins

The distinctive features of scarlet fever - particularly the rash, fever, and strawberry tongue - are caused by streptococcal pyrogenic exotoxins (SPE), specifically SPE types A, B, and C. These toxins act as "superantigens," meaning they can activate a massive number of immune cells simultaneously. This triggers an intense inflammatory response characterized by high fever and widespread tissue effects.

The toxins spread through the bloodstream to affect the skin, causing the characteristic rash. They cause small blood vessels in the skin to dilate and become more permeable, leading to the red color and slight swelling that creates the sandpaper texture. The toxins also affect the tongue, causing the inflammation and papillary swelling that produces the strawberry appearance.

Immune Response and Recovery

The body's immune system responds to the infection and toxins by producing antibodies. These antibodies neutralize the bacteria and toxins, eventually clearing the infection. Importantly, once a person develops antibodies against a particular pyrogenic exotoxin, they become immune to the effects of that toxin. This is why people typically only get scarlet fever once - subsequent strep infections may cause sore throat, but the rash and other toxin-mediated symptoms don't recur.

However, there are three main types of pyrogenic exotoxins (A, B, and C), and immunity to one doesn't protect against the others. Theoretically, a person could have multiple episodes of scarlet fever if infected with strains producing different toxins, though this is uncommon. Additionally, immunity to the toxin doesn't prevent strep throat - subsequent infections can still cause pharyngitis, just without the characteristic rash.

Frequently Asked Questions About Scarlet Fever

Medical References