Do I Have Strep? Sore Throat or Strep Throat

Battling a sore throat can be extremely uncomfortable. It can also be difficult to tell whether you’re fighting a virus or dealing with a case of strep throat. Kelsey Redmond, ARNP, and Mercy Rajesh, MD, MBBS UnityPoint Health, explain the signs and symptoms of each as well as the best treatment plan – including when you might need to make a trip to the doctor.

Strep Throat Symptoms

The CDC reports that up to 3 in 10 children with a sore throat may have strep throat. While the symptoms of strep throat and sore throat seem similar, there are noticeable differences.

"When trying to tell the difference between a sore throat and strep throat, keep in mind strep throat is not often preceded by other symptoms that go along with a sore throat,” Redmond says. “If someone has symptoms of congestion, postnasal drip and cough, and then complains of sore throat, that would indicate a possible viral infection. With strep, the sore throat is usually the first symptom."

Other signs of strep throat are fever, typically over 101, and swollen tonsils with white patches.

How can you tell strep throat from a COVID-19 sore throat? Since COVID-19 is a viral infection, it usually feels a lot like other viral sore throats, coming on gradually and resolving after a few days. Generally, sore throat is not the main symptom, nor the only symptom, if you get coronavirus.

Signs of Strep Throat in Children

Telling the difference between sore throat, strep throat and COVID-19 isn’t the only concern brought on by the pandemic. It’s also played a role in the number of strep throat cases clinics are seeing. As people stayed home, fewer infections were reported, but that’s changing as the pandemic comes to an end.

Rajesh says, “the virus isn’t following the typical pattern of a September through February peak season. Instead, cases were up by more than 30 percent in February 2023 compared to pre-pandemic years.”

In addition to a fever higher than 101 degrees and swollen tonsils, look for these other signs of strep throat in children:

• Headache
• Nausea
• Vomiting
• Swollen lymph nodes in the neck
• A swollen, bumpy tongue that looks like a strawberry (strawberry tongue)
• Small, pinpoint spots of bleeding on the palate (petechiae)

Less frequently, children can develop a faint red spotty rash (Scarlet fever) and, in rare cases, may experience abdominal pain.

“While strep throat is uncommon in children younger than three, they may present with runny nose, then later develop prolonged illness with moderate fever, irritability and poor appetite,” Rajesh explains.

Rajesh says a few people can be a carrier of strep yet have no symptoms. “Many parents come in wanting their child to be tested, because someone at daycare or in their class had strep,” she says.
“There is no need to treat for strep throat unless a child has true symptoms consistent with the infection.”

If you’re child has symptoms, and you’re concerned they may have strep throat, easily schedule an appointment with their UnityPoint Health doctor, or another provider on their care team, using the MyUnityPoint app.

Viral Sore Throat vs. Strep Throat Treatment

Based on your symptoms, if you believe you have strep throat, it’s important to be seen by a healthcare provider. Once in the clinic, you’ll likely get a throat swab. If you get confirmation of strep, your care team will prescribe an antibiotic. It’s important to take your medication as recommended.

“When we test for strep throat, we’re looking for strep A, but there are several other strep bacteria that may be contributing to your symptoms. The reason we look for strep A, specifically, is if it’s left untreated, it can cause rheumatic fever (inflammation of the heart, blood vessels and joints) or a kidney disease called post streptococcal glomerulonephritis,” Redmond says.

Strep throat is a contagious respiratory infection with an incubation period of two to five days. Kids and adults alike who’ve been diagnosed with strep throat should stay home from school or work until they’ve been on antibiotics for 24 hours, and their fever subsides without the use of medications.

Sore throats caused by viral infections still might require being seen in the clinic, depending on the severity of symptoms, while others can be managed at home with over-the-counter medications like acetaminophen, ibuprofen, throat sprays and lozenges. For children, be sure to check dosage on the label, which is based on the child’s weight. Redmond says over-the-counter items can also help treat strep throat symptoms, but they don’t treat the infection. For that, you need an antibiotic.

It was once common practice to remove tonsils in children with recurring strep throat, but Rajesh says that’s no longer the case. However, tonsillectomy may be considered when other factors are involved.

Rajesh offers the following signs a child may need their tonsils removed:

• Documented, recurrent throat infections associated with fever, sore throat and enlarged tonsils, along with positive strep tests
• Sleep-disordered breathing accompanied by slow growth, poor school performance, bed-wetting, asthma or behavioral problems
• Sleep-disordered breathing, such as obstructive sleep apnea, which can be diagnosed by an overnight sleep study

Sore Throat Causes

“There are many other causes of sore throat besides strep. Viral infections, dehydration, allergies, acid reflux and postnasal drip from nasal congestion can all contribute to sore throats. The most common viral illnesses that cause sore throats are the flu, mono and a common cold,” Redmond says.

She encourages everyone to watch symptoms closely and, when in doubt, contact your care team.

“Seek medical attention if you develop a fever over 100.4, are unable to swallow or your pain is severe. We’re here for you,” Redmond says.

Battling a sore throat can be extremely uncomfortable. It can also be difficult to tell whether you’re fighting a virus or dealing with a case of strep throat. Kelsey Redmond, ARNP, UnityPoint Health, explains the signs and symptoms of each, as well as the best treatment plan – including when you might need to make a trip to the doctor.