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Strep throat vs sore throat: differences

Strep throat vs sore throat
  • Published: 4 Mar 2025

Each year, it is estimated that approximately 10% of people visit primary healthcare services because of sore throat1. But not all sore throats are the same. The difference depends on the underlying cause of the symptom. In most cases, sore throat is due to a viral infection, like those responsible for colds and flu2. In a smaller number of circumstances, it is caused by a bacterial infection, particularly a streptococcal infection. On average, one in 10 adults and up to one in 3 children have a strep throat3. In other cases that are not caused by infection, sore throat may be due to allergies, exposure to smoking, including passive smoking and other medical conditions2. It is essential to know the true causes of a sore throat so as to understand how to solve it as soon as possible.

 

Causes: common sore throat vs strep throat

Sore throat, or pharyngitis (inflammation of the pharynx), is generally a symptom of an acute infection of the upper respiratory tract, which affects the mucosa of the throat3. This infection is often of a viral nature, but in some cases it can also be bacterial3. Group A streptococcus is the most common cause of acute bacterial pharyngitis4. The incubation period, from infection to the onset of symptoms, can vary from a few days to two weeks, depending on the responsible for the infection4,5. After being infected, a person can become contagious a few days before the actual onset of symptoms.

Key symptoms comparison

A sore throat is often the first symptom of a viral infection, such as a cold or flu. Symptoms of sore throat associated with viral infections may include pain when swallowing, high fever, runny nose, cough, hoarseness, and conjunctivitis2.

The symptoms of strep throat may partly overlap with those described above and include a sore and red throat, high fever, pus on the tonsils, red spots (petechiae) on the roof of the mouth, swollen lymph nodes in the neck and more rarely headache, abdominal pain and skin rashes6.

 

When to seek medical help

If the sore throat does not go away within a few days and is accompanied by breathing difficulties, pain in the joints, blood in the saliva or phlegm, and more generally if the patient is fragile, it is advisable to consult your doctor, who may send you, if necessary, for further clinical examinations12. During the visit, the doctor will examine your throat, nose and ears, and check for any swollen lymph nodes in the neck. If the doctor suspects strep throat, he/she may request a throat swab, a rapid test (RADT) for strep antigens, which provides a result in a few minutes4. Since this type of sore throat requires a different treatment, it is important to have the test and in general to follow your doctor’s instructions.

 

Treatment options for viral sore throat and strep throat

It is essential not to rely on DIY (Do It by Yourself).7 In the case of a viral infection, antibiotics are of no use and may actually increase the risk of developing drug resistance2. In most cases, a sore throat goes away on its own within a few days, but if necessary some over-the-counter medications may be suggested, such as anti-inflammatories and painkillers7. In addition, remedies such as mouthwashes and balsamic throat lozenges may be helpful and you should avoid smoking and alcohol7. In the event of strep throat, however, you should take an antibiotic prescribed strictly by your doctor, which will generally consist of penicillin or amoxicillin (which is a penicillin-type antibiotic)4. Antibiotic treatment is also required to reduce the risk of potentially serious complications4.

 

References:

  1. Kenealy T., “Sore throat”. BMJ Clin Evid. 2014 Mar 4;2014:1509. PMID: 24589314; PMCID: PMC3948435, https://pmc.ncbi.nlm.nih.gov/articles/PMC3948435/
  2. U.S. Centers for Disease Control and Prevention (CDC), “Sore throat basics”, 17 April 2024
  3. Wolford R.W., Goyal A., Belgam Syed S.Y., et al. “Pharyngitis”. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519550/ 
  4. Ashurst J.V., Edgerley-Gibb L., “Streptococcal Pharyngitis”. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525997/
  5. Wilson A., “Pharyngitis”. Essential Infectious Disease Topics for Primary Care. 2008:15–24. doi: 10.1007/978-1-60327-034-2_2. PMCID: PMC7121445.
  6. U.S. Centers for Disease Control and Prevention (CDC), “About strep throat”, 1 March 2024
  7. Istituto Superiore di Sanità (ISS), “Faringite – Terapia”, 15 Febbraio 2022

 

 

 

 

 

 

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