Adult scarlet fever

What is scarlet fever in adults?

Scarlet fever is a well-known and not infrequently occurring childhood disease.
Many people are unaware that adults can also become infected.
There is no vaccination against scarlet fever and one can become infected with the streptococcus pathogen at any age.

This bacterium causes many diseases and it is characteristic of scarlet fever that the germ produces a certain toxin, which leads to the typical symptoms.
However, since the course of scarlet fever is often weakened in adults, the disease can be recognized late or not recognized, which in the worst case leads to complications.


Scarlet fever is caused by ß-haemolytic streptococci of group A and is one of the most common infectious diseases in Germany.
In scarlet fever, the pathogen carries a certain toxin with it, which distinguishes the disease from other infections with the pathogen.

In most cases, children between 4-10 years are infected, but you can get infected at any age. When speaking, coughing or sneezing - the so-called droplet infection - the pathogen can be passed on and then absorbed through the inhaled air of the other person.

There is also scarlet fever, but this rarely occurs and infects the soft tissues of humans.

Read more about infection with scarlet fever:

  • How contagious is scarlet fever?


In adults, scarlet fever often takes a milder form or takes an atypical course, so that the diagnosis cannot be made simply by ascertaining the external appearance, as is the case with children.

Learn more about the symptoms of scarlet fever.

If there are no classic symptoms of the disease, such as tonsillitis, red cheeks and a rash, all that remains is the detection of the causative bacterium through a laboratory test.
Depending on the severity, this may require a blood test, a throat swab or other samples to be taken.
Scarlet fever occurs when you become infected with a bacterium called streptococcus, which produces a certain toxin.

Do you want to know how you can still detect scarlet fever? Find out about the:

  • Scarlet fever test

Rapid test

There is a specific rapid test called the Streptococcal A Rapid Test because it specifically looks for this group of bacteria. This test is done in most practices and hospitals.
It is checked whether antigens of the pathogen can be found in the throat swab.

After approx. 10 minutes, it can be said with an approximately 95% certainty whether the germ is the ß-hemolytic group A streptococcus.
In this case, however, it cannot be determined whether it is scarlet fever or a common tonsillitis with streptococci without the characteristic exotoxin.

Please also read our detailed article on:

  • Scarlet fever test

What are the signs of scarlet fever in adults?

If the disease scarlet fever breaks out in an adult, it usually begins 2-4 days after infection with a fever and a general feeling of illness.
Often there is also inflammation of the tonsils and swelling of the regional lymph nodes on the neck.

As the disease progresses, various accompanying symptoms can occur, which are discussed in the next section.

Basically, in adults, in contrast to children, scarlet fever is less severe in the majority of cases.
Symptoms can also be completely absent or changed.

Not sure if you have a scarlet fever infection? Find out more about:

  • The symptoms of scarlet fever

Concomitant symptoms

Scarlet fever occurs when, in addition to fever and, in most patients, tonsillitis, another of the following symptoms occurs:

  • Reddened cheeks, pale around the mouth

  • Delicately reddened soft palate

  • Fine patchy rash on the neck, trunk and extremities (like sandpaper)

  • Scarlet tongue / raspberry tongue

  • Scaly peeling of the skin

Scarlet tongue / raspberry tongue

The so-called raspberry or strawberry tongue is very characteristic of scarlet fever.
A few days after the onset of the disease, a whitish coating appears on the tongue with protruding red papillae of the tongue.
The papillae are small bumps in the lining of the tongue that swell with scarlet fever.

As the disease progresses, the white coating recedes and the tongue appears reddened.
This often happens at the same time as the rash and continues to show swollen papillae on the tongue.

For more detailed information on this topic, also read our article:

  • Scarlet tongue

skin rash

In the classic case, the skin rash is also an important clinical feature for diagnosing scarlet fever.
If there is an infection and the outbreak of the disease, the rash appears after a further 48 hours with reddening of the cheeks, small speckled reddening of the soft palate, small red spots on the trunk, extremities and groin.

In adults, a weakened or atypical course of scarlet fever is much more common and therefore there is a greater risk that the disease will be overlooked.

For more detailed information on this topic, also read our article:

  • Scarlet fever rash

Which rash looks similar?

If a rash occurs, it is important to study its onset and course carefully, as this can be important in making the correct diagnosis.

The doctor must also be informed of any recently changed factors such as diet, detergents, medication or infections around you.
A similarly small-spotted rash can occur, for example, with an allergy to an antibiotic or so-called infectious mononucleosis (Pfeiffer's glandular fever).

The rash in ringlet rubella begins on the face with a garland-shaped spread to the trunk and extremities.
Measles, rubella, three-day fever or other viral rashes are also typical childhood diseases with rashes.

Have you recently taken or are currently taking antibiotics and not sure if this is where your rash could be? Find out more through our article:

  • Rash after taking antibiotics

to cough

Coughing is one of the typical symptoms of scarlet fever.
The infection and swelling of the tonsils can quickly constrict the upper airways.

Difficulty swallowing is also a common problem with scarlet fever.
In the early stages, the cough often comes with other specific symptoms, such as headache and vomiting.

Against the cough, simple remedies such as sufficient amounts of water to drink, lozenges or inhalations can be tried out.
If difficulty swallowing and coughing up become a growing problem, cortisone can help against severely swollen tonsils.

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  • Home remedies for coughs


In some cases, the rash also causes severe itching, which patients then find very annoying.
Since the skin becomes flaky over a few weeks, the rash can always be treated with moisturizing creams that do not contain any fragrances.
Because these irritate the skin additionally.

If there is itching, you can apply Fenistil cream or Imiquimod cream to the affected areas of the skin, for example.
Care should be taken to prevent scars from scratching too hard.

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  • Fenistil gel


Another unspecific symptom of scarlet fever is diarrhea, often combined with nausea and vomiting.
Here you should ensure sufficient fluid intake with water, unsweetened tea and, if necessary, electrolyte solutions.

Some people also respond to the antibiotic that combats the bacteria that causes scarlet fever with diarrhea.
This does not initially mean that there is an allergy to the drug and that it should no longer be taken.
However, it is advisable to discuss this with the attending physician and to use a different antibiotic if you have further symptoms.

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  • Home remedies for diarrhea


Since scarlet fever in adults often does not proceed as it does in the textbook, but the symptoms are weaker, if not even not at all, the diagnosis is very difficult to make in some cases.
If the classic symptoms that often accompany the clinical picture cannot be found, the diagnosis can still be made by detecting the pathogen, for example in the throat.

If it is the streptococcal bacterium, antibiotic therapy should be started immediately, with penicillin as the agent of choice.
Most often the drug is given for 7 days.
Antibiotic treatment can also reduce the time a patient is contagious.
It also reduces the length of time that symptoms appear.

It also prevents long-term effects and complications, which is why antibiosis should be given urgently for scarlet fever.

Antipyretic drugs such as paracetamol, ibuprofen or aspirin can be taken to treat the fever.

The administration of nasal drops also has a relieving effect and obstructs the swollen tonsils in the throat and makes swallowing and breathing difficult, so cortisone can be given to reduce swelling.

For more detailed information on this topic, also read our article:

  • Treatment of scarlet fever


Antibiotics such as penicillin or erythromycin for a penicillin allergy are essential for the treatment of scarlet fever, as this is the only way to avoid long-term effects and complications.

With the reliable detection of the disease by an experienced doctor or detection of the pathogen in a patient sample, viral tonsillitis can be excluded with a high degree of probability.
Antibiotics only help with bacterial infections and should not be given if a virus causes the disease, as it will not work and only promote side effects or the development of antibiotic resistance.

Home remedies

There are also some home remedies and simple methods that can be used to relieve symptoms of scarlet fever.
It is important that the patient ensures that they are drinking enough fluids.

Warm tea, lollipops, hot water with lemon juice and honey, inhalations with table salt, calf wraps for the fever or quark wraps for the sore throat can be used as home remedies.

However, this does not mean that antibiotic therapy can be dispensed with - it is not only the course of the disease itself that is shortened by an antibiotic.
More importantly, it prevents serious complications from the disease.

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  • Complications of scarlet fever


After infection with the scarlet fever-causing streptococcus, the disease breaks out after an incubation period of 2-4 days.
Fever, headache, malaise and the white strawberry tongue can occur.

After another 48 hours, other symptoms can appear, such as the rash on the trunk, head, extremities, cheeks and palate.
The rash can last for up to a week, and the flaky peeling of the skin can continue to spread for weeks to months.

This can then lead to a post-streptococcal infection.

Read more detailed information on this topic at:

  • That's how long scarlet fever lasts

What can the long-term consequences be?

The dreaded sequelae of scarlet fever is the so-called post-streptococcal infection.

To prevent this, antibiotic therapy is essential.
In adults, scarlet fever is easily overlooked due to its often milder course and is therefore not tackled with antibiotics.

The scarlet fever-causing bacterium streptococcus triggers an independent response of the human immune system, which causes damage to individual organs. On the one hand, the germ causes a cross-reaction of antibodies that the body forms against the antigens of the streptococcus. Since the antigens of the germ are very similar to the cells in the heart and nerves, the self-generated antibodies attack these cells and trigger an infection.

This reaction of the immune system can also infect the kidneys, joints and skin.
A typical clinical picture that can occur about 2-6 weeks after the streptococcal infection is rheumatic fever.
This can lead to

  • an elevated temperature,
  • inflammation of the heart muscle,
  • Skin rash,
  • Inflammation of the joints or
  • Inflammation of the kidneys.

In countries that are not medically well developed, this occurs much more frequently than in Germany. Here, too, the therapy is an antibiotic that kills the offending germ.

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