A sore throat describes the pain and irritation accompanying inflammation in the throat, most often caused by a viral infection like the common cold or flu. This type of pharyngitis typically resolves on its own. Strep throat, however, is a specific bacterial infection caused by Group A Streptococcus (GAS). Differentiating between the two is important because untreated strep can lead to serious health complications, making antibiotic treatment necessary.
Key Symptom Differences
The primary difference between a common viral sore throat and strep throat lies in the presence of other upper respiratory symptoms. A viral sore throat develops gradually and is accompanied by common cold symptoms, such as a cough, runny nose, hoarseness, or congestion. These symptoms suggest the body is reacting to a virus affecting multiple parts of the respiratory tract.
Strep throat is characterized by a sudden onset of severe throat pain, and it is notable for the absence of coughing and sneezing. The pain often makes swallowing difficult and is accompanied by a fever of 101°F (38.3°C) or higher. The lymph nodes in the neck may become noticeably swollen and tender, reflecting the body’s localized immune response.
When examining the throat, the tonsils of a person with strep throat often appear bright red and swollen. A visual cue is the presence of white patches or streaks of pus, known as exudates, on the tonsils or the back of the throat. Another sign is the appearance of tiny, pinpoint red spots on the soft palate, medically referred to as petechiae.
The bacterial infection can also trigger other systemic responses. Children, in particular, may experience a headache, stomach ache, and sometimes vomiting alongside the throat pain. These gastrointestinal symptoms are less common in adults. While a viral infection might cause general body aches, the combination of sudden, severe throat pain with high fever and the lack of cold symptoms suggests a Group A strep infection.
Guidelines for Seeking Medical Testing
Since symptoms alone are not definitive for confirming strep, a medical consultation is necessary for an accurate diagnosis. Testing is advised when the sore throat has a sudden onset and is not accompanied by typical cold symptoms like a cough or runny nose. If the sore throat is severe, causes difficulty swallowing, or lasts for more than 48 hours without improvement, a doctor’s visit is warranted.
A high fever of 101°F or greater is another indication to seek medical testing. The appearance of a rough, red rash, known as scarlet fever, is also caused by Group A strep bacteria and signals the need for prompt treatment. Furthermore, if there has been recent close contact with someone who has a confirmed case of strep throat, testing is recommended even if symptoms are mild.
Age is a consideration, as strep throat is most prevalent in school-aged children between 5 and 15 years old. While adults can get strep, testing is approached differently in children due to their higher risk of developing complications from an untreated infection. Healthcare providers may use a clinical scoring system to determine the likelihood of strep and guide the decision on testing. The most accurate diagnosis requires testing, as even white patches on the tonsils can be caused by a different virus.
The Diagnostic and Treatment Process
Once a healthcare provider suspects strep throat, they perform a throat swab to collect a sample from the back of the throat and tonsils. This sample is used for two primary diagnostic methods. The first is the rapid strep test, which detects the presence of Group A Streptococcus antigens within 5 to 20 minutes.
If the rapid test is positive, the diagnosis is confirmed, and treatment begins immediately. If the rapid test is negative but the provider suspects strep—especially in children—a throat culture may be sent to a laboratory. This method involves culturing the swab sample to see if the bacteria grow; this is more accurate but takes 24 to 48 hours for results.
If the strep test is positive, an oral antibiotic, such as penicillin or amoxicillin, is prescribed. Starting antibiotics within 48 hours of symptom onset reduces the duration and severity of the illness. It is very important to complete the entire 10-day course of antibiotics, even if symptoms improve quickly, to ensure all bacteria are eliminated.
Failing to complete the full course of treatment increases the risk of the infection returning and prevents serious complications like rheumatic fever, which can damage the heart, or kidney disease. For a sore throat confirmed to be viral, antibiotics are not effective, and treatment focuses on managing symptoms with rest, fluids, and over-the-counter pain relievers. A person with strep throat is no longer contagious after being on antibiotics for at least 24 hours and is without a fever.