Wonder if your painful sore throat is from a cold or strep throat? Are you wondering if your sore throat requires antibiotics? Here’s how to tell.

Very often a common cold is accompanied by a sore throat, which makes it difficult to distinguish from strep throat. A cold is a virus, but strep is a bacterial infection that typically requires treatment with an antibiotic.

By recognizing the distinguishing characteristics of each illness, you can make the necessary doctor appointment to treat strep or just try to reduce cold symptoms with over-the-counter medications.

Common cold

About 90 percent of all sore throats are caused by viruses and are part of a cold. Viral sore throats are quite contagious.

In addition to a sore throat, a common cold is likely to cause: sneezing, stuffy or runny nose, watery eyes, cough, low fever (less than 102- F), slight body aches or mild headache.

Strep throat

About 10% of sore throats are due to the strep bacteria. The tissues in the back of the throat and the tonsils become irritated and inflamed, causing a sudden, severe sore throat. Often it makes painful to talk or swallow. White or yellow spots on the back of the throat may be present. These spots may also appear on the tonsils.

Coughing is usually absent in strep throat. A stuffy nose is also considered uncommon and is more likely due to a virus instead of the strep bacteria.

How to distinguish between the Cold and Strep Throat

There is no simple way to distinguish a viral sore throat from a bacterial sore throat. Although the throat culture test is the only way to know for sure if you have a strep throat, sometimes you can distinguish between the two based on your symptoms:

Stuffy or runny nose, Sneezing: Common cold usually starts with a runny nose and sneezing. Nasal symptoms are not usually present with strep.

Cough: As a general rule, if you have a prominent cough you are more likely to have viral infection than strep throat.

Temperature: What sets a cold apart from other infections is the lack of a high fever. However, a temperature higher than 38.5-C (101.3-F) is a typical symptom with strep.

Throat symptoms: Bright red inflamed tonsils; white or yellow spots; coating on the tonsils; swollen, tender lymph nodes (swollen glands) in the front of the neck are symptoms of strep.

Colds frequently have a sore throat, but not the other throat symptoms. Typically the degree of neck lymph node enlargement is modest and the throat often does not appear red, although is very painful. With cold the throat discomfort usually resolves by the second or third day.

Onset of symptoms: The onset of a cold is usually gradual. The cold symptoms do not usually occur all at the same time. Strep normally has a more sudden onset, with a fever that peaks on the second day.

Other indicators that increase or decrease the likelihood of strep throat
Increased likelihood	Decreased likelihood
Age 3-18 years	Age 45 years or older
Recent close exposure to group A strep	Hoarseness
Current group A strep epidemic	Diarrhea

Important note: Strep can NOT be accurately diagnosed by looking at the throat alone. It requires a laboratory test.

 

References & Sources

• 1. MedlinePlus Medical Encyclopedia: Strep throat National Institutes of Health
• 2. Pharyngitis eMedicine
• 3. Management of Group A Beta-Hemolytic Streptococcal Pharyngitis American Academy of Family Physicians
• 4. Common Cold National Institutes of Health
• 5. Cold and Flu American Academy of Family Physicians
• 6. The Common Cold: What You Should Know American Academy of Family Physicians
• 7. Diagnosis and Management of Group A Streptococcal Pharyngitis From the Acute Pharyngitis Guideline Panel, Infectious Diseases Society of America