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

Most sore throats come from virus­es, and they clear up on their own with­in about a week. Strep throat is dif­fer­ent. It’s caused by bac­te­ria, it needs antibi­otics, and the only way to con­firm it is with a throat swab. The good news: a rapid strep test takes about 15 min­utes right in the office, so you can usu­al­ly walk out of the same vis­it know­ing what you’re deal­ing with and, if you need one, with a pre­scrip­tion in hand.

What caus­es a sore throat?

You wake up with a scratchy throat. By the after­noon, the back of your throat is red and swollen, and you spot white patch­es on your ton­sils. So you do what any­one would do, and start won­der­ing whether this is strep.

Usu­al­ly, it isn’t. Virus­es cause most sore throats, and only about 1 in 10 adults and 3 in 10 chil­dren with a sore throat turn out to have strep. Strep throat comes from a spe­cif­ic bac­teri­um called group A Strep­to­coc­cus, and it’s the one com­mon cause that requires antibiotics.

Sore throats can also come from aller­gies, dry air, acid reflux, smoke or oth­er irri­tants, and post­nasal drip. Those tend to creep up on you rather than arriv­ing all at once with a fever.

Is it strep throat or a virus?

The symp­toms over­lap quite a bit, and those white patch­es on your ton­sils show up with both. Still, the over­all pat­tern usu­al­ly leans one direction:

These pat­terns help nar­row things down, but they don’t set­tle it. Your provider can’t diag­nose strep just by look­ing at your throat, and nei­ther can you. It takes a swab.

How is strep throat test­ed for, and how fast are the results?

Test­ing for strep is quick, and it hap­pens right there in the exam room. Your provider swabs the back of your throat and runs a rapid strep test, which picks up group A strep bac­te­ria in rough­ly 15 min­utes. There’s no sep­a­rate lab trip and no wait­ing days to find out.

If the rapid test comes back pos­i­tive, that con­firms strep, and you’ll get antibi­otics at the same vis­it. If it’s neg­a­tive, one of two things hap­pens next. For adults, a neg­a­tive rapid test is usu­al­ly enough to rule strep out, and the focus shifts to help­ing you feel bet­ter while a virus runs its course. For chil­dren and teens, your provider will often send a throat cul­ture as a back­up, since rapid tests miss a small share of cas­es and this age group faces the high­est risk of com­pli­ca­tions from untreat­ed strep. Cul­ture results come back in a day or two, and you’ll hear from the office if any­thing changes.

This is where sub­ur­ban-based com­pre­hen­sive care makes a real dif­fer­ence in a small, prac­ti­cal way. Duly Health and Care offers rapid strep test­ing at Pri­ma­ry Care offices and Imme­di­ate Care Cen­ters across the Chica­go sub­urbs, with in-house lab sup­port for cul­tures and test­ing for flu and COVID-19 dur­ing the same vis­it. One swab, one stop, and a clear answer before you head home.

Find Imme­di­ate Care near you

Find a pri­ma­ry care provider

What hap­pens if strep throat goes untreated?

Strep throat is usu­al­ly a mild infec­tion, and plen­ty of cas­es would even­tu­al­ly clear on their own. Antibi­otics still mat­ter, for three rea­sons: they short­en how long you feel awful, they make you far less con­ta­gious with­in about 24 hours, and they pre­vent complications.

Untreat­ed strep can spread to near­by areas and cause ear infec­tions, sinus infec­tions, or an abscess around the ton­sils. Less often, it leads to acute rheumat­ic fever, which can per­ma­nent­ly dam­age the heart valves, or to inflam­ma­tion in the kid­neys. These com­pli­ca­tions are uncom­mon in the U.S. pre­cise­ly because strep gets test­ed for and treat­ed so rou­tine­ly. That’s also why your provider won’t sim­ply wait it out when strep is a possibility.

One more thing: fin­ish the full course of antibi­otics, even after you start feel­ing bet­ter, which usu­al­ly hap­pens with­in a day or two.

Which virus­es cause sore throats?

When strep is ruled out, a virus is almost always the expla­na­tion. A few are espe­cial­ly common.

Com­mon cold

A cold isn’t one virus. More than 200 dif­fer­ent virus­es can cause one, most often rhi­novirus­es. A sore throat is fre­quent­ly the open­ing act, fol­lowed by a run­ny nose and cough that can hang around for up to 14 days.

Flu

Influen­za tends to arrive abrupt­ly, bring­ing fever, cough, body aches, and a sore throat. Most peo­ple recov­er with­in a few days to two weeks with­out treat­ment, though antivi­ral med­ica­tions can short­en things when you start them ear­ly, gen­er­al­ly with­in the first two days. Flu can lead to seri­ous com­pli­ca­tions like pneu­mo­nia, and an annu­al flu vac­cine is still your best pro­tec­tion against get­ting it, or against get­ting a severe case.

COVID-19

A sore throat is a com­mon COVID-19 symp­tom, and it’s been one of the more promi­nent ear­ly symp­toms with recent vari­ants. Most cas­es are mild, though COVID-19 can still cause severe ill­ness or lin­ger­ing symp­toms. Because it looks so much like flu and oth­er virus­es from the out­side, test­ing is the only way to tell them apart, and it can hap­pen at the same vis­it as your strep swab.

Mononu­cle­o­sis

Mono, usu­al­ly caused by the Epstein-Barr virus, is worth know­ing about because it’s so eas­i­ly mis­tak­en for strep. It brings a severe sore throat with white patch­es on the ton­sils, swollen glands, and fever, but the give­away is the exhaus­tion, which can last for weeks. It’s most com­mon in teens and young adults. Mono can enlarge the spleen, so if you’re diag­nosed with it, skip con­tact sports and heavy lift­ing until your provider says you’re clear. A sore throat that isn’t improv­ing after a neg­a­tive strep test, espe­cial­ly in a teenag­er, is a com­mon rea­son to test for mono.

Cox­sack­ievirus

Cer­tain cox­sack­ievirus­es cause hand, foot, and mouth dis­ease, which is very com­mon in chil­dren under 5. Sore throat, fever, and run­ny nose usu­al­ly show up first, fol­lowed by a rash of tiny blis­ters in the mouth or on the fin­gers, palms, soles, or but­tocks. Most chil­dren recov­er on their own with­in 7 to 10 days.

What about tonsillitis?

Ton­sil­li­tis sim­ply means your ton­sils are inflamed and swollen. It describes what your provider sees, rather than nam­ing a sep­a­rate ill­ness. The cause under­neath is usu­al­ly a virus, though it can be bac­te­r­i­al, includ­ing strep. If ton­sil­li­tis keeps com­ing back, or your child’s ton­sils are large enough to dis­rupt sleep or breath­ing, it’s worth talk­ing with an ear, nose, and throat specialist.

When should I get care right away?

Most sore throats get bet­ter with­in a week and can be han­dled at home or with a rou­tine vis­it. A few sig­nal some­thing more serious.

Short of those, reach out if your sore throat lasts more than a week, keeps return­ing, comes with a fever, or is get­ting worse instead of bet­ter. Same-day eval­u­a­tion and test­ing are avail­able at Imme­di­ate Care.

How is a sore throat treated?

Treat­ment fol­lows the cause, which is exact­ly why test­ing comes first. Antibi­otics only work against bac­te­ria. They do noth­ing for a viral sore throat while still car­ry­ing real side effects, so your provider will pre­scribe them when strep is con­firmed, not just suspected.

For viral sore throats, and for strep while you wait for antibi­otics to kick in, these can help:

• Over-the-counter pain reliev­ers like aceta­minophen or ibuprofen
• Warm liq­uids or cold drinks and ice pops, whichev­er feels bet­ter to you
• Salt water gar­gles, using a quar­ter tea­spoon of salt in 8 ounces of warm water, for old­er chil­dren and adults
• Throat lozenges or hard can­dy, for any­one old enough to use them safely
• A cool mist humid­i­fi­er, plus plen­ty of rest and fluids

Don’t give aspirin to chil­dren or teens, and check with your provider before giv­ing over-the-counter cough and cold med­i­cines to young children.

How long is a sore throat contagious?

With strep, you’re con­ta­gious until you’ve been on antibi­otics for at least 12 to 24 hours. Kids can head back to school or day­care once they’re fever-free with­out med­ica­tion and have got­ten through that first day of treat­ment. With­out antibi­otics, strep can spread for two to three weeks.

Viral sore throats are gen­er­al­ly most con­ta­gious in the first few days, though you can keep spread­ing them a bit longer. Stay­ing home while you have a fever, wash­ing your hands often, and not shar­ing cups or uten­sils go a long way toward keep­ing the rest of the house­hold healthy.

Who treats sore throats?

A pri­ma­ry care provider is the right start­ing point for most sore throats and can test, diag­nose, and treat you in a sin­gle vis­it. Imme­di­ate Care han­dles the same eval­u­a­tion on evenings and week­ends, or any time you need to be seen the same day with­out an appoint­ment. Chil­dren can see a pedi­a­tri­cian, who can also weigh in on whether repeat­ed infec­tions deserve a clos­er look. An ear, nose, and throat spe­cial­ist steps in for recur­rent ton­sil­li­tis, an abscess, or a sore throat that just won’t resolve, and is the provider who’ll talk with you about whether remov­ing the ton­sils makes sense.

At Duly, those pieces are con­nect­ed. Pri­ma­ry Care, pedi­atrics, Imme­di­ate Care, ENT, and on-site lab ser­vices work across the same net­work of clin­ics through­out the Chica­go sub­urbs, so a rapid strep test at a walk-in vis­it, a back­up cul­ture, and a spe­cial­ist refer­ral all move through one sys­tem, with­out you repeat­ing your his­to­ry at every stop.

Fre­quent­ly asked questions

How long does a rapid strep test take?

A rapid strep test gives results in about 15 min­utes. Your provider swabs the back of your throat and runs the test in the office, so most peo­ple find out whether they have strep and get a pre­scrip­tion if they need one dur­ing the same vis­it. If the rapid test is neg­a­tive in a child or teen, a throat cul­ture may be sent as a back­up, with results in a day or two.

Can I tell if I have strep throat with­out a test?

No. A provider can’t diag­nose strep just by look­ing at your throat, and white patch­es on the ton­sils show up with both viral infec­tions and strep. Some clues help, like the absence of a cough or run­ny nose, a sud­den fever, and painful swal­low­ing, but a throat swab is the only way to con­firm it.

Do I need antibi­otics for a sore throat?

Only if a test con­firms strep throat. Virus­es cause most sore throats, and antibi­otics don’t help viral infec­tions while still car­ry­ing side effects. Around 1 in 10 adults and 3 in 10 chil­dren with a sore throat have strep, which is why test­ing comes before treatment.

What hap­pens if strep throat is not treated?

Untreat­ed strep can spread and cause ear infec­tions, sinus infec­tions, or an abscess near the ton­sils. Less com­mon­ly it leads to acute rheumat­ic fever, which can dam­age the heart valves, or to kid­ney inflam­ma­tion. Antibi­otics also short­en the ill­ness and reduce how long you’re contagious.

When can my child go back to school after strep throat?

Chil­dren can usu­al­ly return once they’ve been fever-free with­out med­ica­tion and have tak­en antibi­otics for at least 12 to 24 hours. Check with your child’s school or day­care, since some have their own require­ments. Fin­ish the full course of antibi­otics even after symp­toms improve.

Why does my sore throat keep get­ting worse after a neg­a­tive strep test?

A neg­a­tive strep test rules out one cause, not all of them. Mononu­cle­o­sis is a fre­quent expla­na­tion in teens and young adults, bring­ing a severe sore throat with white patch­es and weeks of fatigue. Severe one-sided pain with a muf­fled voice or trou­ble open­ing your mouth can point to an abscess and needs prompt eval­u­a­tion. A sore throat that wors­ens after sev­er­al days is worth rechecking.

Where can I get a strep test in the Chica­go suburbs?

Duly Health and Care offers rapid strep test­ing at Pri­ma­ry Care offices and Imme­di­ate Care Cen­ters across the Chica­go sub­urbs, with results in about 15 min­utes and treat­ment dur­ing the same vis­it when you need it. Test­ing for flu and COVID-19 can hap­pen at the same appoint­ment, and on-site lab ser­vices han­dle back­up throat cultures.

Care at Duly Health and Care

A sore throat is one of the most com­mon rea­sons peo­ple come in, and most clear up on their own. But guess­ing at the cause is what leads to unnec­es­sary antibi­otics or a missed case of strep. Duly brings Pri­ma­ry Care, pedi­atrics, Imme­di­ate Care, ENT, and lab ser­vices togeth­er across the Chica­go sub­urbs, so you can get swabbed, get an answer in about 15 min­utes, and start the right treat­ment in one vis­it. And if your symp­toms point some­where else, the spe­cial­ists who can help are already part of the same team.

Get test­ed at Imme­di­ate Care

Find a pri­ma­ry care provider