When an eight-year-old boy told his mother he had thrown up, she braced for another bout of stomach flu. Just months earlier, a similar virus had swept through their home. Yet, this time was different. The child seemed otherwise fine, leading his mom to suspect simple acid reflux from too many oranges. The vomiting, however, returned the next night, and the night after that, prompting a visit to urgent care. The diagnosis was a surprise: strep throat.
An Atypical Strep Season in Canada
This personal story reflects a broader trend observed by pediatricians across Canada this winter. While strep throat, caused by Group A Streptococcus bacteria, traditionally presents with a rapid-onset sore throat, fever, and painful swallowing, this season's strain is frequently causing prominent gastrointestinal (GI) issues. Symptoms like nausea, vomiting, stomach pain, and diarrhea are appearing, sometimes even overshadowing the classic sore throat.
Dr. Zachary Hoy, a board-certified pediatric infectious disease specialist, confirmed the pattern. "The strain of strep that has been seen this winter season seems to have more associated GI symptoms with it than the typical strain," he stated. He noted that classic cases with severe sore throat and fever are still circulating, but the GI-presenting cases are notable.
The seasonal nature of strep plays a role in its spread. Dr. Monica Abdelnour, a pediatric infectious disease specialist at Phoenix Children’s, explained that while infections can happen year-round, they peak in late winter and early spring. "Strep throat spreads through close contact with respiratory droplets from someone who is infected," she said. "This helps explain why cases increase in winter when people spend more time indoors and children are in close contact at school."
Why Is Strep Causing Stomach Upset?
The connection between a throat infection and vomiting may seem puzzling. Dr. Hoy offered two possible explanations based on observations of past strains. First, typical strep can cause abdominal pain due to swollen lymph nodes in the abdomen, a condition called mesenteric adenitis. Second, the current strep strain may produce toxins that trigger more pronounced GI symptoms.
It is crucial to note, as Dr. Hoy emphasized, that these are clinical speculations and have not been formally documented or proven for this specific winter's outbreak. The medical community is observing these symptoms but continues to rely on testing for definitive diagnosis.
Children are both the most common carriers and can exhibit the most varied symptoms. "Strep throat can affect people of all ages but is most common among school-aged children and adolescents, particularly between the ages of 5 and 15," Dr. Abdelnour said. She added that kids may present with stomach pain, vomiting, and nausea alongside, or even instead of, the classic signs.
Diagnosis, Treatment, and Why Testing Is Critical
Given the overlap of symptoms with other circulating viruses—like influenza, RSV, COVID-19, and norovirus—professional evaluation is essential. Doctors stress that not every sore throat is strep, and not every case of vomiting is a stomach bug.
Key symptoms that should prompt consideration of a strep test include:
- Sore throat or pain with swallowing
- Fever
- Red and swollen tonsils, sometimes with white patches
- Swollen lymph nodes in the neck
- Little to no cough
"When there are uncommon presentations of common diseases such as strep with increased GI symptoms, it highlights the importance of being evaluated by your child’s pediatrician and rapid testing," Dr. Hoy advised. Most clinics can perform rapid tests for strep, flu, RSV, and COVID-19 to guide appropriate treatment.
If strep is confirmed, the standard treatment is a 10-day course of antibiotics, such as amoxicillin or penicillin. Completing the full course is vital to shorten the illness, prevent spread, and avert rare but serious complications like acute rheumatic fever, which can affect the heart. Dr. Abdelnour also noted that skin infections like impetigo or scarlet fever can stem from strep, particularly in children.
Antibiotics should only be used when necessary. A negative strep test means antibiotics are not needed and could cause adverse effects like rashes. In the case of the eight-year-old boy, starting antibiotics promptly resolved his mysterious vomiting episodes, confirming the strep infection.
To curb the spread, experts recommend good hand hygiene and considering masks in crowded indoor settings. Children diagnosed with strep should stay home from school or daycare until at least 12-48 hours after starting antibiotics and showing no fever.
The takeaway for Canadian parents this season is clear: unexplained or persistent gastrointestinal symptoms in children, especially when combined with any hint of a sore throat, warrant a doctor's visit for a proper diagnosis. What looks like a stomach bug may, in fact, be strep throat in disguise.
