Strep Throat vs Tonsillitis vs Sore Throat

by eMedExpert staff
Medical references reviewed: August, 2018

Answers for many frequently asked questions about difference between strep throat, tonsillitis, common cold, and sore throat.

Definitions

Definition is the starting point to help you understand the difference between strep throat, tonsillitis, common cold, and sore throat.

Strep throat (medical terms streptococcal tonsillitis or streptococcal pharyngitis), is an infection with group A beta-hemolytic streptococcus bacteria.

Tonsillitis means inflammation of the pharyngeal tonsils, small tissues located at the back of the throat (pharynx), typically caused by an infection. The inflammation usually extends to other areas of the throat, including adenoids and the lingual tonsils. So the term pharyngitis is often used.

Pharyngitis means inflammation of the pharynx (the Greek word for throat). And this term is often used for conditions like tonsillitis, tonsillopharyngitis, nasopharyngitis.

Now it becomes clear why the terms "tonsillitis," "tonsillopharyngitis", and "pharyngitis" are often used interchangeably.

Sore throat is a broad concept referring to soreness in any area of the throat.

Strep Throat vs Tonsillitis

Strep throat means specifically an infection with Streptococcus bacteria.

Strep throat affects the tonsils and mucus membranes lining the pharynx (the back of the throat), causing inflammation and swelling. So, strep throat involves tonsillitis or pharyngitis.

Tonsillitis covers a broader range of infections. Unlike strep throat, tonsillitis can be caused by viruses, and by bacteria other than streptococci.

If you have strep throat, the term tonsillitis is applicable. But if you have tonsillitis or pharyngitis, it may be not due to strep infection.

Strep Throat Causes

Only bacterial!

  • The great majority of Strep throats (streptococcal pharyngitis/tonsillitis) are caused by Group A beta-hemolytic streptococci (Streptococcus pyogenes)
  • Streptococci of groups C and G are occasionally involved, sometimes causing acute pharyngitis in young adults.

Tonsillitis Causes

Tonsillitis (as well as tonsillopharyngitis, and pharyngitis) is typically caused by viruses or by bacteria.

Bacterial Tonsillitis

  • Group A β-hemolytic streptococcus (GABHS) the major causative bacteria, accounting for about 30% of tonsillitis.
  • Streptococci of groups C and G (rarely)
  • Staphylococcus aureus
    Streptococcus pneumonia
    Mycoplasma pneumonia
    Chlamydia pneumoniae are sometimes involved.
  • Neisseria gonorrhoeae (causes characteristic greenish exudate).
  • Neisseria meningitis
  • Fusobacterium
  • Corynebacterium diphtheriae (serosanguineous nasal discharge and exudative grayish-white pharyngeal membrane are signs of diphtheria).
  • Treponema pallidum

Viral Tonsillitis
Tonsillopharyngitis is usually viral, most often caused by:

  • Rhinovirus the most common pathogen of viral sore throats, accounting for about 50% of episodes 1
  • Coronavirus responsible for about 10% of colds
  • Adenovirus (can cause an exudative tonsillitis similar to that caused by group A streptococci)
  • Respiratory syncytial virus
  • Influenza A, B
  • Parainfluenza
  • Enterovirus
  • Epstein-Barr virus (the causative pathogen of mononucleosis or 'mono')
  • Herpes simplex virus (causes gingivitis and stomatitis)
  • Cytomegalovirus

Strep Throat vs Sore Throat (Cold)

How to distinguish strep throat from sore throat caused by common cold?

While the terms sore throat, cold, and strep are often used interchangeably, there are essential differences between these conditions. Common cold is often referred to as "sore throat" because it the most frequent cause of sore throats.

The principal difference between strep throat and cold is that they are caused by completely different pathogenic microorganisms.

Strep throat (streptococcal pharyngitis) is a bacterial infection with group A beta-hemolytic streptococcus.

Common cold is a viral infection of the upper respiratory tract. Rhinoviruses cause about half of all common colds. Other viruses associated with the cold are coronaviruses are respiratory syncytial virus.


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In most cases strep throat is treated with antibiotis.

Common cold is treated symptomatically:

  • Acetaminophen, ibuprofen, and other NSAIDs for sore throat
  • Decongestants, antihistamines for nasal congestion
  • Antihistamines, antitussives, bronchodilators for cough

Strep throat symptoms vs Cold symptoms checklist

Both strep throat and cold are accompanied by sore throat.

To distinguish one condition from another can help the presence of indicative symptoms and the absence of characteristic symptoms of the other disease.

More likely to be Strep throat More likely to be Cold
Sudden onset of severe throat pain Symptoms develop over few days
Age 5-15 years Age 45 years or older
High fever (> 38 C) Afebrile (without fever)
Most prominent symptoms:
• Very painful sore throat
• Painful swallowing
Sore or scratchy throat
White or yellow spots on the tonsils (exudate)
Most prominent symptoms:
• Rhinorrhea (runny nose)
• Nasal obstruction (stuffy nose)
• Sneezing
Absence of a cough Cough (usually dry and non-productive at the beginning of illness)
Enlarged, tender cervical lymph nodes Hoarse voice
Nausea, vomiting, and abdominal pain are common in children, but very unusual in adults Diarrhea

References

  • 1. Mäkelä MJ, Puhakka T, Ruuskanen O, Leinonen M, Saikku P, Kimpimäki M, Blomqvist S, Hyypiä T, Arstila P. Viruses and bacteria in the etiology of the common cold. J ClinMicrobiol. 1998 Feb;36(2):539-42.

Published: May 08, 2018
Last updated: August 01, 2018


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