Throat Herpes And Strep Throat: Learn The Difference

Two conditions affect your body similarly to a common sore throat: strep throat and throat herpes. Strep throat affects about 14,000 to 25,000 people¹ in the U.S. yearly, while throat herpes is much rarer.

Since it can be challenging to know if you have throat herpes vs. strep throat—or even just a common sore throat—we put together this short guide. This will help you understand the similarities and differences between the two conditions.

What is strep throat?

Strep throat is short for Streptococcus pharyngitis. It is caused by group A streptococcus bacteria (also known as Streptococcus pyogenes). Typically, it takes two to five days to come down with strep throat once exposed to this bacteria.

This bacteria group also causes up to 30%² tonsillitis cases. Strep throat can also lead to scarlet fever, a skin rash most commonly found in children between 5 to 15 years old.

How is strep throat transmitted?

Group A strep bacteria are often transmitted through the air when someone coughs, sneezes, or breathes on another person. It creates droplets that can enter another person’s respiratory tract and set up an infection.

In addition, if you are in physical contact with someone with the bacteria, you may become infected with strep throat.  

What is herpes esophagitis?

Throat herpes is sometimes called oral herpes. It’s a viral skin infection marked by sores and inflammation at the back of your throat and around your mouth.  

The formal medical name for the condition is herpes esophagitis because it causes swelling and irritation of the esophagus. It is common in children and young adults, especially those with weak immune systems.

Both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) cause herpes esophagitis, although HSV-1 causes the vast majority of the cases. 

Herpes esophagitis is much rarer than strep throat. Although an estimated 65%³ of the U.S. population has been infected with HSV-1 and 20–30% with HSV-2, only 0.5–2%⁴ contract herpes esophagitis.

How is herpes esophagitis transmitted?

The first infection with herpes simplex virus occurs through contact with infected saliva, mucous, or skin infections, such as cold sores and blisters. Once infected, your body carries the virus forever. 

Herpes simplex virus spread through sexual activity is considered a sexually transmitted infection. Although it is often in a dormant (inactive) state, meaning it can’t be spread to others, the virus may be reactivated at any time.

Some common reasons for the reactivation of the herpes simplex virus include:

• A compromised immune system

• Chronic or acute (short-term) stress

• Infection with another virus

Symptoms of throat herpes vs. strep throat

Symptoms of the common sore throat 

Sore throats are responsible for about 12 million⁵ outpatient care visits annually in the U.S.

Between 50–80%⁶ of the time, a sore throat is caused by a (non-herpes simplex) virus that infects the upper respiratory system, such as a cold or the flu. This sore throat typically includes a runny nose, cough, and sometimes conjunctivitis (pink eye).

These viral sore throats usually go away within a week and can be treated with over-the-counter cold, flu, or cough medicines.

Symptoms of throat herpes

The most common symptoms of throat herpes include:

• Difficulty swallowing

• Chills

• Joint pain

• Swollen lymph nodes in the neck

About half of people diagnosed with throat herpes also experience chest pain and fever.

Symptoms of strep throat

In American adults, about 5–15%⁷ of sore throats are due to a group A strep infection, which rises to 15–35% in children. If your temperature reaches 100.4°F or higher, your sore throat may be caused by a strep infection.

Common symptoms of strep throat include:

• Small red spots on the roof of the mouth

• Pain and inflammation come on quickly, making it difficult to swallow

• White patches on the tonsils

• Red skin rash, indicating scarlet fever (especially in children 5–15 years old)

• Difficulty breathing

• Swelling of the lymph nodes in the neck

• Dehydration and drooling, especially in children

• Joint and muscle pain, possibly indicating more serious rheumatic fever

Symptom differences

Throat herpes is marked by cold sores or blisters in the mouth, while people with strep throat are more likely to notice small red spots in the mouth and white patches on the tonsils.

Symptom similarities

Fever, swollen neck lymph nodes, a sore throat, difficulty swallowing, joint pain, and inflammation are symptoms common to both strep throat and throat herpes.

Risk factors

Throat herpes

People with suppressed immune systems are more likely to develop throat herpes than those with strong immunity. Anyone with conditions such as HIV, end-stage renal disease, and cancer is particularly susceptible. 

Those taking immunosuppressive therapies and steroids or who have had bone and solid organ transplants are also at a higher risk for developing the condition.

Strep throat

Children between 5–15 years old have the highest chance of contracting strep throat. It’s often spread at schools and childcare centers. Because of this, parents and caretakers of school-aged kids also have an increased risk of developing strep throat. 

Coming in close physical contact with someone with the condition is considered the biggest risk factor.

Diagnosis

The diagnosis for herpes esophagitis vs strep throat begins with an exam.

Herpes esophagitis

For throat herpes, an endoscopy is typically performed. During the procedure, a small camera is put down your throat, and your healthcare provider looks for the telltale signs of herpes simplex virus. Tissue samples are then taken using throat swabs and tested to confirm the diagnosis.

If you’ve been diagnosed with HSV-1 or HSV-2 before and symptoms of herpes esophagitis occur, an antibody test may be performed instead.

Strep throat

There are two main tests used to diagnose strep throat:

• During a rapid antigen detection test, a swab of the throat is taken and immediately tested for group A strep

• During a throat culture swab, a swab of the throat is taken, and it’s checked later to see if group A strep bacteria began growing on it

At-home rapid tests are available if you’d like to self-test for strep throat. However, it’s recommended to consult your healthcare provider if your test is negative, but you have symptoms. Throat cultures are used to test for the condition in these situations.

Treatment

Remedies for throat herpes

Antiviral medications are often prescribed for treating throat herpes, including the gold standard, acyclovir (Zovirax). Sometimes valacyclovir and famciclovir are used; foscarnet is also prescribed for people resistant to other antiviral drugs. Pain medication may also be prescribed to help soothe the throat.

Alternative therapies like laser treatment are now being used to help treat strep throat. One study⁸ found that patients with recurring HSV-1 significantly increased the time it took for a new outbreak, from 3 weeks for the placebo (untreated) group to 37.5 weeks for those treated with laser therapy.

Specific plant-based therapies⁹ have also shown some success in helping treat the symptoms of the herpes simplex virus. For example, aloe vera may be effective in preventing the actions of HSV-2, while “pigeon pea” has shown antiviral effects on both HSV-1 and HSV-2.

What is the outlook for herpes esophagitis?

While infection with the herpes simplex virus lasts a lifetime, treatment with antiviral drugs can often help clear up an outbreak within one to two weeks.

Thanks to clinical trials, there are also many alternative treatment options, including medical devices and plant-based botanicals. These may be used to help decrease both healing times and recurrence rates.

Remedies for strep throat

Antibiotics are most commonly prescribed to clear up a strep throat infection once symptoms start to show. Some common antibiotics include:

• Penicillin

• Amoxicillin

• Erythromycin

• First-generation cephalosporins

If you don’t have symptoms but test positive with a rapid test, your healthcare provider may decide to wait before prescribing antibiotics. These tests sometimes give a false positive when you have a common viral infection.

What is the outlook for strep throat?

With antibiotics, strep throat symptoms typically improve in a few days, and the infection usually clears up within ten days. While strep throat may clear up on its own, complications can be worse than the initial infection if it doesn’t. 

Children are especially susceptible to scarlet and rheumatic fever, so it’s recommended to consult with your doctor when strep throat symptoms are present.

The lowdown

While throat herpes and strep throat share common symptoms, such as sore throat, fever, and difficulty swallowing, they are caused by two different types of infections.  Group A streptococcus bacteria cause strep throat, while herpes simplex virus causes throat herpes. 

School-aged children are the highest risk group for strep throat, while those with compromised immune systems are the most likely to have an oral herpes outbreak. 

A rapid antigen test or throat culture helps determine if you have a case of strep throat, which is treated with antibiotics. The infection usually clears up within ten days when treated.  An endoscopy followed by a throat culture test can help diagnose throat herpes caused by HSP-1 and HSP-2. The condition is treated with antiviral drugs and alternative therapies like lasers and botanicals.  

While the virus never leaves your body, these treatments help clear up an active case of throat herpes, usually within one to two weeks. 

Frequently asked questions

Can herpes be mistaken for strep throat?

Because they have some of the same symptoms, you may be unsure if you have throat herpes vs strep throat. Your healthcare provider can help you tell the difference by performing an initial diagnostic checkup and testing for strep throat or throat herpes.

How do you tell if it’s strep or just a sore throat?

With strep throat, your fever may reach 100.4° F or higher. With a common sore throat, your symptoms will usually clear up within a week.

Is sore throat a herpes symptom?

The blisters, cold sores, and inflammation caused by the herpes simplex virus may lead to a sore throat.

Does herpes cause white spots on the tonsils?

No, strep throat causes white spots on the tonsils.

How is herpes esophagitis treated?

Herpes esophagitis is most commonly treated with antiviral medications like acyclovir (Zovirax) and alternative therapies like laser treatments and certain botanicals.

How do they test for oral herpes?

An endoscopy of the throat followed by a tissue sample using throat swabs is used to test for oral herpes.

Do any STIs start with a sore throat?

Oral herpes (throat herpes or herpes esophagitis) is sometimes considered an STI if transmitted during sexual activity. A sore throat due to swelling and painful sores or blisters is one symptom of the condition.

Can herpes cause fever and sore throat?

Yes, herpes may cause fever, sore throat, and chills.

How can I soothe herpes in my throat?

Your healthcare provider may prescribe you pain medication to help with your symptoms, and certain herbal combinations may also help ease the burning and soreness.