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How Do I Know If My Sore Throat Is Viral or Bacterial?

Reviewed on 1/19/2021

Bacterial and viral sore throats

Knowing whether your sore throat is viral or bacterial is usually determined by symptoms. Viral sore throats usually consist of a cough, swelling in the throat, and runny nose whereas bacterial sore throats are typically accompanied with nausea and vomiting, stomach ache, and there is no cough.
Knowing whether your sore throat is viral or bacterial is usually determined by symptoms. Viral sore throats usually consist of a cough, swelling in the throat, and runny nose whereas bacterial sore throats are typically accompanied with nausea and vomiting, stomach ache, and there is no cough.

A sore throat is something we’re all familiar with, but it’s not easy to tell if it’s because of a virus or bacteria. And this can confuse you when you’re trying to treat it.

A bacterial sore throat is called strep throat, caused by the streptococcus bacteria. It is contagious, spreading either through the air via droplets — like when someone coughs — or on surfaces that someone with the infection has touched.

On the other hand, a viral sore throat is caused by inflammation resulting from a virus, such as the common cold. It has entirely different symptoms and progression than a bacterial sore throat. It is still contagious, but it doesn’t respond to antibiotics the way a bacterial infection does. 

Almost everyone will experience a sore throat at some point, but certain lifestyle factors may increase your risk. Some of these are:  

  • Exposure to airborne irritants, especially air pollution or cigarette smoke
  • Not washing your hands frequently or thoroughly enough
  • Being in close contact with people who have colds or other upper respiratory infections

It’s important to have your sore throat symptoms reviewed by a doctor because an untreated infection can be dangerous. Many complications could arise, such as: 

Signs and symptoms of sore throat

The way you’re most likely to tell the difference between a bacterial and a viral sore throat is by the symptoms. Below are three symptoms each of bacterial and viral sore throats that do not appear in the other type.

Bacterial

Painful swallowing is common to both bacterial and viral sore throats, but bacterial sore throats often come with red and swollen tonsils at the back of the throat. You may very well also see white patches or streaks of pus there. Fever is also common to both, but the fever associated with bacteria tends to be higher and more severe than with a viral infection

Some people with a strep throat infection will also notice tiny red spots, called petechiae, on the roof of the mouth. These are actually tiny blood vessels, capillaries, that have broken as a result of the infection and are leaking little bits of blood. 

Here are some more common symptoms that distinguish a bacterial sore throat from a viral one: 

  1. Nausea and vomiting. A bacterial strep throat infection can cause nausea and vomiting. Loss of appetite is also a common symptom. Children especially are prone to nausea because of a strep throat infection. 
  2. Stomach ache. Although the throat and stomach may seem unrelated, stomach and abdominal pain is a common symptom of bacterial strep throat. The infection can cause a range of symptoms associated with indigestion, also called dyspepsia.
  3. No cough. It may sound counterintuitive, but bacterial sore throats seldom come with coughing. A few classic cold symptoms like cough and runny nose indicate a viral sore throat — so if you do have them, it’s probably not strep throat. 

Viral

A viral sore throat has a very different presentation. It imitates, and very often accompanies, the symptoms of the common cold

Here are some of the major signs to look for: 

  • Cough. Viral sore throats almost always have a cough, unlike their bacterial counterparts. The coughing is your body’s way of expelling foreign substances from your lungs and may last up to two weeks. 
  • Visible swelling in the throat. Viral sore throats will often be red and swollen at the back of the mouth, but there shouldn’t be red and white specks like there would be with a bacterial infection. 
  • Runny nose. Viral sore throats often accompany other common cold symptoms, especially runny noses and hoarseness

You can also expect to run a fever with a viral sore throat. In general, bacterial and viral sore throats can feel very similar to one another, but it may feel more like a cold if a virus is the cause. 

This is why an accurate medical diagnosis is necessary. 

SLIDESHOW

A Cold or The Flu? How to Tell the Difference See Slideshow

Causes of sore throat

Viruses are the more common source of sore throats. Most of the time, it’s from flu or common cold viruses. That said, other viruses can also cause it — like chicken pox, measles, and mononucleosis, which are more serious and very contagious.

If your infection is bacterial, it is most likely strep throat at the back of the throat and tonsils.

Diagnosing Sore throat

Rapid strep screening is a common way of diagnosing strep throat. It involves taking a quick sample from the back of your throat and only takes about five minutes for the results to be ready. 

To eliminate the possibility of a false negative on the rapid strep test, doctors may also use a throat culture. Sample cells are placed in a growth medium, and their development is observed by a trained technician. The results of this lab work will determine your course of treatment.

Treatments for bacterial and viral sore throats

If your lab results indicate a viral sore throat, your doctor won’t prescribe any antibiotics. You’ll unfortunately have to wait it out from there, but doctors often do recommend a number of therapies to help, such as: 

  • Hot teas and broths to soothe the throat
  • Sleeping in a slightly elevated position to improve mucus drainage
  • Over-the-counter pain medications to treat your ancillary symptoms and relieve your discomfort
  • Gargling with warm water

But some medical intervention will be necessary if the infection is bacterial. Your doctor will probably prescribe antibiotics to target the bacteria directly. Your recovery can take up to a week, so be patient with your body and get the rest you need.

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References
American Academy of Pediatrics: "Abdominal Pain in Children."

Centers for Disease Control and Prevention: "Strep Throat: All You Need to Know."

Longwood University: "Sore Throat/Cough."

Michigan Medicine: "Sore Throat."

Nationwide Children's Hospital: "Strep Throat (Bacterial)."

Nationwide Children's Hospital: "Sore Throat (Viral)."

Stanford Children's Health: "What You Need to Know About Strep Throat."

University of Utah Health: "4 TELL-TALE SIGNS YOU HAVE STREP THROAT."

University of Rochester Medical Center: "Strep Screen (Rapid)."

UR Medicine: "Sore Throats."

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