Before the classic scarlet rash appears, the initial signs of strep infection can vary. Most children and adults develop a sore throat and fever, often accompanied by red, swollen tonsils and sometimes white patches or exudate. However, it can also start with more vague symptoms such as headache, nausea or vomiting, abdominal pain, fatigue, and general body aches. Some children may appear irritable or less active before the rash shows up. Because the early symptoms can be non-specific, close monitoring in the first couple of days is important if strep infection is suspected.