A sore throat is a broad term for pain or irritation, often caused by inflammation of the pharynx (pharyngitis). Most sore throats result from viral infections, such as the common cold or flu. Strep throat is a specific bacterial infection caused by Streptococcus pyogenes (Group A Streptococcus or GAS). Differentiating them is important because viral sore throats typically resolve on their own, but strep throat requires medical treatment to prevent serious complications.
Key Differences in Symptoms
Strep Throat Symptoms
Strep throat symptoms often present with a sudden, intense onset, causing severe throat pain and difficulty swallowing. A fever is common, usually reaching 101°F (38.3°C) or higher. Physical signs may include tiny red spots (petechiae) on the roof of the mouth, or white patches and streaks of pus on the tonsils. Swollen, tender lymph nodes in the neck are also frequent findings.
Viral Sore Throat Symptoms
In contrast, a sore throat caused by a virus usually begins gradually and is often accompanied by classic upper respiratory symptoms. These symptoms include coughing, congestion, a runny nose, hoarseness, and sometimes conjunctivitis (pink eye). Unlike strep, a viral infection can cause a mild fever, but it is less common to have the sudden, high-grade fever. The presence of cold-like symptoms, particularly a cough, makes strep throat much less likely.
When to Seek Medical Attention
Most sore throats resolve within a few days, but certain symptoms require professional medical evaluation. Seek attention if you have a sore throat accompanied by a persistent fever above 101°F lasting more than 48 hours. A visit is also warranted if you observe white spots or pus on the tonsils, or if the pain severely impedes swallowing.
If symptoms do not improve after five days, a medical appointment is necessary, as this duration exceeds a typical viral course. Immediate medical attention is required for difficulty breathing, excessive drooling, or an inability to swallow liquids. These urgent signs can point to a more serious condition, such as an abscess or epiglottitis, which requires swift treatment. A rash appearing with a sore throat may also suggest scarlet fever, a complication of untreated strep infection.
Confirming the Diagnosis and Treatment Paths
Visual inspection alone is insufficient to accurately diagnose strep throat, as viral infections can mimic its appearance. Definitive diagnosis requires laboratory confirmation to identify the presence of Streptococcus pyogenes. This is typically done using a rapid antigen detection test (RADT), which involves a quick swab of the throat and tonsils and provides results within minutes.
If the rapid test is negative, especially in children, a healthcare provider may send the sample for a throat culture. The culture takes 24 to 48 hours to process but is more accurate at detecting the bacteria. These tests ensure antibiotics are only prescribed when a bacterial infection is confirmed, helping prevent the rise of antibiotic resistance.
If strep throat is diagnosed, a full 10-day course of antibiotics, such as penicillin or amoxicillin, will be prescribed. Finishing the entire prescription, even after symptoms improve, is absolutely necessary to eliminate the bacteria completely. Stopping treatment early increases the risk of the infection returning and can lead to serious complications, including rheumatic fever and kidney inflammation.
If the test is negative and the sore throat is viral, antibiotics are ineffective and will not be prescribed. Treatment for a viral sore throat is supportive, focusing on managing symptoms. This typically includes rest, staying hydrated, and using over-the-counter pain relievers like acetaminophen or ibuprofen to ease throat pain and reduce fever.