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Strep Throat vs. Sore Throat: What’s the Difference?


We all get sore throats at various times. The soreness can vary from being a temporary annoyance to a feeling like having swallowed broken glass.

There are many terms that healthcare professionals use to describe a sore throat, and unfortunately, there is a lot of overlap. The most used word is pharyngitis, but it is helpful to understand the language and description of discomfort of the throat in order to differentiate between types of sore throats, including Strep throat.

Strep throat is a bacterial infection of the throat. It is caused by the bacteria called Streptococcus pyogenes. The name is derived from the Greek, meaning a chain (streptos) of berries (kokkos [coccos in Latin]). The infection is pus (pyo) forming (genes).

What is a sore throat?

Sore throat is called pharyngitis. The best description includes the symptoms of pain, discomfort, scratchiness, and problems swallowing.

Difficulty swallowing is called dysphagia.

Pain with swallowing is called odynophagia.

There are many reasons one can have a sore throat. Most of us think of infection, particularly Strep infections, but in reality, Strep infections cause only a minority of sore throats. It is important to recognize a Strep throat infection because there are several complications, which can easily be avoided such as rheumatic fever and heart disease with proper treatment.

The description of a sore throat includes the broad categories of:

  • Infection (bacterial, viral, or fungal).
  • Inflammation (allergy, hay fever, environmental irritants).
  • Trauma (this includes harsh chemicals, acids or bases, smoking, and other injuries).
  • Tumors (benign and malignant).

Inflammation can occur from several causes we all know well. These may include allergies, postnasal drip, and even stomach acid from gastroesophageal reflux. Coughing or gagging can cause a sore throat. Nasal and sinus problems can cause sore throats, but they are not Strep throat.

Trauma is another popular cause. We may inadvertently choke on some food or drink or ingest something that is particularly spicy or hot, and we are all familiar with that brief sore throat.

Lesions or tumors of the throat or mouth cause a myriad of different symptoms. Everyone can relate to the fact that even the slightest perturbation in our mouth or throat causes us all a great deal of discomfort. It is like a rock in our shoe that we desperately need to remove.

Examples include getting food caught or a mouth ulcer. Interestingly, people who develop tumors, whether they are benign or malignant, learn to live with them. They tend to tolerate the sore throat, call it their ongoing “Strep throat,” and figure it will eventually go away. Of course, it does not.

And that is why any “Strep throat,” even if it is not anything to do with infection should be checked out by a healthcare professional. In other words, “Strep throat” has become a euphemism for many diverse types of sore throats.

Many of these sore throats are solved as soon as the reason for the sore throat is identified. We all like to think of a Step throat as being a reason we can latch on to as a definite cause, especially in children, so that we know there is an immediate answer.

Sore throats may be one of the most common complaints for patients presenting to the doctor, urgent care clinic, or emergency room. The reality is that a careful history and a physical diagnosis may be more important in the diagnosis than any testing.

What are the symptoms associated with sore throats and which ones suggest Strep throat?

Generalized symptoms occur with sore throats relating to infection or inflammation. Because the throat is so sensitive, it can affect how we feel in general.

Generalized symptoms may include:

  • Fever, chills
  • Fatigue, malaise
  • Abdominal pain (quite common for children to complain of a concomitant “stomach ache”
  • Nausea or vomiting

More specifically, many have a viral infection rather than a bacterial or fungal infection. In most cases, these are viral infections that have been transmitted by airborne droplets, cough, sneezing, close contact or by touching object surfaces or fomites (items likely to carry infection).

The symptoms that are suggestive of a viral illness include:

  • Runny nose, nasal congestion.
  • Ear fullness, popping or congestion (eustachian tube dysfunction).
  • Eye redness or pink eye (conjunctivitis caused by an Adenovirus).
  • Hoarseness or loss of voice.
  • Body or muscle aches (myalgias are common with Influenza).
  • Enlarged lymph nodes (These can occur with cytomegalovirus, mononucleosis, HIV, and various other viral infections and can affect the whole body. Strep throat is usually associated with enlarged lymph nodes in the neck region only. This is called anterior cervical lymphadenopathy).

The signs and symptoms suggestive of Strep throat are similar to other bacterial infections of the throat, but there are several that make the healthcare provider think more about “Strep throat” than another cause. Strep throat is the most common bacterial cause and many times the history helps as well. Many children can be carriers of Strep and spread the disease in families and among their friends.

Symptoms that are highly suggestive of Group A Streptococcus pharyngitis include:

  • The Anterior Cervical Adenopathy as described above.
  • Fever which can be high and last for up to five days.
  • Whitish coating in the mouth, particularly on the tongue and back of the throat, including the tonsils.
  • Foul-smelling breath. While this is not pathognomonic or definitive, after a healthcare provider sees enough patients, children in particular, that smell is not something that anyone forgets. Some mothers bring their children to the clinic not because of any impending symptoms, but they know their child is developing Strep throat due to the characteristic odor.
  • While viral infections are more associated with eustachian tube dysfunction symptoms like ear popping or fullness, children with Strep throat are more likely to develop middle ear infections or otitis media.
  • Lack of cough.

Conclusion

Sore throats and Strep throat symptoms have a lot in common, but your healthcare provider will be able to determine whether you or your child have a virus – such as a head cold – or a bacterial illness causing Strep throat.

Key takeaways

  • Every sore throat is not a Strep throat, but every Strep throat usually causes a sore throat.
  • Yes, everyone can get Strep throat, even those who have previously undergone a tonsillectomy and/or adenoidectomy. This is particularly disappointing to those who have undergone surgery only to find out they have Strep throat again.
  • Strep throat can be diagnosed with or without a rapid Strep test or throat culture. These tests, particularly the rapid Strep test, can offer misleading results and often can lead to overuse or underuse of antibiotics.
  • Use of antibiotics for Strep throat in the right circumstances saves lives. The incidence of complications such as rheumatic heart disease has decreased significantly because of judicious use of penicillin and other antibiotics.

References:

Mayo Clinic. Strep Throat.

Mount Sinai. Pharyngitis – Sore Throat.

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