Strep throat vs. sore throat causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources
Strep throat and sore throat are two specific types of pharyngitis. Pharyngitis is a term used to describe inflammation of the pharynx in the back of the throat. Pharyngitis is considered an upper respiratory infection (URI). Strep throat and sore throat are differentiated by their route cause which can be determined by a throat culture. There are symptoms common between the two types of pharyngitis including pain, swelling, and irritation. There are also some really important differences that determine how each can be successfully treated. We will discuss the differences between the two conditions including their causes, symptomatology, and impact.
Causes
Strep throat
Strep throat gets its name from the class of bacteria that causes it, Group A streptococci (GAS) or streptococcus pyogenes (S. pyogenes). Streptococcal pharyngitis is most commonly spread by person-to-person transmission through contact with an infected person’s saliva or nasal secretions. It is possible, but rare, for it to spread by contaminated food. For most, the time from exposure to the first symptom is two to five days.
Sore throat
A sore throat is a type of acute pharyngitis typically caused by viral infections like those that cause the common cold and flu. Sore throats are not a bacterial infection. There are other potential causes of sore throats. A sore throat can also result from allergies or exposure to pollutants such as smoke. Transmission likelihood depends on the source. Viruses are typically spread with person-to-person contact or sometimes airborne transmission, increasing the chance you could develop a sore throat. Sore throats caused by allergies are not contagious.
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Prevalence
Strep throat
The Centers for Disease Control and Prevention (CDC) estimates that several million cases of non-invasive group A strep infections, like strep throat, occur each year. GAS is the most common bacterial cause of pharyngitis in children and adolescents. The rates of infection are highest in winter and early spring. Infection is more likely in school-age children (5 to 15 years of age) who attend crowded schools and daycares. Of all episodes of pharyngitis, GAS is responsible for 15%-30% of the cases in children, and 5%-15% of cases in adults.
Sore throat
Sore throat incidence is harder to track as it can be caused by many things and may not be diagnosed by any lab or reported to any health officials. Sore throat is pharyngitis caused by viral or other irritations. The majority of pharyngitis cases fall under the term “sore throat.”
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Symptoms
Strep throat
There are some key characteristics that make it possible to distinguish strep throat from sore throat. Strep throat typically has a sudden onset and is accompanied by a high fever. Upon clinical exam, a healthcare provider will check to see if tonsils are red or swollen. This can cause difficulty swallowing. Typically, there will be small, white patches on the back of the throat known as exudates. Small red spots may also be visible on the palate.
Sore throat
A sore throat also makes it difficult to swallow. The throat typically feels dry or scratchy and may lead to hoarseness in the voice. The distinguishing factors for a sore throat caused by a virus or allergies tend to be a runny nose, cough, and conjunctivitis (pink eye). You will not see white spots upon examination of the pharynx and tonsils.
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Diagnosis
Strep throat
Strep throat is not responsible for the majority of acute pharyngitis cases. Before testing for strep throat, a primary care or urgent care provider will perform an examination and screen out symptoms that are specific to a strep infection. These include fever, swollen lymph nodes, and the presence of white spots on the back of the throat. If those are present, your doctor will likely test you to confirm a strep throat diagnosis.
Strep throat is diagnosed by obtaining a swab of the back of your throat to test for strep bacteria. That swab can be used in a rapid antigen test, sometimes called a rapid strep test, which provides results in minutes. Unfortunately, the rapid strep test has a significant false-negative rate. If that rapid test is negative, but symptoms are present, the swab can be sent to a laboratory for a more definitive culture test.
Sore throat
The majority of acute pharyngitis cases are sore throat, otherwise referred to as viral pharyngitis. This is a sore throat caused by common viruses such as a cold or flu. There is no lab diagnosis for sore throat. The focus is on the lack of symptoms specific to strep throat. A patient with no fever, no swollen lymph nodes, and a lack of irritation of the tonsils or pharynx will be presumed to have a sore throat. The presence of allergy symptoms and a history of smoking are also factors used in the distinction. There is no laboratory test to confirm a sore throat. However, someone with throat pain and irritation who was suspected of strep throat, but their test was negative, can be presumed to have a sore throat.
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Treatments
Strep throat
Strep throat is treated with antibiotics. Most patients will be prescribed a ten-day course of penicillin or amoxicillin. Symptoms will begin to drastically improve within 48 hours of starting therapy. Patients with a penicillin allergy may have alternatives like azithromycin or clindamycin prescribed. It is important that although treated patients will be relatively symptom-free very quickly, it is important to finish the full prescribed regimen. Antibiotic treatment decreases the duration of symptoms, reduces the likelihood of transmission to others, and prevents further complications from a streptococcal infection. For most patients, it is also acceptable to use anti-inflammatories like ibuprofen or over-the-counter pain relievers like Tylenol (acetaminophen) to further alleviate fever and discomfort. Throat sprays and throat lozenges may also provide temporary relief.
Sore throat
Sore throats caused by viruses, allergies, or pollutant exposure will typically resolve on their own within a week. Antibiotics are unnecessary, and even harmful, if used for sore throats. The use of antibiotics can lead to side effects as well as resistance in the future when you may need effective antibiotic therapy. There are ways to alleviate the discomfort. Gargling with saltwater, sucking on ice chips or popsicles, drinking warm liquids, and getting plenty of fluids are good home remedies and practices. Throat lozenges are helpful for older patients but dangerous for young children. Your healthcare provider may make other suggestions as well, such as cough remedies, if they are appropriate.
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Risk factors
Strep throat
The most common risk factor for strep throat is contact with another infected person. Strep throat can occur in people of any age but is most common in children 5 through 15 years of age. It is rare in children younger than 3. Crowding, such as in schools and daycares, increases the risk of the spread of streptococcus bacteria. Adults can get strep throat and spread it. Parents of school-age children, those in frequent contact with children, and adults who live in crowded spaces like dorms or military barracks, are at the highest risk.
Sore throat
Risk factors for sore throats caused by a viral source are similar to that of strep throat. Viruses can be airborne or spread by contact, therefore school-age children and anyone working or residing in crowded spaces may be at an increased risk. Seasonal allergies which are not treated or inadequately treated increase the risk for sore throat. Smoking or other activities which expose you to airborne pollutants increase your risk for sore throat.
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Prevention
Strep throat
Two of the most effective ways to prevent the spread of strep throat are good handwashing and covering a cough or sneeze. Once diagnosed, an infected person should stay home from work, school, or other activities outside the house until they have been on antibiotics for at least 12 hours and have no fever.
Sore throat
To avoid a sore throat, you must avoid the cause. Good handwashing and covering a cough or sneeze will reduce the transmission of common viruses such as flu or colds. Allergy symptoms like rhinitis and post-nasal drip can lead to a sore throat as well. Treating allergy symptoms effectively lessens the chance of a sore throat. This can include antihistamines, decongestants, and nasal sprays. Avoiding irritants such as cigarette smoke also prevents the irritation they can cause which leads to a sore throat.
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When to see a doctor for strep throat or sore throat
You should seek medical attention if you have any distinguishing symptoms of strep throat such as fever or swollen lymph nodes. Other symptoms that may develop and require immediate medical attention include difficulty breathing or swallowing, blood in phlegm or saliva, dehydration, excessive drooling, and joint swelling or pain. A specific rash known as a scarlatiniform rash may develop in the presence of strep throat. This syndrome is referred to as scarlet fever or scarlatina and should be evaluated by a medical professional.
Frequently asked questions about strep throat vs. sore throat
How do you tell if you have strep or just a sore throat?
If you are experiencing fever, feel swollen lymph nodes, have white spots in the back of your throat, or have a visible rash, you should see a doctor to be evaluated for strep throat. If your sore throat symptoms have lasted longer than one week, even if other symptoms are not present, you should visit a healthcare professional for evaluation.
Is strep throat worse than sore throat?
Strep throat is a more serious concern. Untreated strep throat can lead to dangerous secondary infections and infect many other people because it is contagious. Sore throat is generally self-limiting and will not last more than a week, even if no specific interventions are done.
How does strep throat feel?
Strep throat will have a very sudden onset of a very painful throat. It is typically accompanied by fever, nausea and vomiting, and abdominal pain.
How do I know if my sore throat is viral or bacterial?
A viral sore throat is typically accompanied by a cough and runny nose, but no fever or swollen lymph nodes. Bacterial sore throats, like strep throat, do typically have a fever, swollen nodes, and do not resolve on their own after a few days.
How long is strep contagious?
Strep throat typically has an incubation period of two to five days. Strep is considered contagious until you have been on antibiotics for at least 12 hours and are free of fever.
Can strep throat clear on its own?
Symptoms can resolve on their own eventually, however, untreated strep throat leaves a person at increased risk of severe complications such as acute rheumatic fever, peritonsillar abscess, and mastoiditis.
Resources
- Streptococcal Pharyngitis, StatPearls
- Group A Streptococcal (GAS) Disease, Centers for Disease Control and Prevention (CDC)
