Sore throats are pretty common. In fact, they make up about 6% of all primary care visits. Of those appointments, only about 20-30% of people test positive for strep.
Strep throat is most common in children ages 5-15 during the winter. While it's a seasonal illness, it can occur year-round.
A plain old sore throat is much more likely than strep throat. But how can you tell when it's time to take your child to their doctor? Our pediatricians Lena van der List and Dean Blumberg break it all down in their Kids Considered podcast.
How can you tell the difference between sore throat and strep throat?
Strep throat symptoms typically come on pretty quickly. Colds and sore throat symptoms are more gradual in that you slowly start feeling more and more sick.
With strep throat, there are no other upper respiratory symptoms. With the common cold and general sore throat, patients often have other symptoms like a cough, congestion, runny nose or sneezing.
Strep throat is also very rare in children under 3 years old.
Listen to our Kids Considered podcast on sore throat vs. strep throat
What is the main cause of a sore throat?
Many different viral illnesses can cause sore throat. Some common ones are rhinovirus (common cold), flu, adenovirus, and coronaviruses, like COVID-19. These typically lead to redness and rawness in the back of the throat.
One virus that really mimics strep throat is the Epstein-Barr virus, the virus that causes mono. Both of them cause a lot of inflammation in the back of the throat and lead to "white stuff" in the back of the throat.
What are symptoms of strep throat?
The typical strep throat symptoms that health care providers look for include:
- Fever
- Swollen or tender lymph nodes in the front of your neck
- White pus on the back of the tonsils
- Little red dots on the roof of the mouth
Some children can also experience abdominal pain, vomiting and headache.
Learn about more strep throat symptoms to watch for
How does strep throat spread?
Strep throat is caused by a bacteria that is spread through respiratory droplets. The most common causes of strep infection include:
- Breathing it in through respiratory droplets in the air when an infected person coughs, sneezes or talks.
- Sharing items that contain saliva (i.e. eating utensils, toothbrush, etc.) from a person with strep infection.
- Direct contact with infected sores on an infected person's skin.
The time from exposure until you start feeling sick – known as the incubation period – is typically two to five days.
How do you rule out strep throat?
When you or your health care provider suspect strep throat, they will do a throat swab. There are two kinds of tests for strep throat.
Rapid antigen test
A rapid antigen test is performed in your provider's office. Results come back in 10-15 minutes. Not many tests come back false-positive, or positive when a person actually doesn't have strep. However, there can be false-negatives, or the test shows no strep infection when there actually is infection. If there's a false-negative result, providers typically perform a throat culture, or PCR test to confirm.
Throat culture
This test is more sensitive to the detection of strep but takes longer for results to come back. A throat culture, also known as a PCR test, is where the throat is swabbed and then sent out to grow or detect the virus. This usually takes a couple days to come back with results.
Learn more about the types of strep tests
How does strep throat go away? What are some strep throat treatments?
If the throat swab comes back positive for strep, it's usually treated with antibiotics. Most people will get better without antibiotics, but if it's not treated, there's a risk of developing acute rheumatic fever. Antibiotics also help patients feel better faster.
Patients are typically prescribed oral penicillin or amoxicillin for 10 days. If children are allergic to penicillin, the next choice is a cephalosporin. Patients tend to start feeling better after one or two days of treatment.
Some cases of strep throat are quite bad with a lot of swelling in the back of the throat. In these instances, providers can give a dose of steroids to help with swelling.
Find out more about strep throat recovery
What are some home treatments for sore throat or strep throat?
For both sore throat and strep throat, managing pain with over the counter medications is helpful. This includes acetaminophen and ibuprofen.
Popsicles can help numb a sore throat. These other mixtures can help soothe sore throats:
- Honey can help but should only be offered to children over 1 year old. Mix one tablespoon of honey with one to three ounces of warm water.
- Parents can encourage gargling with warm salt water. However, children can't normally do this until they are about 6 years old. Mix one teaspoon of salt in eight ounces of warm water, gargle and spit out.
Be sure you or your child stay hydrated with water or juice. Children should be urinating at least once every eight hours or more. Anything less than that becomes concerning.
Check out some tips for recovering from strep throat
When do you need antibiotics for a sore throat?
Antibiotics should only be given if you or your child has a positive strep test and has symptoms. It's important not to use antibiotics when they're not needed.
When should I or my child go to the doctor for a sore throat?
Routine sore throats typically start fading away in about five days. However, if symptoms don't go away, or you or your child have a fever of at least 101° F that lasts a few days, call your primary care provider.
Other symptoms along with the sore throat that might be cause for concern include:
- Dehydration
- Trouble breathing
- Drooling
- Blood in saliva
Learn more about primary care for you and your family
If strep throat is going around at school, should I bring my child in for a throat swab?
If your child doesn't have strep throat symptoms, you do not need to bring your child into a health care clinic for a strep test. It's not recommended to bring someone in for testing if they don't have symptoms, even if they've had contact with an infected person.
How contagious is strep throat?
Strep throat is very contagious. It can be spread when people talk, cough or sneeze.
There are also some people who carry strep infection but don't have symptoms. About 15-20% of school-aged children have strep bacteria living in the back of their throats, especially during the winter months. They may test positive, but don't actually have symptoms of infection.
Find out more about how long strep throat is contagious
How long does strep throat last?
Strep throat typically starts going away in two to five days. However, it can take longer in some cases. Patients who get on antibiotics after a positive strep test tend to start feeling better in one to two days.
When is it OK for children to return to school after having strep throat?
Providers typically advise that children can return to school using the following three pieces of criteria:
- Once they are feeling better,
- Fever is gone for 24 hours, and
- The child has been on antibiotics for at least 12 hours.
Get tips on how to prevent strep infection
This blog was medically reviewed by Dean Blumberg, chief of pediatric infectious diseases.
