CONDITIONS

What Is Sore and Strep Throat

There are many reasons for developing a sore throat—the usual culprits include: allergies, colds, post-nasal drip from allergies or colds, overuse of voice, smoking too many cigarettes, viral infection, and bacterial infections. Only 5 to 10% of sore throats are caused by strep throat—named for the Streptococcus bacterium that causes the infection. Strep throat is a more severe form of sore throat that is typically treated with antibiotics. Most sore throats are caused by viruses and do not respond to antibiotic treatment.

A strep infection of the throat often leads to intense discomfort and pain in the throat, which may be accompanied by difficulty swallowing or speaking. Fever is common, and often, the tonsils are covered with a white layer of pus. You will likely have swollen, tender lymph nodes in your neck, and feel unwell. Sometimes, strep throat is accompanied by a cough or runny nose—but this is not due to the strep bacterium, it means that you may have a viral upper respiratory infection with symptoms of a cold in addition to strep. Children may develop a rash when they have strep throat–strep infection with a rash is commonly called scarlet fever.

It’s important to distinguish between viral and bacterial causes of sore throats—treatment for one is not treatment for the other. It is easy for your healthcare provider to perform a rapid strep test, which typically indicates whether Streptococci are present in your throat. As well, a culture sample can be taken with a cotton swab of your throat, and examined in a lab for bacterial growth. The culture test takes about 24 hours before Streptococci can be identified.

Untreated strep throat can be dangerous. It can lead to rheumatic fever, a disease that damages the heart valves and affects joints. Glomerulonephritis, a kidney inflammation, which can result in impaired function of the kidney, may occur as well if the strep infection is not properly treated. The good news is that due the wide availability of antibiotics, these conditions are rarely seen today.

If you suspect that you may have strep throat, visit your healthcare provider to get tested. Do not begin taking any antibiotics until a culture or strep test has confirmed that you have strep, since even a single dose of antibiotic can influence test accuracy. Seek immediate medical help if you have a swollen throat that is causing breathing difficulties or severe problems with swallowing.

What Causes Sore and Strep Throat

Sore throats can be caused by a number of different things, including:

Viral infection—By far the most common cause of sore throat, there are a number of different viruses that can lead to a cold or upper respiratory infection. As well, the following viruses can also cause sore throat.

Bacterial infection—A bacterial infection can lead to strep throat, though is a much less common cause of sore throat than viral infection. Other bacterial causes include:

  • Tonsillitis
  • Aperitonsillar abscess
  • Retropharyngeal abscess
  • Diphtheria
  • Epiglottitis
  • Certain sexually transmitted infections such as gonorrhea and chlamydia can cause a sore throat.

Irritants/Toxins—A number of substances can cause sore throat, including:

  • Cigarette smoke
  • Allergies, especially to dander, pollen, mold
  • Air pollution
  • Breathing in airborne chemicals
  • Mouth breathing at night when sleeping
  • GERD
  • Postnasal drip

Trauma/Injury—Excessive yelling or screaming can irritate the throat and larynx; direct injury to the throat or neck may also lead to a sore throat.

Risk Factors For Sore and Strep Throat

While anyone can get a sore throat, there are some factor that may make you more susceptible, which include:

  • Having allergies—seasonal allergies or ongoing allergies to mold, dust, dander, or some other irritant means that you’re more likely to develop a sore throat
  • Chronic or frequent sinus infections—postnasal drainage from the nose from sinus infections can cause sore throat
  • Smoking or being exposed to secondhand smoke—Exposure to tobacco or other smoke can irritate the throat and increases risk of cancer.
  • Exposure to chemical irritants—commonly used household chemicals, exhaust from cars, fumes from airborne chemicals can all cause throat irritation
  • Living and/or working in close quarters—the tighter the quarters the easier it is for both viral and bacterial infections to spread—particular hotspots include: classrooms, offices, military barracks, childcare centers
  • Having decreased immunity—low immunity caused by HIV, diabetes, chemotherapy medication, stress, fatigue, poor diet can all increase susceptibility to sore throat
  • Being a child or teenager—Children and teens are more likely to develop sore throats—and are more likely to develop strep throat infections.

Diagnosing Sore and Strep Throat

Determining the cause of sore throat—which dictates proper treatment—is typically done via physical exam and lab test. During the physical portion of the exam, your healthcare provider will look for signs and symptoms of strep throat, which include: fever, enlarged and tender lymph nodes, difficulty swallowing, and will look at your throat and tonsils to see if whitish pus is visible. Current guidelines recommend lab test confirmation for strep throat, either by rapid strep test or throat culture. A rapid strep test analyzes the bacteria in the back of your throat, gathered via cotton swab. A throat culture also analyzes bacteria from the back of the throat, gathered in the same way. The cells are placed in a container with substances that promote growth of the strep bacteria—if strep bacteria grow, then the throat culture is positive, if no bacteria grow, the culture is negative. A rapid test yields results in 10 to 15 minutes, whereas a throat culture takes 1 to 2 days. A throat culture is more accurate, however, than a rapid test. A rapid test can give a false negative, so even if your results are negative for strep with a rapid test, if you have some or all of the markers listed below, your doctor may begin you on a course of antibiotics anyway, and will likely do a throat culture to back up what they think.

Your healthcare provider may begin treatment for strep throat prior to confirmation by lab test, however, if you have three or four of the following symptoms:

  • Fever of 101°F or higher
  • Whitish spots on the throat or tonsils
  • Enlarged and tender lymph nodes in the neck
  • Lack of signs of a cold or upper respiratory infection, like coughing or sneezing

Prompt treatment of strep throat reduces the:

  • Spread of strep throat to others (antibiotics hasten the time in which you are able to infect others)
  • Risk of complications, which can include the infection spreading to other parts of the body, sinus infection, or more rarely peritonsillar abscess (an abscess behind or near your tonsils)

Symptoms of Sore and Strep Throat

Signs and symptoms of sore throat depend on the cause of the sort throat—but sore throats from strep and from other causes do share many common symptoms—most notably:

  • Pain
  • Difficulty swallowing
  • Scratchy feeling in the throat
  • Swollen glands

Most cases of sore throat are due to infection. These symptoms are common to sore throat from either bacterial or viral infection:

  • Fever, possibly with chills
  • Nausea / vomiting
  • Achy body
  • Headache
  • Earache
  • Fatigue
  • Swollen glands
  • Nasal congestion or runny nose
  • Hoarse voice
  • Lack of appetite
  • Bloody mucus

Certain symptoms can help differentiate viral and strep throat. Usually, those with strep present with:

  • Red, swollen tonsils with whitish patches of pus
  • Fever
  • Swollen, tender lymph glands

But what they present with, and what they present without can be equally elucidating—symptoms typical of cold like runny nose, congestion, sneezing usually indicate a viral infection. While this is good for quick read when diagnosing, the distinction does not always tell the full story, and evaluation by a healthcare provider is important if your symptoms are not abating.

Prognosis

Symptoms of both viral and bacterial sore throat generally get better, regardless of treatment, within 3 to 7 days. Antibiotic treatment, however, eradicates the bacterial infection, and reduces the risk of transmitting strep throat to others, along with reducing risk of complications. Left untreated, a strep throat infection can cause serious complications, which can include:

  • Rheumatic fever
  • Scarlet fever
  • Peritonsillar abscess
  • Ear infection
  • Sinus infection
  • Inflammation of the kidneys

Children can go back to school 24 hours after beginning a course of antibiotics for strep throat. Due to the ease of access to antibiotics, complications from strep throat are thankfully rare in the United States.

Living With Sore and Strep Throat

Both viral and bacterial sore throats can be contagious—for this reason, it’s important for measures to be taken to prevent the transmission of the infection. Frequent hand washing, taking care to cover one’s mouth when coughing or sneezing, and not sharing cups or utensils are good ways to help stop the spread of the sore throat infection.

Screening

Current guidelines recommend lab test confirmation for strep throat, either by rapid strep test or throat culture. A rapid strep test analyzes the bacteria in the back of your throat, gathered via cotton swab. A throat culture also analyzes bacteria from the back of the throat, gathered in the same way. The cells are placed in a container with substances that promote growth of the strep bacteria—if strep bacteria grow, then the throat culture is positive, if no bacteria grow, the culture is negative. A rapid test yields results in 10 to 15 minutes, whereas a throat culture takes 1 to 2 days. A throat culture is more accurate, however, than a rapid test. A rapid test can give a false negative, so even if your results are negative for strep with a rapid test, if you have some or all of the markers listed below, your doctor may begin you on a course of antibiotics anyway, and will likely do a throat culture to back up what they think.

Prevention

Whether a sore throat is caused by viral or bacterial infection, there are a number of things you can do to help prevent it in the first place. Here are some top tips:

  • Avoid close contact with people that are already sick with a cold, upper respiratory infection, or sore throat (whether from strep or not)
  • Frequent and thorough hand washing is key to lowering transmission risk
  • Avoid sharing personal objects with those that are already ill—like cups, utensils, dishes
  • Cover your mouth when sneezing or coughing, and encourage those around you to do the same. And make sure to sneeze or cough into your elbow, NOT your hand
  • Avoid touching potential infected surfaces like doorknobs and phones—and stay away from Kleenex or towels used by those that are already sick
  • If you’re given a course of antibiotics—finish them! You cannot fully eradicate the infection, if bacterial, if you don’t complete the course of antibiotics—and may risk getting others ill
  • Stay hydrated

With respect to preventing other sources of sore throat, outside of infection, here are some pointers:

  • Try taking OTC medications for sore throat due to allergies, postnasal drip, cough or GERD
  • Chew food carefully in order to prevent physically scratching or injuring the throat
  • Avoid prolonged speaking or yelling as this can really irritate the tissues of the throat

Common Treatment

While antibiotic treatment for sore throat depends on whether you have a viral or bacterial infection, symptom relief medications are often the same for both types of sore throat.


OTC Medications.

There are a number of over-the-counter medications that can help soothe a sore throat, like:

  • Ibuprofen (Advil, Aleve, Motrin), acetaminophen (Tylenol) are pain-relievers that can help with both the pain, and in the case of ibuprofen, discomfort and pain from swelling. Both medications help reduce fever. Be sure to avoid aspirin in children and teens as it can cause a rare but serious illness known as Reye’s syndrome.
  • Throat lozenges and pain-relieving throat sprays can be very helpful to some.
  • Antihistamines and decongestants can help if your sore throat is caused by allergies.
  • Antacids, and proton pump inhibitors can help if your sore throat is caused by GERD or acid reflux.
  • Cough syrup can help if your sore throat is due to coughing from a cold or upper respiratory infection.
  • Zinc lozenges have been found to lessen duration of a cold.

Antibiotics.

A course of antibiotics should only be used in the case of strep throat, or if your doctor determines that it is needed to treat a bacterial infection. Do not take unless directed by your healthcare provider. If prescribed antibiotics, be sure to take the entire course of treatment, even if you’re feeling better after a few days. All strep throat bacteria are killed by penicillin, but if for some reason, penicillin does not cure your strep throat, see your doctor. Rarely, other bacteria can create a reaction that can block the efficacy of penicillin.

Complementary and Alternative Treatment

While having a sore throat can be a drag—the good news is that sore throats can be soothed by a number of different home remedies!

Here are some of the top home remedies for a sore throat:

  • Gargle with warm saltwater (use about 1 teaspoon of salt in 8 oz. of water) for 15 – 30 seconds at a time, and then spit out. Repeat as needed.
  • Use a humidifier to moisten air. Very dry air can worsen symptoms.
  • Cold can help. Try eating very cold food like frozen yogurt or shake mixed with ice
  • Heat can help too. Drink warm to hot liquids like tea, water with lemon and honey, or soup broth like miso
  • Take some vitamins: Vitamin C, Zinc, and Echinacea.

When To Contact A Doctor

While most cases of sore throat are due to a viral infection that will run its course and resolve without need for intervention, it’s critical that those with strep get antibiotic medication. So how to know when to see the doctor?  If you exhibit these signs or symptoms, you might want to go to your healthcare provider:

  • Severe sore throat with fever 101 F (38.3 C) or over
  • Difficulty swallowing even soft food or liquids
  • Drooling
  • Severe pain in your glands
  • Difficulty breathing
  • Bleeding from your throat, or blood in your saliva or phlegm

Questions For Your Doctor

To treat a sore throat, visit your family or general practitioner.

Questions For A Doctor

If you find yourself sick with a sore throat, regardless of its cause, you may have some questions for your doctor. Some top ones to ask may include

  • What is causing my sore throat?
  • What I can do to make myself more comfortable?
  • I have a fever and a sore throat. Could it be strep throat?
  • Should I use a humidifier?
  • How long will it take before I know what is causing my sore throat?
  • Should I go to work if I have a sore throat?

Resources

For more information about sore throat, please see:

Center for Disease Control (CDC)

National Institutes for Health (NIH)