Strep Throat: Sorting the Viral from the Bacterial Sore Throat

What is strep throat?

Strep throat is a sore throat caused by a bacterial infection, specifically a group of bacteria called streptococcus. It is one cause of a sore throat, but it is far from the most common — the majority of sore throats are actually caused by viruses, such as those behind colds and flu. Telling the two apart matters because it determines whether antibiotics are useful. For background on bacterial illness, see bacterial infections explained.

Viral versus bacterial sore throats

This distinction is the heart of the matter:

• Viral sore throats are the most common. They often come with cold-like symptoms — a runny nose, cough, sneezing and a hoarse voice — and they get better on their own without antibiotics.
• Bacterial sore throats (strep throat) are less common but can be more intense. They are more likely to involve sudden, severe throat pain without the typical cold symptoms.

Antibiotics only work against bacteria, so they have no effect on viral sore throats. Taking them unnecessarily contributes to antibiotic resistance.

Signs that point towards strep throat

No single symptom is definitive, but features that make strep throat more likely include:

• A sudden, severe sore throat.
• Pain when swallowing.
• Red, swollen tonsils, sometimes with white patches or pus.
• Swollen, tender glands in the neck.
• A high temperature.
• The absence of a cough and runny nose.

Strep throat is more common in children and teenagers than in adults.

Self-care for a sore throat

Most sore throats, whether viral or mild bacterial, can be soothed at home while they settle:

• Rest and drink plenty of fluids.
• Try warm drinks or gargle with warm salty water (adults only).
• Suck on lozenges or ice to ease discomfort.
• Over-the-counter pain relief may help — a pharmacist can advise on what is suitable for you.

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When antibiotics are appropriate

When a doctor judges that strep throat is likely or confirmed, antibiotics may be prescribed. If you are given them, use them responsibly:

• Finish the entire course as directed, even once you feel better, to fully clear the infection.
• Never share antibiotics or use leftovers from a previous illness.
• Tell your prescriber about any allergies — penicillin allergy, for example, is important to flag so an alternative can be chosen.

Responsible use helps slow the rise of antibiotic resistance, which keeps these medicines effective for everyone.

When to see a doctor

See a doctor if:

• A sore throat is severe or does not improve within about a week.
• You have a high temperature that is not coming down.
• You have white patches or pus on the tonsils with swollen neck glands.
• You keep getting sore throats.

Urgent red flags

Seek urgent help if you have difficulty breathing, difficulty swallowing fluids or saliva, drooling, a muffled voice, or severe swelling — these are uncommon but need prompt attention.

The takeaway

Most sore throats are viral and clear up on their own with rest and self-care. Strep throat is a less common bacterial cause that may need antibiotics, which should always be taken exactly as prescribed and never used for viral infections. A doctor or pharmacist can help you decide what is needed.

General information only — not medical advice. Always read the patient information leaflet and consult a doctor or pharmacist before starting any medication.