Sore Throat, White Spots On My Tonsils — Is it Strep or a Virus?

You’ve wok­en up with a dread­ed sore throat. A few hours lat­er, you notice that the back of your throat is red and swollen. And, you’ve devel­oped some sus­pi­cious-look­ing white spots on your ton­sils. You’re won­der­ing — what could be caus­ing this?

If you have a sore throat, chances are a virus is the cul­prit, since most sore throats stem from viral infec­tions. But while the major­i­ty of sore throats are caused by virus­es, strep throat is caused by the bac­te­ria group A Strep­to­coc­cus (group A strep). 

Both virus­es and strep throat can cause symp­toms in addi­tion to a sore throat. Some of these symp­toms over­lap. For exam­ple, those white patch­es on the back of your ton­sils (the lumps of tis­sue at the back of your throat that help fight infec­tion) can be a sign of either a virus or strep throat. 

How­ev­er, cold-like symp­toms, such as cough or run­ny nose, are tell­tale signs that the sore throat is from a virus.

When Sore Throat is Caused by Strep Throat

Strep throat can be very painful, but the infec­tion itself is usu­al­ly pret­ty mild. Besides sore throat, you may also expe­ri­ence symp­toms like fever, pain while swal­low­ing, swollen lymph nodes at the front of your neck, or red spots on the roof of your mouth. Chil­dren, espe­cial­ly, may also have stom­ach pain, headache, nau­sea, or vomiting.

Even though infec­tions are mild, it’s crit­i­cal to be treat­ed with antibi­otics. Untreat­ed, the bac­te­ria caus­ing strep throat could trav­el through­out the body and cause com­pli­ca­tions like ear or sinus infections.

If you have a sore throat, con­tact your pri­ma­ry care provider or vis­it a Duly Health and Care Imme­di­ate Care Cen­ter to learn about test­ing and treat­ment options. 

When Sore Throat is Caused by Viruses

With strep throat, it’s easy to know why your throat is sore — if you test pos­i­tive for it, the mys­tery is solved. Your sore throat came from bacteria.

Virus­es make it a lit­tle more tricky. That’s because there are a whole host of virus­es that can bring on a sore throat, including:

Com­mon Cold

It could come down to a plain old com­mon cold. A cold itself isn’t a virus — it could be the result of any one of more than 200 dif­fer­ent virus­es. Most often, colds are from rhinoviruses. 

Cer­tain cold symp­toms, like a run­ny nose or cough, can last up to 14 days. 

The Flu

Flu comes from the influen­za virus. It can cause many symp­toms, like fever, cough, body aches, and sore throat. For­tu­nate­ly, most cas­es of the flu go away with­in a few days to less than two weeks. While there are sev­er­al antivi­ral med­ica­tions avail­able, most peo­ple can recov­er with­out treatment.

How­ev­er, the flu can some­times cause seri­ous com­pli­ca­tions, like pneu­mo­nia. In severe cas­es, the flu can even be life-threat­en­ing. The best way to reduce your chance of get­ting the flu or get­ting a severe case of it is to get your annu­al flu vaccine.

Sched­ule a flu shot or find a walk-in flu shot clin­ic at Duly Health and Care.


A sore throat is among the vast array of symp­toms caused by COVID-19 (caused by the SARS-CoV­‑2 virus). In fact, it was one of the first known symp­toms back in the begin­ning of the pandemic. 

Most cas­es of COVID-19 are mild and don’t require treat­ment. But as we’ve all seen in the past few years, there are times when COVID-19 can lead to long-last­ing effects (long COVID) or be severe enough to require hos­pi­tal­iza­tion or cause death. 

As with the flu, the best way to com­bat COVID-19 is to get your vac­cine and boosters. 

Sched­ule your COVID-19 vac­cine or boost­er at Duly Health and Care.

Cox­sack­ievirus (Com­mon in Children)

Cer­tain types of cox­sack­ievirus­es cause sore throat-induc­ing infec­tions, like hand, foot and mouth dis­ease. Hand, foot, and mouth dis­ease is very com­mon in infants and chil­dren, usu­al­ly in those younger than 5 years. Sore throat, along with fever and run­ny nose, are gen­er­al­ly the first symp­toms to appear. The next sign is a rash with tiny blis­ters that shows up in the mouth or on the fin­gers, palms of the hands, soles of the feet, or buttocks.

In most cas­es of cox­sack­ievirus, chil­dren recov­er on their own with­in 7 to 10 days, with no last­ing problems.

What About Tonsillitis?

Ton­sil­li­tis” is anoth­er term you might hear when talk­ing about what caus­es a sore throat. Ton­sil­li­tis is when your ton­sils are swollen. This swelling is usu­al­ly due to a viral infec­tion, but it can some­times be from a bac­te­r­i­al infec­tion, like strep throat. 

Treat­ing a Sore Throat

Find­ing out the root cause of your sore throat is the best way to get the most effec­tive treat­ment. If your provider does not pre­scribe antibi­otics or antivi­ral med­ica­tions, you can still get some relief from over-the-counter med­ica­tions, like aceta­minophen, or lozenges.

Also read, Cold & Flu Med­ica­tion Guide: How to get safe (and effec­tive) relief for your cold and flu symp­toms

The Next Steps

Find­ing out the root cause of your sore throat is the best way to ensure that you’re get­ting the most effec­tive treat­ment. Reach out to your provider to see if you should take fur­ther steps, like get­ting test­ed for strep throat or COVID-19. 

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