The Difference Between Tonsillitis And Strep Throat

It can start with nothing more than a tickle in your throat, but with time, strep throat and tonsillitis can cause significant discomfort. Understanding the difference between strep throat and non-strep tonsillitis can be difficult. If you are feeling unwell and are experiencing pain and inflammation of your throat, you may have strep throat or non-strep tonsillitis.

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Strep throat and tonsillitis affect the throat area, but their symptoms differ. Learning the key differences between these medical conditions can help you determine which condition you are likely experiencing and when you should see a doctor.

What is tonsillitis?

Tonsillitis is the inflammation of the tonsils, specifically the palatine tonsils, typically caused by an infection or virus. In most cases, tonsillitis is seen together with the inflammation of the pharynx, termed tonsillopharyngitis (acute sore throat), and is caused by viruses or bacteria.

What is strep throat?

Strep throat is a type of tonsillitis. It is a highly contagious tonsillopharyngitis caused by Streptococcus pyogenes, also known as group A Streptococcus (GAS). Strep throat can suddenly cause significant pain and discomfort in the throat, along with systemic signs and symptoms.

How can you tell the difference between strep throat and non-strep tonsillitis?

The most identifiable symptom of tonsillitis is a sore throat. This type of illness may also cause:

  • Pain when swallowing

  • Fever 

  • Headache

  • Coughing

  • Fatigue

  • Swollen and painful lymph glands

Strep throat may show some similar symptoms like fever, pain when swallowing, and a sore throat. In addition, strep throat can cause:

  • White patches on the tonsils

  • Small red spots on the roof of the mouth

Some symptoms like coughing, running nose, and hoarse voice do not indicate strep throat, which means a different type of virus is likely present.

Causes of strep throat and tonsillitis

Viral infections cause most cases of tonsillitis. Tonsillitis is frequently caused by rhinovirus, the same virus that causes the common cold. Other viruses that can lead to tonsillitis are SARS-CoV-2 (COVID-19 virus), influenza A (a type of flu virus), adenovirus, and the Epstein-Barr virus.

On the other hand, the cause of strep throat is the spread of group A streptococcus bacteria (Streptococcus pyogenes). This particular kind of bacteria is also responsible for causing around 30% of cases of tonsillitis. This bacteria can easily be passed from one individual to another through a cough, sneeze, or via airborne mechanisms.¹

Other common viral causes, such as SARS-CoV-2, rhinovirus, and adenovirus infections, share similar spread mechanisms. 

Diagnosis and testing

If you have been feeling discomfort in your throat for more than a few days, your doctor can further investigate the cause of your symptoms. 

To diagnose strep throat, your doctor may perform a rapid strep test or a throat culture. 

The rapid strep test involves swabbing the back of your throat and testing the sample for the presence of group A Streptococcus bacteria. This test can produce results in minutes, but it may not be as accurate as a throat culture. 

A throat culture involves taking a sample from the back of your throat and incubating it in a laboratory to see if group A Streptococcus bacteria grow. This test can take a few days to produce results but is more accurate than the rapid strep test.

To diagnose tonsillitis, your doctor may also perform a physical examination of the throat, checking for signs of inflammation, redness, or swelling of the tonsils. Your doctor may also take a medical history to determine if you have other symptoms of an infection, such as fever, cough, or fatigue.

Depending on the suspected cause of tonsillitis, your doctor may order additional tests, such as a throat culture, to check for specific bacteria or viruses.

Prevention and remedies

There is no absolute prevention of strep throat or tonsillitis. Still, the following can help reduce your risk of getting sick:

  • Good hygiene practices

  • Avoiding sick individuals

  • Being up-to-date on your vaccinations

  • Wearing a high-quality well-fitted mask in high-risk congregate settings

Strep throat and other viral causes of tonsillitis, such as SARS-CoV-2, are highly contagious.

Strep throat treatment, in many cases, involves a course of oral antibiotics prescribed by your doctor. In addition to antibiotics, you can relieve some painful symptoms with warm broth, tea, honey, fluids, plenty of rest, and simple pain reliever medications.

In most tonsillitis cases, treatment includes at-home remedies that can reduce inflammation and discomfort of the throat, such as warm liquids, over-the-counter pain relief, rest, and fluids. Furthermore, in some particular diseases, such as COVID-19, antivirals may be an option.

Antibiotics are not a common option for tonsillitis except for strep throat because most cases are due to viruses.

Antibiotics are usually not prescribed for tonsillitis because viruses cause most tonsillitis cases. However, if your doctor suspects the cause of your tonsillitis is bacterial, they may prescribe you antibiotic treatment.

Risk factors

The virus that causes tonsillitis and the bacteria that causes strep throat are both primarily passed from one infected individual to another. These are common conditions that occur and spread in close contact settings such as between family members, schoolmates, and co-workers. 

Acute tonsillitis is typically common in winter and early spring. GAS is typically responsible for 20–30% of cases of acute tonsillitis in children and 5–15% of cases in adults.²

If left untreated, strep throat infection in children can lead to rheumatic fever, leading to heart problems such as rheumatic heart disease. This can cause long-term health consequences for your heart and existing disabilities.

It is essential to differentiate between tonsillitis and strep throat and seek the proper treatment from your doctor to avoid these possible complications.

The lowdown

Any illness involving the throat can cause bothersome symptoms and pain. If your symptoms and throat pain persist, consider scheduling an appointment with your doctor for an evaluation and treatment. Both strep throat and tonsillitis are very similar in symptoms, so determining which one you have and the best treatment for it can be difficult.

Your doctor can evaluate your throat and tonsils and then recommend further lab testing if they feel you may have a bacteria-related infection. Tonsillitis and strep throat are common throat ailments that usually resolve quickly after treatment.

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