Is It Tonsillitis or Strep Throat? Key Differences You Should Know About
There are many causes of sore throat, with the viruses behind the common cold and flu being prime suspects. While a scratchy throat can be a minor nuisance, it may be a sign of something more serious, like tonsillitis or strep throat.
You may have heard these terms used interchangeably, and the two conditions are often confused because they share many symptoms, but they aren’t the same. Knowing the difference matters: Without prompt treatment with antibiotics, strep throat can lead to serious complications.
If your throat pain is severe, lasts more than a few days, or comes with a high fever or trouble swallowing, don’t wait — see your healthcare provider.
Tonsillitis is an inflammation of the tonsils — two oval-shaped tissue masses at the back of your throat that help protect you against invading viruses and bacteria.
Causes
Tonsillitis is most often caused by viruses, typically the same viruses that cause the common cold, including:
Sometimes a bacterial infection — usually by Streptococcus pyogenes (group A streptococcus or strep) — can cause tonsillitis. Other bacterial causes of tonsillitis include:
Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenza
Symptoms
Tonsillitis can cause many of the same symptoms of the common cold, though they typically last longer and become more severe. Symptoms include:
Sore throat
Swollen or red tonsils
White or yellow coating (pus) on your tonsils
Fever and chills
Trouble swallowing
Bad breath
Swollen lymph nodes in the neck
Stomachache
Headache
Stiff neck
Ear pain
Hoarse voice
The tonsils can also swell large enough to cause problems with breathing, eating, and drinking.
Diagnosis
To determine if you have tonsillitis, your healthcare provider will review your symptoms and perform a physical exam. They will look specifically for:
Tonsils that are red, swollen, or have white patches or pus
Swollen lymph nodes in the neck
Fever
The absence of cough
Once your provider confirms that your tonsils are infected, they’ll need to determine if it’s viral or bacterial, using one of two tests (or both):
Rapid antigen testing, which detects whether you have proteins associated with group A streptococcus in your mucus
Throat culture, which involves laboratory testing of a throat swab
The rapid antigen test provides results in minutes but sometimes produces false negative results. A throat culture takes a few days for results but is more reliable and can detect multiple types of bacteria.
If these tests are negative, you have viral tonsillitis.
Treatment
Similar to the common cold, viral tonsillitis clears up on its own with rest, fluids, and over-the-counter pain relievers.
Gargling with salt water may also help to reduce symptoms.
In rare cases, the body isn’t able to kill the virus completely and tonsillitis may return — five or more tonsillitis episodes in a year is considered recurrent tonsillitis. This typically only occurs in people with compromised immune systems.
Bacterial tonsillitis requires treatment with antibiotics.
Strep throat is a specific kind of throat and tonsil infection caused by bacteria.
Causes
Unlike tonsillitis, strep throat is always caused by group A streptococcus bacteria.
Symptoms
Symptoms of strep throat appear two to five days after exposure and include:
Very sore throat that starts suddenly
Painful swallowing
Red spots on the roof of the mouth (petechiae)
Red, swollen tonsils
White patches or pus streaks on the tonsils
Swollen lymph nodes in the neck
Fever, which may begin suddenly and peak on the second day of illness
Chills and body aches
Less commonly, strep throat can also cause:
General ill feeling
Skin rash
Changes in appetite and taste
Headache
Nausea or vomiting
Stomach pain
Strep throat typically does not (but still may) cause runny nose, cough, or hoarseness, which are common in viral infections like the cold.
The only way to diagnose strep throat is through the rapid antigen test and throat culture. Positive test results along with other signs — rapid onset of symptoms and recent exposure to someone with strep — indicate you have strep throat instead of viral tonsillitis.
Treatment
Strep throat is treated with antibiotics, usually penicillin or amoxicillin.
Causative Agents
Tonsillitis: usually the same viruses that cause the common cold, but also sometimes bacteria, most commonly group A strep
Strep throat: always group A strep bacteria
Symptoms
Both: sore throat, fever, difficulty swallowing, swollen lymph nodes in the neck, and tonsils that are swollen or covered in white patches
Tonsillitis: bad breath, ear pain, and hoarseness
Strep throat: sudden onset of symptoms (fever and sore throat), petechiae (tiny red spots in the mouth), and general malaise
Treatments
Viral tonsillitis: rest, fluids, and pain relief with over-the-counter medications
Bacterial tonsillitis: antibiotics
Strep throat: antibiotics
Complications
Strep throat typically leads to more serious issues if left untreated, including kidney disease, rheumatic fever, and secondary infections like ear infections and peritonsillar abscesses. Rarely, bacterial tonsillitis can also cause these issues.
Viral tonsillitis typically resolves on its own but can become recurrent.
Practice good hygiene and limit your exposure to disease-causing viruses and bacteria to prevent contracting and spreading tonsillitis and strep throat. Here’s how.
Avoid sharing utensils, food, or drinks, especially with someone you know is sick.
Cover your mouth when coughing or sneezing.
Stay away from people who are sick.
Stay away from people if you are sick.
Keep kids home from school if they show symptoms.
Replace your toothbrush every three months and after every time you get sick.
Complete your full course of antibiotics, if antibiotics are prescribed.
Seek medical help if you experience:
Sore throat that lasts more than a few days
Sore throat that is accompanied by enlarged lymph nodes or a rash
Trouble breathing or swallowing
High fever
White patches or pus on the tonsils
Tonsillitis and strep throat can look and feel similar, but they’re not the same.
Tonsillitis is often viral and goes away on its own, while strep throat is bacterial and requires antibiotics for treatment and to prevent serious complications.
If you’re unsure what’s causing your sore throat, play it safe and see a healthcare provider.
