Is it Strep Throat?

Or Just a Cold...

Doctor using tongue depressor to allow examination of young boy's throat
ADAM GAULT/SPL / Getty Images

Strep throat is a relatively common infection in children, particularly in the winter months. While most sore throats are caused by viruses, they are often misdiagnosed as Strep throat. In fact, up to 73% of patients are given antibiotics, which are useless against viruses. The problem is that misuse of antibiotics is the primary reason ​for the development of antibiotic-resistant superbugs.

Accurate and appropriate diagnosis of strep throat are important for preventing misuse of antibiotics, as well as prevention of long-term complications associated with Strep throat.

What is Strep Throat?

Strep throat, also known as “Streptococcal Pharyngitis,” is caused by bacterial infection of the inside of the throat. It is caused by the bacterial species Streptococcus pyogenes, also known as Group A Strep.

Strep throat is a common affliction among school-age children (ages 5 to 15), comprising up to 50% of sore throats.

What Are the Common Symptoms of Strep Throat?

Symptoms of strep throat may include:

  • Sore throat that is red and swollen with grayish white patches of pus
  • High fever (101 to 104 F is not uncommon in younger children)
  • Headache
  • Swollen lymph nodes
  • Abdominal pain and vomiting (sometimes)
  • Rash (sometimes)

Is it Strep throat or just a cold?

Most sore throats are caused by viruses, such as those responsible for causing colds. Strep throat is not associated with runny nose, loss of voice, diarrhea, or eye discharge (pinkeye). Most colds are not associated with fever, vomiting, or rash.

However, it is possible to have a cold and Strep throat simultaneously, resulting in overlap of symptoms.

For diagnosis of Strep throat, your doctor will look for four conditions:

  1. Fever higher than 99.9 F
  2. Patches of pus in the throat
  3. Swollen lymph nodes in the neck
  4. Absence of cough

If all four conditions are present, the probability of strep throat is 56%.

The probability decreases with each vanishing condition, going down to less than 2.5% if none of the conditions are present. Based on the presence or absence of these conditions, your doctor will decide whether or not diagnostic testing is needed.

When should I call the doctor?

If you have a sore throat with fever or exhibit any of the other characteristic symptoms, contact your doctor or pediatrician to see if you should be examined or tested for Strep throat.

Why is it important to properly diagnose and treat Strep throat?

The sore throat phase (“acute pharyngitis”) of the infection is less alarming than the complications that can arise from the disease. Complications of Strep throat include rheumatic fever (an immune reaction against part of the heart tissue), rheumatic heart disease and acute glomerulonephritis (kidney disease). Heart-related conditions are the primary reason why doctors will treat aggressively with antibiotics.


Rakel and Bope. Conn’s Current Therapy 2008, 60th ed. ©2008 Saunders. An Imprint of Elsevier.

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