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Is It Strep Throat or Just a Sore Throat?

By February 14, 2024Cold and Flu
strep throat or sore throat how to tell the difference

The treatment protocols for strep throat and sore throat are very different. Therefore, your health provider must determine which ailment is making an appearance before dispensing a recommendation.

Telling the Difference Between Strep Throat and Sore Throat

Most sore throats are not strep throat and are caused by a virus.  Sometimes sore throats serve as a warning that a cold or upper respiratory infection is on its way. Typically, if a sore throat is accompanied by a high fever, rash, headache, stomachache or inability to swallow, your doctor will conduct a rapid strep test (a throat swab) to confirm a strep throat diagnosis.  Strep throat is caused by a Group A streptococcal bacterium and usually afflicts children aged 5 to 15 years old.

The rapid strep test reliably confirms strep throat if present about 86% of the time and correctly rules it out about 96% of the time.  If the swab is negative, but your providers believe the exam and patient’s history suggest strongly it is strep throat, they will send out a “back-up” culture to make sure the strep bacteria is not present.  If strep throat is indicated by the swab test or culture, administering an antibiotic is necessary.  The reason for this is that strep throat can cause complications if left untreated, like rheumatic fever (which can lead to heart damage, among other things) or damage to kidney structures.  Luckily, the medication easily kills this bacterium.

Do Very Young Children Get Strep Throat?

Many parents are concerned about a child under three years old getting strep, especially if older siblings are diagnosed.  It’s exceedingly rare.  If your two-year-old happens to be whiny and have some respiratory symptoms, you may ask for a swab; however, the consensus among infectious disease doctors is that it’s a waste of time and money.  The false-positive rate on the swabs in kids under three is very high.  Why don’t children under three get strep?  Another good question, but we’re not completely sure!  However, we do know that if they do get it, they don’t have the complications associated with strep mentioned above.

Symptoms of Strep in Young Kids

According to the Cleveland Clinic, even though it is rare, it is possible for a very young child to contract strep throat, but you need to look for different symptoms than the ones you see in older children and adults:

  • Red throat with white patches
  • Fever
  • Crankiness or irritability
  • Loss of appetite or excessive drooling
  • Difficulty sleeping
  • Swollen lymph nodes

Again, even if these symptoms are present, your pediatrician may not test for strep since young kids usually don’t have the complications that go along with it, unlike older kids and adults.

Suppose it Really Looks Like Strep?

A first line of defense in our bodies is our tonsils, so that’s where we tend to exhibit symptoms first.  But just because tonsils look big, that doesn’t mean someone has strep.  For example, we recently saw a 7-year-old whose throat was red and had white drainage, his tonsils were a bit large, and he was having difficulty swallowing.  He was also congested, but based on how his throat looked, we couldn’t be sure it wasn’t strep, so we took a swab, and it was negative.  In this case, it was just a horrible pharyngitis (inflammation of the cavity behind the nose and mouth, or pharynx) that required only supportive care, not antibiotics.  This goes to show that you cannot diagnose strep throat just by looking.

How Contagious is Strep?

Just because someone in your household has been diagnosed with strep, doesn’t mean you all will get it.  Strep is pretty contagious, but it’s not a super-bug.  There’s about a 20% chance others in the household may get it.  Use common sense.  Don’t share spoons and cups with the person who is ill, and you all should be fine.  There is no need to run to the doctor to get the whole house swabbed. IF someone becomes symptomatic with a sore throat after being exposed to a known case of strep, then that is the time to visit the doctor.

How to Treat Strep and Sore Throat

For strep throat, besides taking an antibiotic as directed, supportive measures will help the patient feel better until the antibiotic kicks in (usually about 24 hours).  This can include giving cool or warm fluids to drink (whatever feels best on the throat) and rest.  In our office, we recommend giving a probiotic when the patient starts the course of antibiotics and continue for a month afterwards.  Take the probiotic once per day, two hours before or after the antibiotic dosage and don’t take it with hot food or drink, as that kills the good bacteria in the probiotic.  After the third day of antibiotic treatment, replace the patient’s toothbrush, to avoid re-infection.

For a sore throat caused by a virus (not strep), give warm or cool fluids to drink and have some ibuprofen on hand for pain if you choose.  Vitamin C, elderberry syrup, colloidal silver spray and zinc can also be helpful.  Rest is also recommended.  With either illness, kids may not want to swallow food and may lose a pound or so, but it’s nothing to worry about.  Just keep them well hydrated.

Don’t Forget Salt Therapy for Sore Throat!

As mentioned, a sore throat may just be a harbinger of a cold or other respiratory illness so you may also see congestion and cough as the sore throat fades.  Alternatively, someone with allergies may experience post-nasal drip or mouth-breathe all night, which may also irritate the throat.

A sore throat and its accompanying symptoms (whether from cold/flu or allergies) can also be helped by salt therapy sessions!  Breathing in salt air will help cleanse the nasal passages and lungs of allergens and bacteria.  Salt therapy reduces inflammation, thins mucus and helps facilitate sinus drainage.  Salt therapy brings relief for chest congestion and cough as it accelerates mucus clearance from the lungs.  These sessions help drive away sneezing and coughing as well as decrease your dependence on over-the-counter drugs.  Salt therapy also reduces stress which might otherwise weaken your immune system and helps rejuvenate your natural defenses.


We hope this discussion helped to demystify the difference between a sore throat and strep throat and that you feel more educated and prepared to face either illness with confidence!


Image by karlyukav on Freepik

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