Scarlet fever: symptoms, rash, how long it is contagious and treatment

The NHS says the first signs of scarlet fever can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of the neck). NHS inform says symptoms usually develop 2 to 5 days after infection, although it can be as short as one day or as long as 7 days.

A rash appears 12 to 48 hours later. NHS inform describes red blotches first, which turn into a fine pink-red rash that feels like sandpaper and looks like sunburn, and may be itchy. It usually starts on the chest and stomach and spreads to places such as the ears, neck, elbows, inner thighs and groin.

• A rash of small raised bumps that feels like sandpaper. On white skin it looks pink or red. On brown and black skin the colour change may be harder to see, but you can still feel the rash and see the raised bumps.

• The rash does not appear on the face, but the cheeks can look red, with the area just around the mouth staying quite pale (NHS inform).

• A white coating on the tongue that peels, leaving the tongue red, swollen and covered in little bumps, called strawberry tongue.

• Skin that peels like sunburn as the rash fades.

• Other possible symptoms from NHS inform: loss of appetite, nausea or vomiting, red lines in body folds such as the armpit, and a general feeling of being unwell.

NHS inform describes scarlet fever as a bacterial illness that mainly affects children and causes a distinctive pink-red rash. It is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus, which are found on the skin and in the throat. It usually follows a sore throat or a skin infection such as impetigo caused by particular strains.

The NHS lists scarlet fever, strep throat and impetigo among the infections that strep A can cause. Most strep A infections are mild and easily treated, but some are more serious.

Yes. The NHS says scarlet fever spreads very easily. NHS inform says it can be caught by breathing in bacteria in droplets from an infected person's coughs and sneezes, touching the skin of a person with a streptococcal skin infection such as impetigo, and sharing contaminated towels, baths, clothes or bed linen. It can also be caught from people who have the bacteria in their throat or on their skin but do not have symptoms.

The NHS says you can spread scarlet fever until 24 hours after you take your first dose of antibiotics. If you do not take antibiotics, you can spread the infection for 2 to 3 weeks after your symptoms start (NHS inform says 1 to 2 weeks).

The NHS says to stay off nursery, school or work until 24 hours after you take the first dose of antibiotics, wash your hands often with soap and water, use tissues to trap germs from coughs or sneezes and bin them quickly, and not share cutlery, cups, towels, clothes, bedding or baths. There is no vaccine for scarlet fever, according to NHS inform.

If you have scarlet fever a GP will prescribe antibiotics. The NHS says these help you get better quicker, reduce the chance of a serious illness such as pneumonia and make it less likely that you will pass the infection on. Keep taking the antibiotics until they are finished, even if you feel better.

NHS inform says scarlet fever is usually treated with a 10-day course of antibiotics, often penicillin or amoxicillin, and that erythromycin or another alternative can be used for people allergic to penicillin. It says most cases clear up after about a week even without treatment, but treatment reduces the length of time you are infectious, speeds recovery and lowers the risk of complications.

Things you can do yourself while taking antibiotics are listed below.

• Drink cool fluids.

• Eat soft foods if you have a sore throat.

• Take painkillers like paracetamol to bring down a high temperature. Do not give aspirin to children under 16.

• Use calamine lotion or antihistamine tablets to ease itching.

The NHS says scarlet fever lasts for around 1 week. NHS inform says that with treatment most people recover in about 4 to 5 days and can return to nursery, school or work 24 hours after starting antibiotic treatment, with symptoms improving within 24 hours of starting antibiotics and other symptoms disappearing within a few days.

The rash usually fades after about a week, but NHS inform says the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards.

NHS inform says most cases occur in children under 10, usually between 2 and 8 years of age, but people of any age can get the illness. It explains that symptoms only develop in people who are susceptible to toxins produced by the bacteria, and that most children over 10 will have developed immunity to these toxins. It is possible, but rare, to have scarlet fever more than once.

The NHS says the symptoms are the same for children and adults, although scarlet fever is less common in adults. Outbreaks can occur in nurseries and schools where children are in close contact, according to NHS inform.

The NHS says there is no evidence to suggest that getting scarlet fever during pregnancy will harm your baby, but it can make you feel unwell, so it is best to avoid close contact with anyone who has it. Contact a GP if you get symptoms, and the NHS says many of the antibiotics used for scarlet fever can be taken during pregnancy.

NHS inform adds that if you are heavily pregnant, you should tell the doctors and midwives in charge of your care if you have been in contact with someone who has scarlet fever.

The NHS says GPs can often diagnose scarlet fever by looking at your tongue and rash. Sometimes they may wipe a cotton bud around the back of your throat to test for bacteria, or arrange a blood test. NHS inform says a sample from the back of the throat may be taken to confirm the diagnosis in a laboratory.

Because scarlet fever spreads very easily, the NHS says to check with the GP surgery before you go in, as they may suggest a phone consultation.

The NHS says scarlet fever can be a serious illness, but thanks to antibiotics it is less common than it used to be and easier to treat. Complications are rare and can happen during or in the weeks after the infection. The NHS lists ear infection, throat abscess, sinusitis, pneumonia, meningitis and rheumatic fever.

NHS inform adds very rare later complications such as a bloodstream infection (bacteraemia), septic arthritis, necrotising fasciitis and streptococcal toxic shock syndrome. It says to contact your GP practice urgently if, in the first few weeks after the main infection has cleared, you or your child feel very unwell or develop severe pain, severe headaches, vomiting or diarrhoea, and to phone 111 if the practice is closed.

The NHS says to see a GP if you or your child have scarlet fever symptoms, do not get better in a week after seeing a GP, have scarlet fever and chickenpox at the same time, are ill again weeks after scarlet fever got better (which can be a sign of a complication such as rheumatic fever), or are feeling unwell and have been in contact with someone who has scarlet fever.

For strep A infections in children, the NHS says to get an urgent GP appointment or help from NHS 111 if your child is getting worse or not improving, is feeding or eating much less than normal, has fewer wet nappies, or is very tired or irritable. It says to call 999 or go to A&E if your child has difficulty breathing, pauses in breathing, blue or grey skin, tongue or lips, or is floppy and will not wake up or stay awake.

On the NHS, scarlet fever is diagnosed and treated by a GP, who may do a phone consultation first because it is so contagious. Out of hours, NHS 111 can advise, and the NHS says a pharmacist can help with symptom relief.

Some people choose a private GP or urgent care appointment for quicker assessment. The same rules apply: antibiotics need a prescription, the full course should be finished, and the child should stay off nursery or school until 24 hours after the first dose.