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Strep Throat or Just a Sore Throat? How to Tell the Difference

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  • By Covenant Health
  • Medically Reviewed by Justin McGoldrick, MD
  • 9 minute read.
  • Last Updated: 12/30/2024

Sore, scratchy throats often accompany winter weather as colder temperatures drive everyone indoors. A sore throat can result from a cold or irritation, but it can also indicate a more serious case of strep throat. Knowing how to tell the difference is important for treatment and recovery.  

A cold-related sore throat is caused by a virus. Treatment typically involves managing symptoms while waiting for the illness to run its course. Strep throat, on the other hand, is bacterial and usually requires antibiotics for treatment. This article describes common causes and symptoms of sore throats, helping you decide when to see a doctor and when medicine may be needed.

What Causes a Sore Throat? 

A sore throat, also called pharyngitis, is caused by inflammation and swelling in the tissues around the throat. Sore throat from a virus, or viral pharyngitis, is the most common form of sore throat. It stems from illnesses like the common cold, flu, and RSV. For at least half of people with a cold, sore throat s the first symptom signaling onset of an illness.

Other common causes of sore throat include allergies, dry air, mouth breathing, straining from shouting, irritants like smoke or spicy food/hot drinks, reflux disease (heartburn), abscess, and rarely, benign or cancerous growths.

Tonsillitis is an inflammation or infection of the tonsils caused by viral or bacterial infection.

Mononucleosis (mono) is a different viral infection caused by the Epstein-Barr virus. Typical symptoms include fatigue and swollen lymph glands, along with a sore throat.

Strep throat is a bacterial infection caused by group A Streptococcus bacteria (Strep pharyngitis). It is more common among children. The infection accounts for 30 percent of sore throats in children and 5-15 percent of sore throats in adults. According to the CDC, strep throat causes about 5.2 million outpatient visits per year and 2.8 million antibiotic prescriptions annually among non-Medicare-age patients. 

Sore Throat vs. Strep Throat 

Because symptoms often overlap, differentiating between sore and strep throat can be challenging. But there are distinguishing factors. “Strep can present in a variety of ways. The most common symptoms with strep are fever, sore throat, and fatigue,” said Justin McGoldrick, MD, Medical Affairs and Graduate Medical Education Officer for Covenant Health. “But you may also have a headache, stomachache, or swollen glands in your neck.”

Sore Throat Symptoms 

Viral sore throats are typically accompanied by common cold symptoms such as:

  • Runny nose
  • Red or watery eyes
  • Sneezing
  • Hoarse, raspy voice
  • Cough

“The presence of a cough can help distinguish between sore throat and strep throat. Coughing does not typically accompany strep,” Dr. McGoldrick said.

Strep Throat Symptoms 

Strep throat symptoms tend to be more severe, often with sudden onset. Symptoms may include:

  • Sudden sore throat
  • Red and swollen tonsils with white spots
  • Pain when swallowing
  • Fever (101 degrees or higher)
  • Swollen neck glands
  • Loss of appetite
  • Headache
  • Abdominal pain

Sore Throat vs. Tonsillitis 

Tonsillitis is a painful inflammation or infection of the tonsils and throat. Strep throat is a type of tonsillitis, but it’s possible to have tonsillitis without having strep. Tonsillitis is usually caused by viruses such as flu, coronavirus, or adenovirus; but in 15-30 percent of cases, it results from a bacterial infection like strep.

“A common misconception is that you can’t have strep throat if you don’t have tonsils. Unfortunately, even when your tonsils are removed, it’s still possible to contract the infection in different areas of your throat,” said Dr. McGoldrick.

Tonsillitis symptoms may include:

  • Swollen and red tonsils
  • Difficulty swallowing
  • Fatigue
  • Swollen and painful lymph nodes in the neck
  • Fever
  • Headache
  • Loss of appetite
  • Bad breath

Comparison of Sore Throat Symptoms

SymptomsSore Throat (Viral)Strep ThroatTonsillitisMononucleosis
Congestion/runny noseX   
Hoarse/raspy voiceX   
Difficulty swallowingXXXX
Sudden onset of sore throat X  
Mild feverXXXX
Fever > 101 degrees X X
Swollen lymph nodes XXX
Rash on neck X X
Symptoms for 48+ hours X X
Fatigue   X
Headache XX 
Stomach pain X  
Bad breath XX 

How are Sore Throats Diagnosed? 

If you seek medical care with a sore throat, your provider will perform a visual exam and consider a rapid strep test to diagnose your illness. Examining your throat helps your doctor determine the type of illness based on appearance. For example, someone with a viral sore throat usually does not have white patches or pus in the back of the throat as they would with strep.

If you have recently been exposed to someone with strep, tell your medical provider. If strep is suspected, your doctor can perform a rapid test in the office by using a throat swab to check for the presence of strep bacteria. If the test is positive, you can immediately start antibiotics to treat the infection. 

“If the rapid test is negative but you still have strong signs of strep, we may do another throat swab and send it to the lab for a culture,” said Dr. McGoldrick. “Results from the lab are typically returned within a day or two. If concern for mono exists, your provider may perform a simple blood test for mononucleosis.” 

While some at-home tests are available, they are not typically recommended. They may give a false negative that could delay the start of treatment.

 Throat Conditions Throat Appearance
Healthy ThroatPink, moist and shiny tissue on either side of back of throat (tonsils)
Sore Throat (Viral)Redness or mild swelling
Strep ThroatSwollen, very red tonsils

White patchy areas on tonsils or back of throat

Throat may be red with moderate swelling; may be tiny red spots in mouth
TonsillitisRed, swollen tonsils

May be a yellow or white coating over tonsils
MononucleosisRedness in throat; may be tiny red spots on roof of mouth

Swollen tonsils

Sore Throat Treatment 

Regardless of the cause of your sore throat, you can take steps to ease discomfort and speed your recovery. Colds do not respond to antibiotics but typically go away on their own within 5-7 days. Strep, however, usually doesn’t go away on its own. Because strep can lead to other infections if left untreated, it’s important to see your primary care or other provider for testing and treatment.

Antibiotics such as penicillin and amoxicillin kill the bacteria causing strep infection. While treatment can take up to 10 days, antibiotics usually relieve symptoms within a day or two.

“Stay home for at least 24 hours after starting the antibiotic and after your fever resolves to prevent spreading the illness. Even when you feel better, be sure to finish your medication to prevent reinfection. If your symptoms continue to worsen or don’t improve, see your primary care or other provider for re-evaluation,” said McGoldrick.

In severe cases or if you can’t breathe, your doctor may prescribe a steroid to decrease inflammation. If infections occur repeatedly or interfere with sleeping or breathing, your provider may recommend removing your tonsils surgically.

Natural Remedies for Sore Throat 

If your sore throat is cold-related, natural remedies can go a long way in relieving your symptoms. These methods can alleviate discomfort and potentially accelerate your recovery:.

Wman resting on sofa; cold medicines, lemon, drinking glass and teapot are close by
  • Drink plenty of fluids, alternating between warm and cold liquids to see what soothes your throat best. Warm liquid ideas are chicken soup, mild tea, or hot water with a teaspoon of honey. Cold liquids could include ice chips, popsicles, and ice cream. Avoid crunchy or spicy foods, as they may irritate your throat.
  • Reduce swelling and irritation in your throat by gargling with warm salt water. Dissolve ½ teaspoon salt or baking soda in a glass of warm water and gargle, but don’t swallow. Repeat every three hours.
  • Steam from a hot shower can help loosen mucus and moisturize your throat. You can also use a cool mist humidifier to increase humidity and ease throat discomfort.
  • Over-the-counter cold medicines can help relieve cough and congestion. Throat sprays and lozenges can also soothe sore throats.
  • Get plenty of rest. If lying flat worsens your symptoms, try elevating your head or sitting propped up to relieve swelling and pressure in your throat.

How to Prevent a Sore Throat 

The best way to prevent a sore throat is by avoiding exposure to colds and other illnesses. Strep is highly contagious and can be easily spread by sharing personal items or having close contact with someone who’s infected. Because strep has a 2-5-day incubation period, you can pass it to someone before you start experiencing symptoms.

Dark-haired man washing hands to prevent illnesses like sore throat

Protect yourself and your loved ones by making these precautions part of your daily routine:

  • Wash your hands often.
  • Cover your coughs and sneezes.
  • Maintain physical distance with those who are infected.
  • Avoid touching or rubbing eyes, nose, or mouth.
  • Open windows or use a purifier to clean indoor air.
  • Clean and disinfect surfaces like countertops, handrails, and doorknobs.
  • Replace your toothbrush after being sick.
  • Get sufficient sleep, eat a well-balanced diet, and stay hydrated.

When to Contact Your Doctor  

Because infections can worsen if left untreated, it’s important to see your primary care or other doctor if you suspect strep or another serious illness. Consult a medical provider if your sore throat is severe or lasts longer than 48 hours. If you need immediate care, contact Covenant Health’s Virtual Urgent Care or go to the nearest emergency department.

Contact your doctor if you have any of the following symptoms:

  • Trouble swallowing or breathing
  • Coughing up blood
  • Enlarged lymph nodes
  • White patches or swelling in the tonsil area at the back of your throat
  • High fever (higher than 101.5 for two days or longer) or rash
  • No voice for more than a week

Covenant Health has medical providers who can evaluate and treat your symptoms. Visit our website to find a physician near you.

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About the Author

Covenant Health

Headquartered in Knoxville, Tennessee, Covenant Health is a not-for-profit, community-owned, healthcare enterprise committed to providing the right care at the right time and place. Covenant Health is the area’s largest employer and has more than 11,000 compassionate caregivers, expert clinicians, and dedicated employees and volunteers.