A report has issued advice to doctors to tell them to use antibiotics early when people get an infection because the results can turn serious very quickly. A new report has been released looking at the infection rate of Group A streptococcal, otherwise known as scarlet fever.
The UK Health Security Agency (UKHSA) report said that as normal with this seasonal illness, numbers of people seeking help from their GP rose in the first three weeks of 2025. It said doctors have been given advice to treat it quickly with antibiotics.
It explained: “Given the potential for severe presentations, scarlet fever cases should be treated promptly with antibiotics to limit further spread and reduce risk of potential complications in cases and their close contacts. Clinicians should continue to be alert to the severe complications of GAS infections and maintain a high degree of clinical suspicion when assessing patients, particularly those with preceding viral infection (including chickenpox) or their close contacts.”
In a bid to stop major outbreaks of the illness which can be fatal national guidance on the management of scarlet fever explains that the UKHSA need to be notified quickly along with Health Protection Teams (HPTs). Then the health services need to collection of throat swabs prior to commencing antibiotics ‘when there is uncertainty about the diagnosis and exclusion of cases from school and work until 24 hours of antibiotic treatment has been received.’
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 your neck). A rash appears 12 to 48 hours later. It looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes your skin feel rough, like sandpaper.
A white coating also appears on the tongue. This peels, leaving the tongue red, swollen and covered in little bumps, called ‘strawberry tongue’. The NHS says scarlet fever can be a serious illness, but thanks to antibiotics, it’s less common than it used to be and easier to treat.
But cases of scarlet fever have increased in recent years. Complications from scarlet fever are rare. They can happen during or in the weeks after the infection, and can include:
- ear infection
- throat abscess
- sinusitis
- pneumonia
- meningitis
- rheumatic fever
The UKHSA said so far this season, the highest notification rates were in London and the North East (2.3 per 100,000 population), followed by Yorkshire and the Humber (1.9), and the West Midlands (1.7). Worryingly the dominant strain this year is the emm 49.8 gene style which is resistant to certain types of antibiotics.
The report said: “Early investigations show that emm 49.8 isolates have a higher frequency of resistance to tetracycline and erythromycin [types of antibiotics].” The UKHSA said: “Detailed genomic and biological investigations are under way to investigate this emergence.”
It added: “Prompt treatment of scarlet fever with antibiotics is recommended to reduce risk of possible complications and limit onward transmission. GPs and other frontline clinical staff are also reminded of the increased risk of invasive disease among household contacts of scarlet fever cases . Clinicians should continue to maintain a high index of suspicion in relevant patients for invasive disease as early recognition facilitates prompt initiation of specific and supportive therapy for patients with iGAS infection.”
For more information from the NHS on Scarlet Fever click here.