Coming down with a sore throat is never ideal, and if accompanied by other symptoms can be concerning. But a sore throat isn’t always serious and may occur for a number of reasons.
Sore throats are often caused by either colds or strep throat. While you may notice similar symptoms, there are a few distinguishing characteristics to help you decide if you should call a doctor.
Sore throats can be caused by both colds and strep throat, as well as other causes like allergies, acid reflux, and environmental factors.
If you think you have either a cold or strep, it’s important to distinguish between them so you can get proper treatment if you have strep.
The cause of colds and strep throat are different:
- Colds are caused by a virus in your upper respiratory tract. The most common one is the rhinovirus.
- Strep throat is caused by a bacterium known as Streptococcus pyogenes. Each year, strep throat is the cause of 15 to 30 percent of sore throats in children and 5 to 15 percent of sore throats in adults. If left untreated, strep throat may become rheumatic fever, scarlet fever, or poststreptococcal disorder.
Both colds and strep are contagious and spread through the air or by contact with an infected person.
It is possible to have a cold and strep throat at the same time, as you can have both a viral and bacterial infection simultaneously. See your doctor to diagnose the underlying causes of your symptoms.
In children
It may be difficult to distinguish whether your child has a cold or strep throat. Infants and toddlers are less likely to get strep throat than older children.
In infants and toddlers, strep throat symptoms may be milder and include:
- a low-grade fever
- bloody, thick snot
- behavioral changes
- appetite changes
Children ages 3 and over will mostly likely:
- have a high fever
- complain of a very sore throat
- have spots on their tonsils
- have swollen glands if they have strep
Contact your doctor if you’re concerned your child has strep throat to get a proper diagnosis.
Signs and symptoms of strep throat may include inflamed, red tonsils, sometimes with white or gray spots. The lymph nodes in your neck may also be swollen. Not everyone gets these symptoms, however.
Some symptoms of the common cold and strep throat overlap, but many are distinct. Keep in mind that you may not have every symptom listed below.
| Cold (viral infection) | Strep (bacterial infection) |
| sore throat | sore throat |
| fever | red, inflamed tonsils with white spots |
| cough | swollen lymph nodes |
| nasal congestion | pain when swallowing |
| headache | fever |
| runny nose | lack of appetite |
| muscle aches and pains | headache |
| red, watery eyes | abdominal pain |
| sneezing | rash |
| mouth breathing | |
| abdominal pain | |
| vomiting | |
| diarrhea |
Note that coughing isn’t usually a sign of strep throat and is more likely a symptom of a viral infection.
Do I have strep throat?
Here are a few questions you may have about whether your symptoms point to a cold or strep throat.
Question: I have a sore throat and fever. Do I have a cold or strep throat?
Answer: You can have both of these symptoms with either a cold or strep throat. Look for signs of swollen glands and inflamed tonsils if you suspect strep.
Q: My throat hurts, and when I look at my tonsils in the mirror they look red and have white spots. Is this a sign of strep?
A: Possibly. Inflamed tonsils with white spots along with a sore throat may indicate that you have strep throat.
Q: I don’t have a fever. Could I still have strep?
A: Yes, you can have strep without a fever.
Q: My throat hurts and I’ve been coughing a lot. Do I have strep?
A: It’s more likely that you have a cold than strep throat. Coughing isn’t a symptom of strep.
Doctors will diagnose colds and strep throat based on your symptoms. They may conduct a test for strep throat if they suspect the condition based on your symptoms.
Colds
There’s not a lot a doctor can do to treat a cold caused by a virus. It will have to run its course, which usually takes 7–10 days.
Some children may benefit from steroid treatments for wheezing if they have a cold.
If your cold symptoms linger and you don’t feel better after a week or so, you should contact your doctor and schedule an appointment. You can develop complications due to a cold.
Strep
You should see a doctor if you suspect strep throat. This will ensure that you get diagnosed and treated quickly.
Your doctor may use the Centor score to determine how likely it is that you have strep throat based on physical symptoms and your age. This scoring system assigns points based on:
- the absence of a cough
- swollen, tender cervical nodes located on the front of the neck
- a fever greater than 100.4°F
- a white or gray coating on the tonsils
Your doctor will also factor in your age to determine whether you need a rapid antigen detection test (RADT).
Children are more likely to get strep throat than adults, so your doctor will consider that when evaluating the possible diagnosis.
Your doctor will take a RADT or throat culture to confirm a strep throat diagnosis. A RADT will provide immediate results in your doctor’s office and other cultures may take a few days for results.
A cold and strep throat require different treatments.
Colds
There are no medicines available that cure colds caused by viral infections. However, you can manage your symptoms with some medications and home remedies.
Some over-the-counter medications that may alleviate a sore throat and other cold symptoms for adults include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- decongestants (may include an antihistamine)
- cough medicines
You should only use over-the-counter medications specifically for children if your child has a sore throat. Children shouldn’t use cough or cold medications if they’re 4 years old or younger.
Some medications or home remedies to try for children with sore throats include:
- children’s NSAIDs or acetaminophen
- saline spray
- buckwheat honey (for children older than one)
- vapor rubs (for children older than two)
- a humidifier
Home remedies that may provide adults comfort from a sore throat caused by a cold include:
- a humidifier
- fluids like water or hot tea
- a saltwater gargle
- ice chips
Strep
A positive test for strep will prompt your doctor to prescribe antibiotics to treat the bacterial infection. Antibiotics will:
- shorten the time you have strep throat
- reduce the chance of spreading it to someone else
- decrease the risk of developing a more serious condition
Antibiotics will lessen the symptoms of strep throat by about a day.
Your doctor may prescribe penicillin as the first-line antibiotic for strep throat. If you’re allergic to it, your doctor may try cephalosporin or clindamycin. Recurring cases of strep throat may be treated by amoxicillin.
Make sure to take the antibiotic for the entire period prescribed by your doctor, even if you start to feel better before the dosing ends.
You may feel better within three or five days after starting antibiotics. You may return to your regular routine like work or school after being on antibiotics for 24 hours or more.
NSAIDs can calm symptoms of strep throat before the antibiotics take effect. Ask your doctor about using throat lozenges or pain relievers you can apply directly to your tonsils.
In cases where your strep throat keeps returning, your doctor may suggest having your tonsils removed. This is known as a tonsillectomy.
If you suspect you have strep throat, see a doctor for a diagnosis and treatment.
You should also see a doctor if your symptoms linger for several days or weeks. Always see a doctor if your symptoms cause difficulty breathing or if you experience a rash following antibiotic treatment.
Your sore throat may be a sign of either a cold or strep throat.
Consider your symptoms and contact your doctor if you suspect strep throat. You can treat strep throat with antibiotics to heal faster and get back to your day-to-day life.
The common cold is a virus that can’t be cured, but you can try using some over-the-counter medications and home treatments to relieve your symptoms.