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Is It a Sore Throat or Strep Throat? How to Tell the Difference

Even if you don’t have strep, there are reasons to see a doctor


spinner image Close up of woman touching the sides of her throat with both hands and a red circle behind it to signify pain or discomfort
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A single swallow feels as though a thousand tiny daggers are stabbing the inside of your neck. No doubt you have a sore throat. But is it strep?

While the most common cause of a sore throat is a virus — including the viruses that cause the common cold and flu — other triggers, including allergies, postnasal drip and environmental irritants can cause the throat to be sore. So can a bacteria group known as A Streptococcus, or group A strep, which is to blame for strep throat, a highly contagious illness that is most common in the winter and spring seasons.

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What are the symptoms of strep throat?

“There isn't any single symptom that you hang your hat on to rule in or rule out strep,” says John Mafi, M.D., a primary care physician and associate professor of medicine in the Division of General Internal Medicine and Health Services Research at University of California, Los Angeles.

Rather, it’s a combination of symptoms that can help you spot strep throat; but just know that a simple swab of the throat at the doctor’s office is the only way to confirm it.

According to the Centers for Disease Control and Prevention (CDC), people who have strep also tend to experience:

  • Fever
  • Red and swollen tonsils
  • White patches or streaks of pus on the tonsils
  • A sore throat that started quickly and may appear red

Also common with strep throat is tender and swollen lymph nodes, says Viviana S. Martinez-Bianchi, M.D., a family medicine physician at Duke Health. And some people, especially kids and teenagers, will get “a little rash that is red and feels like sandpaper,” she says. When strep throat is accompanied by a rash, which often starts on the neck, underarm and groin before spreading over the body, it's referred to as scarlet fever. Sometimes people with strep can get a headache or experience nausea or vomiting.  

On the other hand, a cough, runny nose, pink eye and a raspy or hoarse voice are all signs that your sore throat stems from a viral infection and is not strep, the CDC says. “When we start seeing all of those other symptoms, we're thinking it's more likely to be a virus than bacteria,” Martinez-Bianchi says.

Can older adults get strep?  

While strep is often associated with school-age children, adults are not immune to the painful and contagious illness. About 1 in 10 adults with a sore throat has strep throat, the CDC says.

“A lot of people think, ‘Oh, I'm an older adult; I don’t have it, I had it as a kid.’ But it's not one of those things that if you had it once you're not going to get it again,” Martinez-Bianchi says. So if you were around someone with strep throat and go on to develop symptoms, get tested for it.

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Strep spreads very easily and in the same way that many illnesses do: through respiratory droplets — from coughs and sneezes, for example — and direct contact with an infected person.

Because strep is caused by a bacterial infection, it’s treated with antibiotics. If left untreated, the infection can lead to complications, including kidney inflammation, a bloodstream infection and rheumatic fever, a serious condition that can damage the heart.

Mafi says while older adults aren’t necessarily more susceptible to serious illness from strep throat, it’s important to remember that “the older you are, the more likely that any infection can lead to complications.”

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When to see a doctor

If you think you have strep, you should see a doctor to get tested and treated. Results from a rapid test are available in minutes. However, even if you think your sore throat is not due to strep, there are instances that warrant a doctor’s visit.

For example, the viruses that cause COVID-19 and flu can cause a sore throat, so if you suspect you have one of these illnesses, call your health care provider. There are prescription antiviral treatments for both flu and COVID-19, and these medicines can reduce the risk of serious symptoms that can be especially dangerous for older adults and that can lead to other complications like pneumonia.  

The take-home message, Mafi says, is “if you're older, you have chronic comorbidities, you're vulnerable for different reasons, then you should be more vigilant.”

Another warning sign that you need medical attention is if you’re having so much pain and trouble swallowing that you’re drooling; this could be a sign of an abscess, Martinez-Bianchi says. Worsening symptoms, a high fever, difficulty breathing, chest pain and blood in the saliva or mucus are other signs that you should see a doctor. 

Relieving sore throat symptoms

If it’s a virus causing your sore throat, antibiotics won’t help and can, in fact, cause additional health issues, including diarrhea or rash, Mafi says. But several other remedies may bring relief, the CDC says, including:

  • Ice chips, popsicles, or lozenges
  • Gargling with salt water
  • Drinking plenty of fluids
  • Over-the-counter pain relievers, though you should always check with your doctor first to discuss any side effects or potential drug interactions.
  • Rest. “You really need to take at least a day or two to really let your body rest and recover,” Mafi says.

And don’t forget about honey. A large review of studies published in the journal BMJ Evidence-Based Medicine found that honey is more effective than over-the-counter medications for cough and cold symptoms, including sore throat. “So I actually advise my patients to take honey,” Mafi says, though it’s not recommended for people who are immunosuppressed or for infants. “But, in general, it's very safe and it is effective.”

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