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Sore Throat: Is It Strep or Viral?

Although many people assume that a sore throat means strep throat, most sore throats are not strep.

Most sore throats are caused by viruses. Strep throats are caused by group A streptococcal bacteria. Strep throats are usually not associated with a cough or runny nose. Viral sore throats, on the other hand, often are accompanied by a cough, runny nose, or congestion. Doctors treat group A strep with antibiotics. Antibiotics do not help viral infections. 

Strep is more common in school-age children than in infants. It's common where people are in close quarters, and it's more common in the winter when we're crowded together indoors.

Test needed

In some cases that are clear cut, your health care provider may not need to do any testing. However, in other cases your health care provider may do a rapid strep screen, a throat culture, or both. 

The rapid test sometimes yields "false negatives" when strep is actually there. If the test is negative but other symptoms exist, your doctor may swab the infected area to do a culture for the suspected bacteria. Culture results take 24 to 48 hours to come back, but they rarely miss a case of strep.


Strep infections can also occur in the lungs, skin, or ears. Untreated strep throat can lead to damage to the heart valves, kidneys, and other parts of the body. 

This is why it's so important to keep children on an antibiotic for the entire prescribed length of time, even if they're feeling better.

Signs of strep throat may include:

  • Sore throat

  • Difficulty swallowing

  • Fever, usually 101 degrees Fahrenheit (38.3 degrees Celsius) or higher

  • Swollen glands in the neck

  • Swelling of tonsils, possibly with pus or bleeding spots

  • Headache

  • Abdominal pain and/or nausea

  • A red skin rash (scarlet fever), but not in all cases 

Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: newMentor board-certified, academically affiliated clinician
Date Last Reviewed: 7/17/2013
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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