A sudden, intensely painful sore throat is a miserable experience familiar to almost everyone. It can make swallowing feel like an ordeal and is often accompanied by fever and a general feeling of being unwell. While the vast majority of sore throats are caused by common viruses that simply need to run their course, a specific and very common type caused by bacteria, strep throat stands apart. Strep throat is more than just a severe sore throat; it is an infection that requires definitive treatment with antibiotics. The primary reason for this is not just to relieve the painful symptoms, but to prevent the development of serious, long-term complications, most notably acute rheumatic fever, a condition that can cause permanent damage to the heart. Understanding the difference between a viral sore throat and strep throat is crucial for knowing when to see a doctor and why completing the prescribed treatment is so important.

Strep throat is a contagious infection of the pharynx (the throat) and the tonsils caused by a specific type of bacteria. The medical term for the condition is streptococcal pharyngitis. Unlike a viral sore throat, which is often part of a broader common cold that includes symptoms like a runny nose and cough, strep throat is a direct bacterial invasion of the throat tissues. This invasion triggers a powerful inflammatory response from the body’s immune system, resulting in the characteristic severe pain, redness, and swelling.

Strep throat is most common in school-aged children and adolescents, typically between the ages of 5 and 15, although adults can certainly get it as well. It is the most common bacterial cause of sore throat, accounting for up to 30% of cases in children and about 10% in adults (CDC, 2024).

In my practice, when a patient complains of a sudden sore throat with fever, but no cough, I always consider strep. Rapid testing helps catch it early and start treatment quickly.

Strep throat is caused by Group A Streptococcus (Streptococcus pyogenes). These bacteria are very common and are known to cause a variety of skin and throat infections.

When Group A Strep bacteria infect the throat and tonsils, they adhere to the mucosal cells and begin to multiply. They produce toxins and enzymes that cause direct injury to the surrounding tissues, leading to the intense inflammation that is responsible for the severe pain and redness. The body’s immune response brings a large number of white blood cells to the area to fight the bacteria, which can result in the formation of the white patches or streaks of pus often seen on the tonsils.

Some strains of Group A Strep also produce a specific toxin that can cause a widespread body rash. When a person has strep throat accompanied by this characteristic rash, the illness is called scarlet fever.

Most sore throats are viral, but when I hear about throat pain with fever, no cough, and exposure to someone recently ill, strep jumps to the top of my list.

Strep throat is highly contagious and spread primarily through respiratory droplets from coughing, sneezing, or touching contaminated surfaces. The Group A Strep bacteria live in the nose and throat of an infected individual.

The primary modes of transmission are:

• Inhaling Respiratory Droplets: When an infected person coughs, sneezes, or talks, they release tiny droplets containing the bacteria into the air. If a nearby person inhales these droplets, they can become infected.
• Direct Contact: Touching surfaces that have been contaminated with these droplets (like a doorknob or a desk) and then touching your own mouth, nose, or eyes can transfer the bacteria.
• Sharing Personal Items: Sharing utensils, cups, or food with an infected person can also spread the infection.

A person with untreated strep throat is contagious until they have been on antibiotics for at least 24-48 hours. This is why it is so important for individuals with strep throat to stay home from school or work until they are no longer infectious to prevent spreading the illness to others.

I’ve seen whole families catch it from one school-aged child. Teaching proper hygiene like handwashing and not sharing drinks, is just as important as antibiotics.

Strep throat typically has a rapid onset with symptoms developing within hours. It may begin like a typical sore throat but quickly becomes more intense.

The most common signs and symptoms of strep throat include:

• Sudden and Severe Sore Throat: The pain is often described as feeling like “swallowing glass” and comes on quickly without the preceding runny nose or cough typical of a cold.
• Painful Swallowing (Odynophagia).
• Fever: A fever of 101°F (38.3°C) or higher is common.
• Red, Swollen Tonsils: The tonsils at the back of the throat will appear bright red and enlarged.
• White Patches on Tonsils: Streaks or patches of white pus (exudates) are often visible on the tonsils.
• Petechiae on the Palate: Tiny, red spots may be seen on the soft or hard palate (the roof of the mouth).
• Swollen Neck Glands: The lymph nodes in the front of the neck are often swollen and tender to the touch.

Other symptoms can include headache, stomach pain, nausea, or vomiting, particularly in younger children.

It is also important to recognize the symptoms that make strep throat less likely, and point toward a viral cause. These include a cough, a runny nose, hoarseness, and conjunctivitis (pink eye). The presence of these “cold-like” symptoms makes a viral infection much more probable.

One question I always ask is, “Do you have a cough?” If the answer is no, and there’s fever and swollen nodes, strep is much more likely than a virus.

Diagnosis is based on clinical presentation and confirmed with lab tests.

The Clinical Evaluation

A doctor will begin by taking a history of the symptoms and performing a physical exam. To help decide whether a test for strep is needed, doctors often use a clinical scoring system, such as the Centor criteria. This system awards points for the presence of key features:

• Fever
• Absence of a cough
• Tender anterior cervical lymph nodes (swollen glands in the neck)
• Tonsillar exudates (white spots)
• Age (with children scoring higher)

A high score increases the likelihood of strep throat and indicates that a test is warranted.

Diagnostic Tests

• Rapid Antigen Detection Test (RADT): This is the “rapid strep test.” A healthcare provider uses a long cotton swab to collect a sample from the back of the throat and the tonsils. The swab is tested in the clinic, and results are available within 5 to 10 minutes. Rapid tests are very accurate when they are positive.
• Throat Culture: If the rapid strep test is negative but the doctor still has a high suspicion for strep throat (especially in a child), they will send a second swab to a laboratory for a throat culture. This is the “gold standard” for diagnosis. In the lab, the sample is placed on a special plate to see if Group A Strep bacteria will grow. Results typically take 24 to 48 hours.

If rapid test is negative but symptoms are classic, I always send a throat culture, especially in kids. Missing a strep diagnosis can lead to serious complications down the line.

The treatment for a viral sore throat is simply rest and supportive care. For strep throat, however, antibiotic treatment is essential.

The Goals of Treatment

The primary goals of treating strep throat with antibiotics are to:

1. Prevent Acute Rheumatic Fever: This is the single most important reason to treat strep throat. Rheumatic fever is a serious inflammatory complication that can develop several weeks after an untreated strep infection. It can cause permanent damage to the heart valves, a condition known as rheumatic heart disease, which can lead to heart failure later in life.
2. Reduce the duration and severity of symptoms.
3. Prevent the spread of the infection to others.
4. Prevent other, rarer complications like a peritonsillar abscess (a collection of pus behind the tonsil) or post-streptococcal glomerulonephritis (a kidney problem).

Antibiotic Therapy

• Antibiotics are essential for treating strep throat. The drugs of choice for treating strep throat are penicillin or amoxicillin. They are highly effective, safe, and inexpensive. For individuals with a penicillin allergy, other antibiotics can be used.
• It is absolutely critical that you or your child complete the entire course of antibiotics as prescribed by the doctor, even if the sore throat starts to feel better after a day or two. Stopping the medication early can allow a small number of bacteria to survive, which can lead to a relapse of the infection and, most importantly, still carries the risk of developing rheumatic fever.

Supportive Home Care

While the antibiotics work to kill the bacteria, several home care measures can help to relieve the painful symptoms:

• Use over-the-counter pain relievers like acetaminophen or ibuprofen to control pain and fever.
• Gargle with warm salt water several times a day.
• Drink plenty of cool fluids to soothe the throat and prevent dehydration.
• Eat soft, easy-to-swallow foods.
• Use a cool-mist humidifier to add moisture to the air.

A person with strep throat should stay home from school or work until they have been on antibiotics for at least 24 hours and their fever is gone.

I always remind patients: even if you feel better in a few days, finish the full antibiotic course. It’s not just about you, it’s also about preventing rheumatic fever and protecting others.

Strep throat is a common bacterial infection that causes a sudden and severe sore throat, particularly in children. While it shares some symptoms with a viral sore throat, it is a distinct illness that requires antibiotic treatment. A definitive diagnosis should be made with a rapid strep test or a throat culture. The importance of treatment goes far beyond simply feeling better faster. The primary and most critical reason for taking a full course of antibiotics is to completely eradicate the Group A Strep bacteria and prevent the devastating and permanent heart damage of acute rheumatic fever. What I always tell families is this: strep throat is one of the few sore throats we can treat with antibiotics, and it’s worth catching early. Quick treatment means faster recovery and fewer risks.

Centers for Disease Control and Prevention (CDC). (2024). Strep Throat: All You Need to Know. Retrieved from https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

American Heart Association. (n.d.). Rheumatic Fever. Retrieved from https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/uncommon-heart-valve-conditions/rheumatic-fever

Mayo Clinic. (2023). Strep throat. Retrieved from https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338