Is It Just a Sore Throat—or Something More Serious?

You might need to see a doctor—or you might only need a good night’s rest.

Is It Just a Sore Throat—or Something More Serious?

Before you wake up and open your eyes, you know something’s wrong. You feel like someone’s raked your throat with hot needles. Ouch.

If you’ve also got head congestion, a runny nose, watery eyes and a cough, then it’s possibly a simple upper respiratory infection—a.k.a. the common cold. Colds are caused by viruses and can last, as you probably know from experience, for about a week.

Absent those other symptoms, however, you may have strep throat, a potentially more serious infection caused by the Streptococcus bacteria.

Strep throat in children vs. adults
Though strep throat is common among children, especially those aged 5 to 15, it’s rarer in adults. According to the Centers for Disease Control and Prevention, 4 to 6 of every 20 children with sore throats have strep. Only about 1 to 3 of every 20 adults with a sore throat has strep.

“In my practice, I may see five or six adults a year who have strep, but I see plenty of kids with strep,” says Kathryn A. Boling, MD, a Family Medicine specialist at Mercy Hospital in Baltimore and Mercy Personal Physicians in Lutherville, Maryland.

But many adults with throat pain just assume it’s strep, says Boling. “And since we’re in an age of instant gratification, as soon as a patient gets a sore throat, they come right in expecting me to make it go away—and fast,” Boling adds.

The symptoms of strep throat
How do you know whether your sore throat is strep? These symptoms can signal the bacterial infection, says Boling:

  • Pain comes on quickly, can be severe, and it hurts to swallow.
  • Lymph nodes under your chin on the sides of your neck are swollen.
  • You have a fever over 101°F. Adults over 65 may not present with a fever but can still have strep and should see a doctor if they have other symptoms of strep.
  • There are white patches or streaks of pus in the back of your throat.

You may also feel generally sick; you might even feel nauseated or have stomach pain (more common in kids than adults). However, even if you have all these symptoms, there’s still a good chance it’s something else—and not strep throat.

How to treat a sore throat—and strep throat
If your sore throat is accompanied by general cold symptoms—congestion, runny nose, a cough, watery eyes and either a low fever or no fever—then follow the standard procedure for dealing with an uncomplicated cold. Rest and drink plenty of fluids—hot tea with honey and lemon is especially soothing, advises Boling, or try a bowl of soup made with clear broth.

If you suspect strep, see your doctor, recommends Boling. She can give you a rapid strep test which will immediately detect the bacteria. It’s important to have strep diagnosed and treated with an antibiotic, she says, because untreated strep can escalate into strep pneumonia, an ear infection or a sinus infection. Untreated strep is especially dangerous for children.

“In children, untreated strep can develop into rheumatic fever, which affects the heart,” says Boling.

Though strep can heal on its own in about a week without antibiotics, says Boling, it’s best to treat it with an antibiotic such as amoxicillin. After 24 hours of taking the medicine, you’re no longer contagious, which is important if you’re taking care of older adults, people with weakened immunity or younger children.

In fact, anyone who has strep should avoid being around people with a weakened immune system, says Boling, including pregnant women, people with HIV, anyone undergoing chemotherapy treatments and frail older adults.

Whether you have a case of strep or just throat soreness stemming from a common cold, it’s important to keep either illness from spreading. Wash hands with soap and warm water often, especially if you’re around others who may be sick. Cover your nose and mouth when sneezing. When using hand sanitizer, rub it into your hands completely and let it dry. Finally, avoid sharing food, utensils, glasses and even your cell phone with others while you’re feeling ill.

Medically reviewed in February 2020.

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