Sore Throat vs STREP throat: How to tell the difference

Gah, you’ve got a sore throat and you’re trying to figure out if it’s just something viral (or allergies) or if it’s strep. I can say I have BEEN there (especially with kids) and I have some good tips for you on how they’re often different!

Sore throats are the worst!  Especially in kids. Their heads are so small that EVERYTHING just hurts, their eyes, their throat, their ears.  It’s all connected and they’re so miserable (although, frankly as an adult I felt pretty miserable as well).

I just did a podcast on strep throat that you might enjoy:

How do you know if it’s just your basic sore throat (which is usually just a viral infection) or strep — where you need to see a doctor?  How is a mom ever to know all of this?  Also, how do you get rid of it?  Take a deep breath, I’m going to go over all of that!

Hi, I’m Hilary, a lot of people know me as The Pregnancy Nurse®, but I used to work for a pediatrician right out of nursing school so I did a lot of phone triage and learned a LOT about strep throat (and did a LOT of strep tests).

I moved around a few times and landed in labor and delivery. I now have 20 years of L&D experience and am the creator of The Online Prenatal Class for Couples.

Normal Sore Throat vs Strep Throat:

My daughter woke up sick this morning.  It all hurt and her throat was awfully red, with some possible white patches ( a tell-tale sign of strep).  It was hard to tell because she’s so miserable, she’s unwilling to open up much (I am guessing this is sounding familiar if you’re reading this article) 🙂

So, we took her into the office (offices USED to provide strep tests as a walk-in, but that doesn’t seem to be the case anymore) to test for strep.

FYI, Actual Strep throat is something that truly needs to be seen by a physician (or healthcare provider).  They will need antibiotics and people often died of it before antibiotics because it can attack your heart causing serious issues.

Pro Tip: Viral infections do NOT respond to antibiotics, ONLY bacterial infections will do that. There are also risks to taking an antibiotic, so you want to be sure which you have going on (which is why you see a doctor).

Strep Throat – Symptoms

Sometimes the symptoms of it, especially in children can be masked.  In adults, it’s just the usual REALLY painful sore throat (and tonsils, and glands and often ears — as they’re all connected).

Get out a flashlight, open wide, say ahh and check down that throat of yours (or have your spouse do it — although I can do mine in a mirror pretty well).

Instead of looking just red, it will also look white (and, likely also red).  That’s because there is pus in your throat, on your tonsils.

** Keep in mind, you’re looking at the THROAT, not the TONGUE — many people’s tongue is white, and that is not it!** You are looking at the back of the throat, there are two small blobs of tissue on the left and right — those are your tonsils.

You may have to have them tilt their head back and forward to really get a good view of the throat. Tell them to touch you with their tongue (or try — don’t be close enough they can). That way the tongue gets out of the way.

You could also try this in a cooperative child (sometimes it’s good to do this when you’re healthy also, just to have a good idea on what regularly lurks down there).

Symptoms of Strep Throat in Children

1.  Nausea and vomiting (fun, I know)
2.  Headaches
3.  Sometimes rashes, but if that’s the case you need to be seen by a doctor ASAP.

It may or may not include a fever (this thermometer is good for all ages!).

Signs of Strep throat in Adults:

In adults it is usually seen as a sore throat with no other major symptoms, besides extreme (often radiating to the ears and glands) pain in their throat.

I am talking a REALLY sore throat, not like just a mildly scratchy throat.

Pro Tip: Glands are also called lymph nodes, and may feel like swollen balls underneath your chin and the sides of your neck.

You will still see white patches on the tonsils/throat though.

I have a whole post on a sore throat in pregnancy also if that is you!

Symptoms that are likely not strep:

Do you/your child have a cough?  It is likely not it.  Strep doesn’t feel like a cold, it feels like a VERY sore throat, and possibly the other symptoms.

If you/your kid has common symptoms of a cold (a runny nose, cough, etc.) it is likely not strep.  Most of those are viral sore throats.

Unless, they have strep AND a cold — then double whammy. Which can totally happen, kids are incubators. 🙂

Most often, we don’t see it in kids under 2. Although it’s possible, it’s not as likely (probably from immunity from the mom/womb).

Sore Throat and a Rash

This could possibly be Scarlet Fever (or rheumatic fever), which is when the strep goes through your whole body. It must be seen by a doctor ASAP so you can be placed on antibiotics for treatment. Scarlet Fever normally looks like a “sandpaper” rash (the skin looks red and rough)…

My Great Grandma actually died from this because it can attack your heart and cause life-long issues. Hence, strep is really serious.

Strep throat without a fever?

Strep throat doesn’t always have a fever, especially if it’s early (btw, this is my favorite kind of thermometer).

Pro Tip: Fevers themselves aren’t bad — they’re just your immune system revving up to FIGHT — and we WANT that. But, if kids are feeling miserable, talk to your provider about what medication to give. High fevers can be scary though, so be sure to contact your provider if you have questions.

The main symptom is the sore throat, and it must be confirmed by a rapid strep test or throat culture.

Sore throat with NO other symptoms?

This could be strep. Often, the sore throat is the main symptom (although it can extend to ear and gland pain because the throat is so sore).

But, it could also be allergies, or poor air quality.

How to diagnose strep throat:

In order to know for SURE that you or your child doesn’t just have tonsillitis (and not use antibiotics unnecessarily), you’ll need a strep test.

**Strep throat can NOT be diagnosed just by looking at it.

Strep Test Types

• Rapid Strep test — which results can be told within 5 minutes
• Overnight Strep culture where you have to wait til’ the next day.

Both of those tests are looking for Group A Streptococcus (also called Strep A — which is the strep which causes step throat (vs Beta strep, which is what they culture for in Pregnancy).

On the day our daughter was sick, we took her to the doctor and they did a rapid test.

The visit ended up costing around 100 dollars — just to find out it was viral.  Then, you just treat the symptoms with plenty of fluids and maybe some Lolleez 🙂

Viral sore throat is called tonsilitis — or an infection of the tonsils.  It should NOT be treated with antibiotics, as that can only help a sore throat that is bacterial (vs viral).

Tonsillitis can be due to a variety of issues — allergies, yelling too much, viral infections like colds.

It seems like doctors no longer offer strep tests without seeing a provider (we saw a very nice nurse practitioner), which is a shame (and a waste of our health care dollar, but I digress…).

Diagnosis of Strep Throat at Home

I really wasn’t a fan of paying so much, just find out the sore throat was viral.

BUT, then I googled it, and guess what I found:

That’s right, my very own tests

They go in and out of stock (and often can only be bought by a small business), so I have a few other places you can find them (which also go in and out of stock).

• Walmart

I’m not afraid to culture a kid.  It sounds like everything’s in the box (mostly a giant Q-tip, the solutions, and a vial to mix it all in).  SO, if you’re willing to swab your own family I think this could save you some serious dough.

** Keep in mind these tests are only accurate if you do/read them correctly, so take them at your own risk and if you have ANY concerns, call your healthcare provider!

On the few occasions that I get a positive, I do need to go see a doctor.  However, when I have hauled in my positive test they have always taken my word and not had to re-swab me (saving me about $20 dollars). You could also try an online consult.

Personally, I have a DPC with a Healthshare and you can easily either see him or do a virtual visit.

Of course, you might be wondering how to swab your child — and YouTube (as always) has some helpful tips!

I should also say that these rapid tests sometimes give a false negative.  So, if the tonsils have a white or pussy spots and it was still negative I think I’d have no choice but to take them in and shell out the cash.

You can also swab too early or not well enough, and that can lead to other false negatives — if your child is really miserable, it would be worth it to take them to a doctor.

**A note, if you plan to get these for your family you need to be willing to get back to their tonsils and really give it a good swab with the q-tip thing.  Maybe have a nurse friend show you the first time.  It isn’t hard, but it does need to be done right.  Swabbing their cheek won’t get you the info you need!

The true standard of a strep test is a culture on the ol’ petrie dishes

Strep Throat Remedies

Natural Sore Throat Remedies

There is nothing natural that can cure strep throat. However, there are some natural ways to help with the throat/gland pain.

Essential Oils for Strep Throat

While it HAS to be treated with antibiotics (and I can’t say that any more strongly) you can use some essential oils to mitigate symptoms.  I really like using some diluted lemon oil on my neck to help my glands process their swelling and go back down.

Natural Throat Remedies for Kids:

Momeez Choice reached out to me about their Lolleez product line and I thought it was the perfect addition to this conversation!  Let’s talk about sore throats and how this organic remedy on a stick can help ease sick days for kids and moms (sponsored by Momeez Choice).

Lolleez are organic throat soothing lollipops for kids and my secret weapon on sick days. I can very much relate to the founder’s story, as she didn’t feel comfortable giving her kids a throat lozenge because of the risk of choking and artificial ingredients they are usually made with, so she invented Lolleez!  Go mom! They are flattened suckers, which make them less of a choking hazard than a round ball.

Note on how I’d use them:  If your kid has a sore throat, of course, I’d see if it was strep FIRST (as that needs an antibiotic).  But, once it’s negative — you just need to treat the symptoms. These are a GREAT option for that! Especially because sometimes sore throats are from environmental things drying their throat, so these effective suckers really help!

Strep Throat Treatment

Strep has to be treated by antiobiotics.  I have seen some people mentioning that they will treat it at home, but my own great-grandmother died from a strep infection, so it really does need treatment.

It is also really important that strep be positively identified with a test or culture — BUT, once those are positive, you really need treatment via penicillin (that is the recommended treatment — there is no reason to get a really broad-spectrum antibiotic).

It’s just my “culture.” {wah-wah}

What antibiotics treat strep throat?

The gold standard is a routine dosage of penicillin to treat strep bacteria.  It’s best to just get that vs a broader-spectrum Z-pack.

You MUST take the entire course of antibiotics that you are given.  It helps it not come back even worse!  Make sure to set a reminder in your phone for the duration!

How do you get strep throat?

It is passed by

• Anything that was in your mouth — utensils, cups and then someone uses those items
• Coughing
• Improper/infrequent hand washing

It is SUPER contagious.  Often if one family member gets it — I’d ask your doctor if you can call to get a prescription for the rest if others get a sore throat.

Pro tip: Many people recommend changing out your toothbrush once you’re no longer contagious as you could re-infect yourself (they recommend this with all sore throats, actually).

How Long is Strep Throat Contagious?

It is super contagious, so be sure to watch your other children if one of them gets it.  It is contagious until you have been on antibiotics for 24 hours. Tonsilitis is contagious while you have throat pain.

Is strep throat contagious?

YES, very much so. If one child has it make sure to quarantine them as MUCH as possible, but also talk with your provider about what to do if your other kids get it (or if YOU get it).

Strep Throat FAQ’s

This post was originally written in Sept 2012 and has been updated.