Tonsillitis vs. Strep: Similarities and Differences

Tonsillitis Symptoms
Strep Throat Symptoms

Sore throat
Sore throat

Fever
Fever

Painful swallowing
Painful swallowing

Difficulty swallowing
Petechiae (tiny red spots on the roof of the mouth)

Bad breath
White patches or pus streaks on the tonsils or red, swollen tonsils

Swollen, sore lymph nodes in the neck
Red, swollen tonsils

Fatigue
Headache

Malaise (feeling unwell)
Nausea or vomiting

White patches or redness on the tonsils
Rash (scarlet fever)

While tonsillitis and strep throat have similar symptoms, their causes, methods of diagnosis, and treatments differ in some ways.

Causes

Tonsillitis can develop as a result of a viral or bacterial infection. Viral tonsillitis is the most common form, with viruses causing approximately 70% of all tonsillitis cases.

Viruses associated with tonsillitis include: 

Adenoviruses
Influenza 
Parainfluenza
Enteroviruses 
Epstein-Barr virus (EBV) 
Herpes simplex virus (HSV) 
Cytomegalovirus (CMV)
Measles

Tonsillitis can be caused by bacterial infections, including the same bacteria that cause strep throat: group A Streptococcus (strep). Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenza are other bacteria that can cause tonsillitis.

Contracting Group A Streptococcus bacteria is the only cause of strep throat.

Diagnosis: Rapid Strep Test vs. Clinical Examination 

Tonsillitis and strep throat have slightly different diagnostic approaches. Still, with both conditions, healthcare providers will likely first ask about your symptoms and perform a physical examination.

During the physical exam, they may gently touch the sides of your neck to check for swollen lymph nodes and look into your mouth to assess your tonsils for redness, swelling, and white patches or streaks.

With tonsillitis, a swab test may be performed to rule out other health conditions. The rapid strep test is a specific test to diagnose strep throat.

A healthcare provider gently rubs a long cotton swab on or around the tonsils to collect bacteria and check for group A Strep bacteria. Results are typically available within minutes after the swab. A negative rapid strep test doesn’t always rule out strep throat.

Your healthcare provider may still suggest more tests, including a culture test. This involves taking another swab from the back of your throat and sending it to the lab for testing. If group A Strep bacteria are causing your strep throat symptoms, the bacteria will grow in the lab from the sample your healthcare provider sent.

Treatment: Antibiotics vs. Home Care

Viral tonsillitis typically resolves on its own within a week or two. Antibiotics are ineffective against viruses, so healthcare providers do not prescribe them if they can confirm you have viral tonsillitis.

Treatment for viral tonsillitis focuses on symptom relief with home remedies, such as the following: 

Get adequate restGargle with warm salt waterDrink plenty of fluidsTake over-the-counter (OTC) pain relievers, such as Tylenol (acetaminophen) Eat warm or soft foods if swallowing is painful 

Treatment for bacterial tonsilitis and strep throat is similar. Strep throat and bacterial tonsillitis require antibiotic treatment to eliminate harmful bacteria and speed up recovery.

Amoxil (penicillin) is the most commonly prescribed antibiotic for treating strep throat. In most cases, you will take antibiotics for 10 days—even if your symptoms improve within a few days—to ensure the infection does not return.

Tonsillitis Is More Common 

While tonsillitis and strep throat are common, tonsillitis affects more people because of its broad range of viral and bacterial causes. Tonsillitis is the third most common ear, nose, and throat (ENT) condition in the general population.

Strep throat affects 5-20% of adults and up to 30% of children.

Tonsillitis and strep throat share several similarities, including how they spread, how to prevent them, and who they affect. The bacteria and viruses that cause tonsilitis and strep throat are contagious.

Viruses and bacteria that cause tonsillitis and the bacteria that cause strep spread from person to person through:

Respiratory droplets: People with viral or bacterial infections can spread the contagious germ through respiratory droplets when coughing, speaking, or sneezing. You can become infected with the germ when you breathe in the droplets or they land in your eyes, nose, or mouth. 
Direct contact: Bacteria and viruses can spread through direct contact with a person with an infection, such as having close physical contact or sharing utensils or drinks with someone with the germs.
Contaminated surfaces: Viruses and bacteria can live on surfaces and spread when you touch a contaminated surface and then touch your mouth, nose, or eyes. 

Prevention

Good hygiene can help lower your risk of tonsillitis and strep throat. Keeping your hands clean by regularly washing them with soap and water can help prevent the spread of bacteria and viruses.

If you are in contact with someone with a cold, flu, or sore throat, washing your hands can help minimize the risk of infection. If possible, avoid being in close contact with someone you know is sick.

What you put into your body is also important for ensuring that you don’t get sick often. A robust immune system can help you fight viral and bacterial infections. Eating a balanced, nutrient-rich diet, getting adequate hydration, exercising regularly, and getting enough sleep can help lower your risk of infection. 

Most Common in Children 

Anyone can develop tonsillitis or strep throat, but both are most common in children aged 2 or older. Younger children are most likely to develop viral tonsillitis, whereas children between 5-15 are more likely to develop bacterial tonsillitis. Most children in the U.S. have had tonsillitis at least once. 

Strep throat is most common in children 5-15 and is rare in younger children. Older teens and adults can get strep, too, especially when in regular contact with children or in crowded settings. 

It is possible to have a type of tonsillitis and strep throat simultaneously. Strep throat can develop into bacterial tonsillitis from group A Streptococcus bacteria.

It is also possible to have a bacterial and viral infection simultaneously, known as a co-infection. This may happen when a virus weakens your immune system, making you more susceptible to a bacterial infection. Co-infections can sometimes cause more severe symptoms and may require a combination of treatments to fight both infections.

See a healthcare provider if you have a sore throat that persists for more than two days or a sore throat with any of the following symptoms:

Fever for more than 1-2 days
Skin rash
Difficulty swallowing
Pain when swallowing
Trouble sleeping 
Fatigue or weakness
Swollen lymph nodes in your neck

In most cases, a primary care provider can diagnose and treat both tonsillitis and strep throat. If you have recurrent or chronic tonsillitis, your provider may refer you to an ENT specialist—a doctor specializing in conditions affecting the ears, nose, and throat—for further evaluation.

Tonsillitis and strep throat cause a sore throat and other similar symptoms, but they are different conditions. Tonsillitis is inflammation of the tonsils and can develop from a virus or bacteria. Strep throat is a bacterial infection caused by group A Streptococcus bacteria.

See a healthcare provider if you have a sore throat that persists for two days or longer. Viral tonsillitis typically goes away within a week with at-home treatments like rest and hydration, whereas bacterial tonsillitis and strep may require antibiotics to treat the infection.