A sore throat is common, but determining the cause is important since most cases are viral, while others are caused by the bacteria Group A Streptococcus (GAS), leading to strep throat. Differentiating between viral pharyngitis and a bacterial strep infection is necessary because the treatment approach changes drastically. While a viral sore throat resolves on its own, strep throat requires specific antibiotics to prevent serious health complications. Knowing the distinguishing signs helps guide appropriate care.
The Key Differences in Symptoms
A hallmark of strep throat is the sudden onset of symptoms, often beginning with a rapidly developing and painful throat. This intense pain is accompanied by difficulty swallowing (odynophagia), which can make eating and drinking uncomfortable. The throat may reveal visibly red and swollen tonsils, sometimes displaying white patches, streaks of pus, or tiny red spots (petechiae) on the palate.
Strep throat commonly causes a fever of 100.4°F (38°C) or higher, and tender, swollen lymph nodes in the neck. These nodes become enlarged as the immune system responds to the bacterial infection. Children, who are more commonly affected than adults, may also experience gastrointestinal symptoms like stomach pain, nausea, or vomiting.
Symptoms That Rule Out Strep
While strep throat symptoms focus on the throat, the presence of other cold-like symptoms strongly suggests a viral cause. A persistent cough is rarely a symptom of strep throat and indicates a common cold or other viral respiratory infection. Similarly, a significant runny nose (rhinorrhea) and sneezing are not associated with a bacterial strep infection.
Hoarseness or laryngitis, which involves a change in the voice, also points toward a viral cause. When these upper respiratory symptoms are present alongside a sore throat, it is much less likely that the cause is Group A Streptococcus. The sore throat is expected to be self-limiting and resolve within a few days, as antibiotics are ineffective against viruses.
Medical Diagnosis and Treatment
If you suspect strep throat based on severe symptoms, a medical evaluation is necessary to confirm the diagnosis. A healthcare provider will perform a physical exam and order a throat swab to test for Group A Streptococcus bacteria. Diagnostic tools include the rapid antigen detection test (RADT), which provides results in minutes, and the throat culture, which is more accurate but takes up to two days.
If the test confirms a strep infection, treatment involves a 10-day course of antibiotics, such as penicillin or amoxicillin. It is imperative to complete the full course, even if symptoms improve quickly, to ensure all bacteria are eliminated. Stopping antibiotics early can lead to the infection recurring and increases the risk of developing non-suppurative complications.
These complications, though rare, can be severe. They include rheumatic fever, which causes permanent damage to heart valves, or post-streptococcal glomerulonephritis, a condition affecting the kidneys. Beginning treatment within 48 hours of symptom onset reduces the illness’s duration and severity, limits the infection’s spread, and helps prevent these long-term health risks. Patients are typically no longer contagious after being on antibiotics for a full 24 hours and having no fever.