Sore Throat – is it Strep or Something Else?

Its that time of the year when we see lots of Strep in Clinic.  All year long we see Sore Throats, that everyone fears its strep, but 90% of the time it is just a virus.  So how do you know?  When do you go to see your doctor?  When do just stay home and take care of the symptoms? It’s so confusing!  So here are a few tips that can help.

Sore Throat can be caused by a variety of things: allergies, colds, mono,  flu and other viruses, bacteria like strep or deeper infections that are bacterial, and lastly reflux.

Viral Sore Throat:



Viral Sore Troat with Reddness on the edges of the back of the throat

Mono Throat, the Pus is Viral
Ulcers on Palate
Ulcers on Palate
  • Flu – high fevers, aches, pains, hit by a Mack Truck feeling
  • Coxackie Virus – ulcers on tonsils, mouth, hands, feet, diaper area, etc.
  • Adenovirus – stomach ache, +/- nausea/vomiting/diarrhea, headache, fever, +/- red eyes, +/- body aches
  • Mono – sore throat does not go away after 5-7 days, fatigue, swollen and tender neck lymph nodes


  • scratchy throat
  • sore throat that can be mild to severe
  • pain especially first thing in the morning
  • dry throat, especially in the morning
  • difficulty swallowing
  • +/- fever
  • runny nose
  • cough
  • congestion
  • headache
  • stuffy head
  • body aches


  • acetaminophen or ibuprofen – pick ones without dyes
  • cold drinks, popsicles
  • lozenges without artificial sugars
  • local honey, especially before bed and before brushing teeth
  • humidifier in the bedroom to keep throat from drying up
  • essential oils: peppermint, lemon, oregano, eucalyptus, clove – proceed with caution if you have Asthma.
  • Saline nose wash/ spray 3 times a day will decrease congestion and decrease the snot draining down the back of throat
  • Benadryl at night will dry out snot to lessen the burden on the sore throat 


  • generally spread through coughing and oral secretions
  • teach kids to cough in elbows
  • teach kids, again, to wash hands


Strep Throat Sore Throat:



  • sudden onset sever sore throat lasting all day
  • fevers, on the higher sided
  • chills
  • speech is gargled
  • headache (but not a stuffy head)
  • nausea
  • abdominal pain
  • enlarged lymph nodes around he neck, generally painful
  • back of throat appears very red and with pus
  • rash on the upper chest and neck that looks like sandpaper that is sunburned (scarlet fever) – of note lots of cases in these past 2 weeks of April 2016
  • OF NOTE: if there is also a cough, runny nose, and/or stuffy head, its most likely viral


Scarlet Fever Rash


  • Antibiotics are needed to treat strep.
  • Strep Pharyngitis does go away by itself, but it is treated to prevent Rheumatic Heart Disease (heart condition caused by damage to the heart valves)
  • Change toothbrushes of the person affected 24hrs after being on antibiotics, and change any other toothbrushes that may be in the vicinity of the “infected” toothbrush

**** Special Note **** Some people carry strep in the back of their throat without any symptoms and it causes them no problems.  Thus, its best not to swab and treat those with viral sore throats that clearly do not have strep on an exam done by their doctor or mid-level provider.  Sometimes the Strep Test comes back positive when throats are swabbed for “parent concern” and the child has a virus.  So it is treated.  Treating asymptomatic strep turns this bug into one that will cause problems.  ******


  • Spit Contact – no sharing cups, bottles, toothbrushes (I know disgusting but little siblings often don’t care), etc.
  • Return to school 24hrs after starting antibiotics

Allergies and Sore Throat:


  • itchy and scratchy throat
  • dry throat
  • sneezing
  • coughing
  • watery eyes
  • fatigue
  • swollen face
  • runny eyes
  • goopy eyes


  • local honey daily (on and off allergy season) will help develop oral tolerance to local pollen, grasses, ragweed, mold, etc.  AND soothe the throat
  • take showers at night
  • change clothes after playing/working outside
  • Check out all the tips and trick in this Survival Guide to Spring Allergies

Acid Reflux Sore Throat


  • sore throat in the middle of the night and especially first thing in the AM
  • lots of belching
  • lots of hiccups
  • burning of the chest and or stomach, esp with laying down
  • abdominal pain first thing in the AM
  • nausea, especially first thing in the AM
  • vomiting in the AM or after meals
  • abdominal pain associated with eating
  • daily dry, non productive cough


  • Keep a food diary – usual triggers are spicy foods, citrus juices such as OJ and lemonade, caffeine such as sweet tea/coke/mountain dew/sun drop/too much coffee, dairy, tomato based items, chocolate, processed foods such as lunchables/poptarts/frozen dinners, etc.
  • Constipation – this indicates poor digestion and causes a back up that can lead to reflux.  Read here on how to tackle this problem Treatments for Constipation
  • Viral illnesses that can trigger acid overproduction
  • Smoking and Alcohol consumption
  • Stress
  • Medication
  • Supplements


  • Seek advice from your doctor, to better understand the cause and thus develop a treatment plan


When to Seek Immediate Medical Care

  • difficulty breathing
  • drooling
  • difficulty swallowing and concerns for dehydration
  • symptoms of sever sore throat that are progressing rapidly


How to Prevent Recurrent Sore Throats and Strep?????


In Good Health, Ana-Maria Temple, MD

References :

Do You Have ‘Just’ a Sore Throat — Or Is It Strep? (Infographic)

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