Most sore throats are caused by viruses and get better on their own. Strep throat is different: it’s a bacterial infection that needs a test to confirm it and antibiotics to treat it. In the video above, family physician Dr. Richard Honaker explains the quickest clue for telling them apart: a virus usually brings a runny nose and a cough, and strep usually doesn’t.
Strep throat vs. viral sore throat at a glance
| Strep throat | Viral sore throat | |
|---|---|---|
| Cause | Group A Streptococcus bacteria | Viruses, such as those that cause colds and flu |
| How it starts | Often suddenly | Often gradually, with cold symptoms |
| Cough, runny nose, hoarseness | Usually not | Common |
| Throat | Red, swollen tonsils, sometimes with white patches or streaks of pus | Red and sore, usually without pus |
| Other signs | Fever, pain when swallowing, swollen glands in the front of the neck, tiny red spots on the roof of the mouth | Pink eye, sneezing, congestion |
| Test | Rapid strep test or throat culture | Usually none needed |
| Antibiotics | Yes, when a test confirms strep | No; they don’t work on viruses |
| Usual course | Improves within days of starting treatment | Usually better within about a week |
Symptoms overlap, so the table is a guide, not a diagnosis. Only a test can confirm strep.
What Dr. Honaker says in the video
Dr. Honaker explains that children get sore throats all the time, and that there are two kinds: viral and bacterial. Strep throat is the bacterial kind, and it’s the one that needs antibiotics. Viruses don’t; they run their own course.
His rule of thumb: a virus affects the throat, the nose and the lungs, so it tends to cause a sore throat plus a runny nose and a cough. The strep germ stays in the throat, so it usually causes a sore throat without a runny nose or cough. If a child has a sore throat and a fever along with a runny nose and a cough, it’s probably a virus that needs fluids, comfort and time. If it’s mainly a sore throat, especially with white or yellow patches at the back of the throat, Dr. Honaker says the child should see a doctor.
Symptoms of strep throat
According to Cleveland Clinic, strep throat usually starts 2 to 5 days after contact with someone who has it. Common symptoms include:
- a sore throat that starts quickly
- pain when swallowing
- fever
- red, swollen tonsils, sometimes with white patches or streaks of pus
- tiny red spots on the roof of the mouth
- swollen lymph nodes in the front of the neck
Children may also have a headache, stomach pain, nausea or vomiting. Some types of strep cause a red, sandpaper-like rash called scarlet fever.
Signs it’s more likely a virus
The American Academy of Pediatrics says a cough, runny nose, hoarseness or pink eye (conjunctivitis) point to a virus rather than strep. Viruses cause most sore throats: the Infectious Diseases Society of America estimates that strep is the cause in up to 30% of children and 15% of adults with a sore throat.
What causes strep throat, and who gets it
Strep throat is caused by group A Streptococcus bacteria. It spreads easily through close contact, often within households, and through droplets from coughs and sneezes or shared cups and utensils.
It’s most common in children aged 5 to 15 and rare in children under 3. Parents of school-age children, adults who work with children, and people in crowded places such as schools and daycares are at higher risk. Mayo Clinic notes it circulates most in winter and early spring.
How strep throat is diagnosed
You can’t tell strep from a virus just by looking at the throat, so a test is needed.
- Rapid strep test: a swab of the throat, with results during the visit.
- Throat culture: MedlinePlus, from the National Institutes of Health, explains that a rapid test can miss strep. If it’s negative but strep is still suspected, a throat culture can be done, with results in 1 to 2 days.
Treatment
Strep throat is treated with antibiotics, which help you feel better faster, lower the chance of spreading it, and help prevent complications. MedlinePlus notes that penicillin or amoxicillin is usually tried first. Take the antibiotic exactly as your doctor prescribes, and call if you don’t feel better within 48 hours of starting it.
Viral sore throats don’t get better with antibiotics; they usually clear up within about a week.
For comfort with either kind, Cleveland Clinic and MedlinePlus suggest:
- plenty of fluids, warm or cold
- ice chips, ice pops or lozenges (no lozenges or hard candy for young children, because of the choking risk)
- gargling with warm salt water
- a clean cool-mist humidifier
- an over-the-counter pain or fever reliever, after checking with your doctor or pharmacist which one suits you or your child, and following the label
Possible complications
Untreated strep can spread or trigger other illnesses. Cleveland Clinic lists abscesses around the tonsils, ear and sinus infections, a kidney disease called post-streptococcal glomerulonephritis, and rheumatic fever, which can affect the heart, joints, brain and skin. Antibiotic treatment lowers the risk.
When to see a doctor
Mayo Clinic recommends calling a doctor if you or your child has:
- a sore throat with tender, swollen glands in the neck
- a sore throat that lasts longer than 48 hours
- a fever
- a sore throat with a rash
- strep that hasn’t improved after 48 hours of antibiotics
Get care right away for trouble breathing or swallowing, drooling in a young child, signs of dehydration, or blood in saliva or phlegm, according to the American Academy of Family Physicians and Cleveland Clinic. Babies under 3 months old with a fever of 100.4°F (38°C) or higher need immediate medical care. If you think it’s an emergency, call 911.
How to prevent strep throat
- Wash hands often with soap and water.
- Don’t share cups, utensils or food, and wash a sick person’s dishes in hot, soapy water or a dishwasher.
- Cover coughs and sneezes.
Find a doctor
For a sore throat that might be strep, start with a family physician or pediatrician. For repeated strep or tonsil problems, an ear, nose and throat (ENT) specialist can help. Doctors on Best Docs Network who treat sore throats include:
- Dr. Richard Honaker, family medicine, Dallas-Fort Worth
- Dr. Bradley Friedman, family medicine, Dallas-Fort Worth
- Dr. Timothy Ragsdale, ear, nose and throat, Dallas-Fort Worth
More videos on this topic: Ear, Nose & Throat and Children’s Health.
Frequently asked questions
Is strep throat viral or bacterial?
Bacterial. Strep throat is caused by group A Streptococcus bacteria, never by a virus, Cleveland Clinic explains. Most other sore throats are caused by viruses, which is why a strep test matters before anyone takes antibiotics.
Can you have strep throat without a fever?
It’s possible. Fever is a common sign of strep, but MedlinePlus notes that symptoms can be mild or severe, and Cleveland Clinic says some people with strep have no symptoms at all. Fever alone can’t rule strep in or out: a strep test is the only way to know.
Can you have strep without a sore throat?
A sore throat is the main symptom of strep throat. Strep can also cause a headache, stomach pain, nausea or vomiting (Cleveland Clinic), and some people carry strep bacteria in their throat without getting sick (MedlinePlus). If you’re not sure, a doctor can test for it.
Can you tell if it’s strep by looking at the throat?
No. White patches and swollen tonsils make strep more likely, but viruses can look similar. A rapid strep test or throat culture is the only way to know.
Does a sore throat with a cough mean it’s not strep?
Usually. A cough, runny nose, hoarseness or pink eye point to a virus. It’s still possible to have strep, so see a doctor if a sore throat is severe or comes with a high fever.
Do I need antibiotics for a sore throat?
Only if a test shows strep or another bacterial infection. Most sore throats are viral, and antibiotics don’t help them.
Can adults get strep throat?
Yes. It’s most common in children aged 5 to 15, but adults get it too, especially parents of school-age children and people who work with children.
Will strep throat go away on its own?
Symptoms may ease within about a week, but untreated strep can lead to complications such as abscesses, kidney disease and rheumatic fever. That’s why strep should be tested and treated.
How long is strep throat contagious?
Antibiotics help prevent spread to others. Ask your doctor when you or your child can safely return to work, school or daycare.
Related resources
- StrepCareGuide.com, our companion site on strep throat symptoms and care
Sources
- Cleveland Clinic: Strep Throat
- Cleveland Clinic: Sore Throat (Pharyngitis)
- Cleveland Clinic: Rheumatic Fever
- familydoctor.org (American Academy of Family Physicians): Strep Throat
- Infectious Diseases Society of America: Clinical Practice Guideline Update on Group A Streptococcal (GAS) Pharyngitis (2025)
- HealthyChildren.org (American Academy of Pediatrics): Strep Throat, Sore Throat or Tonsillitis: What’s the Difference?
- HealthyChildren.org (American Academy of Pediatrics): When Is a Sore Throat a More Serious Infection?
- HealthyChildren.org (American Academy of Pediatrics): Fever: When to Call the Pediatrician
- MedlinePlus (National Library of Medicine, NIH): Strep throat
- Mayo Clinic: Strep throat: Symptoms and causes
This page is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
