Is It Tonsillitis or Strep Throat? Key Differences You Should Know About

There are many causes of sore throat, with the viruses behind the common cold and flu being prime suspects. While a scratchy throat can be a minor nuisance, it may be a sign of something more serious, like tonsillitis or strep throat.

You may have heard these terms used interchangeably, and the two conditions are often confused because they share many symptoms, but they aren’t the same. Knowing the difference matters: Without prompt treatment with antibiotics, strep throat can lead to serious complications.

Causes

Tonsillitis is most often caused by viruses, typically the same viruses that cause the common cold, including:

• Rhinovirus
• Respiratory syncytial virus, or RSV
• Adenovirus
• Coronavirus

Other more serious viruses like Epstein-Barr virus, hepatitis A, and HIV can also cause tonsillitis.

Sometimes a bacterial infection — usually by Streptococcus pyogenes (group A streptococcus or strep) — can cause tonsillitis. Other bacterial causes of tonsillitis include:

• Staphylococcus aureus 
• Streptococcus pneumoniae
• Haemophilus influenza

Symptoms

Tonsillitis can cause many of the same symptoms of the common cold, though they typically last longer and become more severe. Symptoms include:

• Sore throat
• Swollen or red tonsils
• White or yellow coating (pus) on your tonsils
• Fever and chills
• Trouble swallowing
• Bad breath

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• Swollen lymph nodes in the neck
• Stomachache
• Headache
• Stiff neck
• Ear pain

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• Hoarse voice

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The tonsils can also swell large enough to cause problems with breathing, eating, and drinking.

Diagnosis

To determine if you have tonsillitis, your healthcare provider will review your symptoms and perform a physical exam. They will look specifically for:

• Tonsils that are red, swollen, or have white patches or pus
• Swollen lymph nodes in the neck
• Fever
• The absence of cough

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• Rapid antigen testing, which detects whether you have proteins associated with group A streptococcus in your mucus
• Throat culture, which involves laboratory testing of a throat swab

The rapid antigen test provides results in minutes but sometimes produces false negative results. A throat culture takes a few days for results but is more reliable and can detect multiple types of bacteria.

If these tests are negative, you have viral tonsillitis.

Treatment

In rare cases, the body isn’t able to kill the virus completely and tonsillitis may return — five or more tonsillitis episodes in a year is considered recurrent tonsillitis. This typically only occurs in people with compromised immune systems.

Bacterial tonsillitis requires treatment with antibiotics.

Strep throat is a specific kind of throat and tonsil infection caused by bacteria.

Causes

Unlike tonsillitis, strep throat is always caused by group A streptococcus bacteria.

Symptoms

Symptoms of strep throat appear two to five days after exposure and include:

• Very sore throat that starts suddenly

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• Painful swallowing
• Red spots on the roof of the mouth (petechiae)
• Red, swollen tonsils
• White patches or pus streaks on the tonsils
• Swollen lymph nodes in the neck
• Fever, which may begin suddenly and peak on the second day of illness
• Chills and body aches

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Less commonly, strep throat can also cause:

• General ill feeling

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• Skin rash
• Changes in appetite and taste
• Headache
• Nausea or vomiting
• Stomach pain

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Left untreated, strep throat can lead to serious complications including:

• Peritonsillar abscesses, which are pockets of pus around the tonsils that can block your airway
• Kidney disease
• Rheumatic fever, a severe infection that can damage the heart
• Ear and sinus infections
• Scarlet fever

Diagnosis

Treatment

Strep throat is treated with antibiotics, usually penicillin or amoxicillin.

Causative Agents

• Tonsillitis: usually the same viruses that cause the common cold, but also sometimes bacteria, most commonly group A strep
• Strep throat: always group A strep bacteria

Symptoms

• Both: sore throat, fever, difficulty swallowing, swollen lymph nodes in the neck, and tonsils that are swollen or covered in white patches
• Tonsillitis: bad breath, ear pain, and hoarseness
• Strep throat: sudden onset of symptoms (fever and sore throat), petechiae (tiny red spots in the mouth), and general malaise

Treatments

• Viral tonsillitis: rest, fluids, and pain relief with over-the-counter medications
• Bacterial tonsillitis: antibiotics
• Strep throat: antibiotics

Complications

Strep throat typically leads to more serious issues if left untreated, including kidney disease, rheumatic fever, and secondary infections like ear infections and peritonsillar abscesses. Rarely, bacterial tonsillitis can also cause these issues.

Viral tonsillitis typically resolves on its own but can become recurrent.

Practice good hygiene and limit your exposure to disease-causing viruses and bacteria to prevent contracting and spreading tonsillitis and strep throat. Here’s how.

• Wash your hands frequently.
• Avoid sharing utensils, food, or drinks, especially with someone you know is sick.
• Cover your mouth when coughing or sneezing.
• Stay away from people who are sick.
• Stay away from people if you are sick.
• Keep kids home from school if they show symptoms.
• Replace your toothbrush every three months and after every time you get sick.
• Complete your full course of antibiotics, if antibiotics are prescribed.

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Seek medical help if you experience:

• Sore throat that lasts more than a few days
• Sore throat that is accompanied by enlarged lymph nodes or a rash
• Trouble breathing or swallowing
• High fever
• White patches or pus on the tonsils

• Tonsillitis and strep throat can look and feel similar, but they’re not the same.
• Tonsillitis is often viral and goes away on its own, while strep throat is bacterial and requires antibiotics for treatment and to prevent serious complications.
• If you’re unsure what’s causing your sore throat, play it safe and see a healthcare provider.