Most sore throats accompany a cold or flu and are caused by viruses. They are usually somewhat painful and annoying but last only 2 to 4 days and go away on their own without antibiotics. Fortunately both conditions are very uncommon. Strep bacteria are spread by infected nose or throat mucus, either through the air with coughing or sneezing or by direct contact. Illness begins from 12 hours to 5 days after exposure.
Some children complain only of headache or stomach pain.
When earache is present it is caused, in most cases, by throat pain extending up to the ear. On examination of the throat the tonsils are usually swollen and bright red and may have white or yellow patches of pus visible on the surface. The roof of the mouth may also be red or contain small red spots. A distinctive bad breath odor is common. When strep throat is accompanied by a red rash and fever, it is called scarlet fever.