Streptococcal pharyngitis, also known as strep throat, is an infection of the back of the throat including the tonsils caused by group A streptococcus (GAS). Common symptoms include fever, sore throat, red tonsils, and enlarged lymph nodes in the neck. A headache, and nausea or vomiting may also occur. Some develop a sandpaper-like rash which is known as scarlet fever. Symptoms typically begin one to three days after exposure and last seven to ten days. Strep throat is spread by respiratory droplets from an infected person. It may be spread directly or by touching something that has droplets on it and then touching the mouth, nose, or eyes. Some people may carry the bacteria without symptoms. It may also be spread by skin infected with group A strep. The diagnosis is made based on the results of a rapid antigen detection test or throat culture in those who have symptoms. Prevention is by washing hands and not sharing eating utensils. There is no vaccine for the disease. Treatment with antibiotics is only recommended in those with a confirmed diagnosis. Those infected should stay away from other people for at least 24 hours after starting treatment. Pain can be treated with paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. Strep throat is a common bacterial infection in children. It is the cause of 15–40% of sore throats among children and 5–15% among adults. Cases are more common in late winter and early spring. Potential complications include rheumatic fever and peritonsillar abscess. The typical signs and symptoms of streptococcal pharyngitis are a sore throat, fever of greater than 38 °C (100 °F), tonsillar exudates (pus on the tonsils), and large cervical lymph nodes. Other symptoms include: headache, nausea and vomiting, abdominal pain, muscle pain, or a scarlatiniform rash or palatal petechiae, the latter being an uncommon but highly specific finding. Symptoms typically begin one to three days after exposure and last seven to ten days. Strep throat is unlikely when any of the symptoms of red eyes, hoarseness, runny nose, or mouth ulcers are present. It is also unlikely when there is no fever.