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While most sore throats are viral, knowing when it’s strep can help prevent complications and reduce spread.
A sore throat (pharyngitis) is a common problem and is usually caused by a viral or bacterial infection. Most sore throats are the result of viruses, allergies, or changes in the weather. A small percentage result from the bacteria Group A Streptococcus (“strep”).
Viral pharyngitis can be caused by one of many viruses, many of which also cause upper respiratory infections such as the common cold. Viral infections are not treated with antibiotics, but instead with rest, pain medication, and therapies aimed at relieving symptoms.
Strep throat is a particular kind of pharyngitis caused by Group A Streptococcus (GAS) and is usually treated with antibiotics. Sore throat usually resolves on its own without complications in adults, although it is important to know when to seek medical attention.
The majority of cases of sore throat are caused by a virus. The most common include viruses that cause upper respiratory infections, such as the common cold.
Symptoms that may occur with a viral infection can include a runny nose and congestion, irritation or redness of the eyes, cough, hoarseness, or soreness in the roof of the mouth. In addition, viral infections may cause a fever and cause the person to feel quite ill.
Approximately 10 percent of sore throats in adults are caused by strep. Signs and symptoms include:
In small children, strep throat may present with fever and sore throat alone, and sometimes headache, abdominal pain, or a sandpaper-like rash (scarlet fever).
Less common but more serious infections that may cause sore throat include:
Consult a healthcare provider if any of the following occur:
Seek immediate medical care if there is:
Pharyngitis resolves without specific treatment in most cases. There is no specific treatment for viral pharyngitis, the most common cause of a sore throat. Symptoms of strep throat may respond a day or so earlier with antibiotic treatment, but will also resolve without treatment. The main reason to diagnose and treat strep is to prevent rheumatic fever, although this complication has nearly disappeared in industrialized countries.
The most accurate way to determine if a person has strep throat is to use a combination of the person’s signs and symptoms (described above) and perform a rapid test or throat culture if there are two or more signs/symptoms of strep. People with fewer than two signs/symptoms usually do not need testing or treatment.
The physician will decide to start treatment before the results of the culture return, based on the clinical symptoms, the medical history, the family history and other factors. Culture results usually return within 24-38 hours. If the decision is made to start antibiotics, and the results come back that there is no streptococcal A infection, then it is almost for certain that the sore throat is not coming from a strep A infection and the antibiotics should be stopped.
A throat swab performed in clinic. Results available within hours. Rapid tests to be done at home can also be purchased at most pharamcies. The test is accurate in most cases, although a small percentage of tests are falsely negative (the bacteria are present but the test is negative).
A throat culture involves swabbing the throat, sending the swab to a laboratory, and waiting 24 to 48 hours for the results. Throat cultures are slightly more accurate than the rapid test.
Usually, throat cultures do not need to be repeated after treatment. Some healthy children may continue to carry the bacteria without needing medication.
Antibiotics do not improve throat pain caused by a virus and are not recommended. Sore throat caused by viral infections usually lasts four to five days. During this time, treatments to reduce pain may be helpful. Several therapies can help to relieve throat pain.
Pain medication - Throat pain can be treated with a mild pain reliever such as acetaminophen or a non-steroidal anti-inflammatory agent such as ibuprofen or naproxen.
Oral rinses - Salt-water gargles are an old stand-by for relief of throat pain. It is not clear that it is effective, but it is unlikely to be harmful. Most recipes suggest 1/4 to 1/2 teaspoon of salt per one cup (8 ounces) of warm water.
Sprays - Sprays containing topical anesthetics (eg, benzocaine, phenol) are available to treat sore throat. However, such sprays are no more effective than sucking on hard candy.
Lozenges - A variety of lozenges (cough drops) are available to treat throat pain or relieve dryness. However, it is not clear that lozenges work any better than other forms of hard candy, which are generally less expensive. Not suitable for young children due to the risk of chocking.
Other interventions - Other interventions include sipping warm beverages (eg, honey or lemon tea, chicken soup), cold beverages, or eating cold or frozen desserts (eg, ice cream, popsicles).
Alternative therapies - Health food stores, vitamin outlets, and Internet Web sites offer alternative treatments for relief of sore throat pain. We do not recommend these type of treatments due to the risks of contamination with pesticides/herbicides, inaccurate labeling and dosing information, and a lack of studies showing that these treatments are safe and effective.
Penicillin, or an antibiotic related to penicillin, is the treatment of choice for strep throat. It is usually given in pill or liquid form two to four times per day for 10 days. A one time injection of penicillin is also available. People who are allergic to penicillin are given an alternate antibiotic. It is important to finish the entire course of treatment to completely eliminate the infection.
Antibiotics are recommended for confirmed Group A Streptococcus infection because they:
The usual treatment is Penicillin or Amoxicillin
These medications are equally effective. Amoxicillin is often preferred for children due to taste.
It is important to complete the full course of antibiotics. Fever usually decreases within 24 hours, and patients become less contagious after 24 hours of treatment. Other symptoms usually begin to improve within three to four days after starting the antibiotic. If symptoms do not begin to improve, or they worsen during this time, the person should see their healthcare provider to determine if further testing is needed.
Anyone who has been diagnosed with strep throat should stay home from work or school until he/she has completed 24 hours of antibiotics. Within 24 hours of beginning antibiotic treatment, the person becomes significantly less contagious.
Anyone who has a sore throat (not diagnosed as strep) may participate in usual activities as soon as he/she feels well.
An essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly, and dried with a single use towel.
Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Hand rubs should be spread over the entire surface of hands, fingers, and wrists until dry, and may be used several times. These rubs can be used repeatedly without skin irritation or loss of effectiveness. Hand rubs are available as a liquid or wipe in small, portable sizes that are easy to carry in a pocket or handbag. When a sink is available, visibly soiled hands should be washed with soap and water.
Hands should be washed after coughing, blowing the nose, or sneezing. While it is not always possible to limit contact with a person who is sick, avoiding touching the eyes, nose, or mouth after direct contact can help to prevent the spread of infection.
In addition, tissues should be used to cover the mouth when sneezing or coughing. These used tissues should be disposed of promptly. Sneezing/coughing into the sleeve of one’s clothing (at the inner elbow) is another means of containing sprays of saliva and secretions and has the advantage of not contaminating the hands.
