What Can Be Mistaken for Strep Throat?

Symptoms of a sore throat may include: 

• Throat pain
• Swollen, red tonsils
• Painful swallowing
• Difficulty swallowing
• Scratchy sensation in the throat
• Swollen glands in the neck
• Hoarseness or voice changes

About 10% of cases of sore throat are strep throat, caused by group A Streptococcus (GAS) bacterium. Additional symptoms of strep throat include:

• Sore throat that may come on quickly
• White patches of pus on the side or back of the throat
• Tiny, red spots on the roof of the mouth 
• Streaks of pus on the tonsils
• Fever (temperature greater than 100.4oF, or 38oC)
• Stomach pain
• Nausea
• Vomiting 
• Headache
• Rash (scarlet fever) 
• Strep throat is usually not accompanied by cough, runny nose, or irritation/redness of the eyes

Most cases of sore throat are caused by viruses, usually viruses that cause upper respiratory infections such as the common cold. Cold symptoms that may accompany a sore throat include:

• Cough
• Runny or stuffy nose 
• Eye irritation or redness 
• Fever
• Feeling unwell (malaise)
• Soreness in the roof of the mouth

The cause of a sore throat is diagnosed with a patient history and physical examination of the throat. 

If strep throat is suspected, tests may include: 

• Rapid strep test
• Throat culture 

Strep throat is a bacterial infection treated with antibiotics, usually penicillin or amoxicillin. For those allergic to penicillin, other antibiotics may be used. If antibiotics are prescribed, take the entire dose as prescribed, even if you feel better before you have finished all the medication. 

If sore throat is caused by a virus, there is no specific treatment. Treatment is aimed at relief of symptoms. 

Home treatment to relieve symptoms of a sore throat caused by a virus may include: 

• Throat sprays that contain topical anesthetics (e.g., benzocaine, phenol) for pain
• Lozenges (cough drops) containing topical anesthetics for pain and throat dryness
  • Lozenges are not recommended for young children; they can be a choking hazard
• Drinking plenty of liquids to stay hydrated
• Drinking really cold beverages
• Sipping warm beverages (e.g., tea with honey, chicken soup, warm water with lemon)
• Eating cold or frozen desserts (e.g., ice cream, popsicles) 
• Using a humidifier or take a steamy shower to help moisten the throat
• Over-the-counter (OTC) pain relievers 
  • Acetaminophen (Tylenol) 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
  • Children under 18 should not be given aspirin due to the risk of a serious illness called Reye’s syndrome
• Salt-water gargle to help loosen mucus 
  • Combine 1/4 to 1/2 teaspoon salt per 1 cup warm water
• Decongestants may be helpful if sore throat is caused by breathing through the mouth due to nasal congestion 

If sore throat is due to gastroesophageal reflux disease (GERD) treatment may include: 

• Antacids
• Avoiding acidic foods and drinks such as soda, fried foods, and citrus fruits 
• Avoiding eating for at least an hour before bed
• Avoiding lying down after eating
• Elevating the head of the bed

Other sore throat remedies include: 

• Avoid allergens or use antihistamines, if sore throat is caused by allergies
• Change your toothbrush
  • Bacteria can accumulate on toothbrush bristles which may cause illness
• Don’t smoke