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Tonsillitis vs. strep: Compare causes, symptoms, treatments & more

Compare the similarities and differences between tonsillitis and strep throat.

Tonsillitis vs. strep causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources

Tonsillitis is the inflammation of the tonsils that causes a sore throat, painful swallowing, and swollen lymph nodes. It may be caused by a virus or bacteria and is spread easily from person to person. Strep throat produces similar symptoms to tonsillitis and is also contagious, but it is caused by a specific bacteria called group A Streptococcus. People with strep may also have flu-like symptoms including body aches and chills.

Causes

Tonsillitis

Tonsillitis may be viral or bacterial, although viral tonsillitis is the most common cause. The viruses that are responsible for the flu and common cold can lead to tonsillitis.

Bacterial tonsillitis is caused by the same bacteria that causes strep, Streptococcus pyogenes (group A strep). Other bacteria may cause tonsillitis, but group A strep is the most common.

Strep

Group A Streptococcus bacteria (group A strep) can also cause strep throat. These bacteria live in the nose and throat and spread through contaminated droplets.

When someone who has strep bacteria sneezes, the droplets spread into the air and on nearby surfaces. Coming into contact with these contaminated droplets increases the risk of developing strep throat.

Tonsillitis vs. strep throat causes
Tonsillitis Strep
  • Virus
  • Bacteria
  • Bacteria

Prevalence

Tonsillitis

According to the National Center for Biotechnology Information, “tonsillitis is a common disease and makes up approximately 1.3% of outpatient visits”. Viral tonsillitis is more common in patients under the age of five. Bacterial tonsillitis is rare in children under the age of two.

Strep

According to the CDC, it’s estimated that “several million cases of non-invasive group A strep illness occur each year”. Group A streptococcus bacteria causes between 20% to 30% of sore throats in children and between 5% to 15% in adults. Children between ages 5 and 15 are more likely to get strep throat, but people of all ages can also become infected with it.

Tonsillitis vs. strep throat prevalence
Tonsillitis Strep
  • Makes up approximately 1.3% of outpatient visits
  • Viral tonsillitis is more common under the age of 5
  • Bacterial tonsillitis is rare under the age of 2
  • Several million cases of non-invasive group A strep illness occur each year
  • Group A streptococcus bacteria causes between 20% to 30% of sore throats in children
  • Group A streptococcus bacteria causes between 5% and 15% of sore throats in adults

Symptoms

Tonsillitis

Tonsillitis is characterized by a sore throat, discomfort when swallowing, fever, and swollen lymph nodes. Acute voice changes are also possible. Some people may develop a stiff neck and headache.

Strep

Symptoms of strep throat are very similar to tonsillitis but tend to be more severe.

Common symptoms include sore throat, pain when swallowing, fever, bad breath, tiny red spots inside the mouth and throat, swollen lymph nodes, and inflamed tonsils. White patches or pus may also be seen near the tonsils. Flu-like symptoms including body aches, headache, and chills. Nausea and vomiting are possible but are more common in children.

Severe strep throat infections can lead to swelling of the throat and difficulty breathing.

Tonsillitis vs. strep throat symptoms
Tonsillitis Strep
  • Sore throat
  • Discomfort when swallowing
  • Fever
  • Voice changes
  • Swollen, tender lymph nodes
  • Headache
  • Stiff neck
  • Sore throat
  • Discomfort or difficulty swallowing
  • Fever
  • Bad breath
  • Tiny red spots inside the mouth or at the back of the throat
  • Inflamed, red tonsils (may have white spots)
  • Swollen, tender lymph nodes
  • Body aches
  • Headaches
  • Chills
  • Nausea or vomiting

RELATED: Learn more about tonsillitis

Diagnosis

Tonsillitis

Your healthcare provider will do a thorough exam to determine whether you have tonsillitis. They will start by asking questions about your symptoms and whether you have had tonsillitis or strep throat in the past.

A lighted instrument is used to check your throat for signs of infection including redness, swelling, or pus. Your doctor will also press gently on your lymph nodes to look for signs of swelling.

If an infection is suspected, a rapid antigen test and culture may be required. A swab is used to take a sample of the fluid in your throat to determine whether the infection is bacterial or viral. The rapid strep test is done in the office and produces results within minutes. These tests aren’t always reliable, so they may still send the sample to a lab for further testing. Throat cultures are also helpful for identifying the right antibiotic for effective treatment.

If this is your first time developing tonsillitis, your doctor will probably categorize your case as acute. This means that it is a short-term case. People with chronic tonsillitis have repeat infections and may be referred to a specialist for further evaluation.

Strep

The diagnosis process for strep throat is very similar to tonsillitis. If you’ve had a sore throat and fever for several days, you should be evaluated for strep throat as soon as possible.

Your doctor will take your medical history and ask you about your symptoms. They will check your lymph nodes for swelling and look into your throat with a lighted instrument.

If your doctor’s exam finds signs of strep throat, they will most likely administer a rapid strep test in the office. A long swab is used to take a sample of the fluid from around your tonsils. Within a few minutes, the rapid test can give you a positive or negative strep result.

Most doctors will send the sample to a lab for culture, regardless of whether the rapid test comes back positive or negative. The rapid test results may be used to guide initial diagnosis and treatment, but the lab results will determine more accurate results.

Tonsillitis vs. strep throat diagnosis
Tonsillitis Strep
  • Medical history
  • Physical exam
  • Rapid antigen test
  • Throat culture (lab)
  • Medical history
  • Physical exam
  • Rapid antigen test
  • Throat culture (lab)

Treatments

Tonsillitis

Viral tonsillitis is treated with over-the-counter medications to alleviate pain and discomfort. Acetaminophen or ibuprofen may be used to reduce the pain and swelling, as well as any fever. If the pain is severe, you can alternate these medications for more effective relief. 

Other at-home remedies include drinking plenty of liquids, taking throat lozenges, gargling warm salt water, and using a humidifier to moisten the air and reduce irritation.

Bacterial tonsillitis can be treated with antibiotics. The most common antibiotic is penicillin

Surgery to remove the tonsils (tonsillectomy) is a treatment option for patients with chronic tonsillitis. This is an outpatient surgery for most people.

Strep

A bacterial strep infection is commonly treated with amoxicillin or penicillin. Other common antibiotics include Zithromax (azithromycin), Suprax (cefixime), Biaxin (clarithromycin), and Cleocin (clindamycin).

At-home remedies for strep throat are the same as for tonsillitis. Drinking warm liquids may temporarily help relieve some of the pain. Popsicles and throat lozenges may also help provide pain relief and comfort. Over-the-counter pain relievers like acetaminophen and ibuprofen will help reduce pain, fever, and swelling.

For patients with recurring strep infections despite antibiotic treatment, surgically removing the tonsils (tonsillectomy) may be considered as a way to prevent future infections and long-term complications. 

Tonsillitis vs. strep throat treatments
Tonsillitis Strep
  • At-home remedies
  • Antibiotics (bacterial)
  • Over-the-counter pain relievers
  • Tonsillectomy (chronic)
  • At-home remedies
  • Antibiotics (bacterial)
  • Over-the-counter pain relievers
  • Tonsillectomy (chronic)

RELATED: Learn more about strep throat treatment

Risk factors

Tonsillitis

School-aged children are at higher risk for developing tonsillitis. Working in an environment that involves frequent exposure to germs, including schools and healthcare facilities, also increases the risk. 

Strep

The bacteria that causes strep throat is very contagious. The virus is most common in school-aged children, making schools a popular location for the spread of strep throat.

Because strep throat is very contagious, being exposed to someone who has strep throat puts you at an increased risk for developing the infection. Person-to-person transmission is very common, making it easy to pick up the group A strep bacteria from surfaces and contaminated air. Adults who work with children are also at increased risk.

Tonsillitis vs. strep throat risk factors
Tonsillitis Strep
  • Being exposed to someone with tonsillitis
  • School-aged children
  • People who come into contact with school-aged children frequently
  • Frequent exposure to germs
  • Being exposed to someone with strep bacteria
  • School-aged children
  • People who come into contact with school-aged children frequently
  • Frequent exposure to germs

Prevention

Tonsillitis

Tonsillitis is contagious. Washing your hands regularly is important for preventing both bacterial and viral infections. If soap and water aren’t available, alcohol-based sanitizers can be used temporarily. Avoid sharing food or drinks with others to prevent spreading infections. 

Strep

The best way to prevent strep throat is to wash your hands frequently. Always wash your hands with soap and water when possible, as this is the best way to kill germs.

Other ways to prevent strep throat include:

  • Cover your mouth when coughing or sneezing
  • Wash your hands for at least 20 seconds
  • Use alcohol-based sanitizer when necessary
  • Avoid contact with others if you have strep throat
  • Take your medication as prescribed
  • Sanitize surfaces in high-traffic areas often

If you’re currently being treated for strep throat, follow your doctor’s medical advice for returning to work or school. Antibiotics help prevent the spread of strep throat. You should have taken your medication for 24 hours and be fever-free before returning to your normal routine.

How to prevent tonsillitis vs. strep throat causes
Tonsillitis Strep
  • Wash your hands regularly
  • Cover your cough
  • Avoid sharing food and beverages with others
  • Keep surfaces sanitized
  • Avoid coming into contact with people who have tonsillitis
  • Cover your cough
  • Wash your hands
  • Avoid sharing food and beverages with others
  • Keep surfaces sanitized
  • Avoid coming in contact with people who have strep throat

When to see a doctor for tonsillitis or strep

If you have symptoms of tonsillitis or strep throat including sudden onset of throat pain, swollen lymph nodes, enlarged tonsils (with or without pus), painful swallowing, and a fever greater than 101F for longer than two days, visit your healthcare provider as soon as possible.

Frequently asked questions about tonsillitis and strep

How to tell the difference between tonsillitis and strep

The symptoms of tonsillitis and strep throat are very similar. Strep throat is caused by streptococcus bacteria and causes fever and persistent pain. Tonsillitis is inflammation of the tonsils and is also painful, but could be viral or bacterial. The best way to tell the difference between tonsillitis and strep is to visit your healthcare provider for a culture.

Difference between viral and bacterial tonsillitis

Several viruses, including the influenza virus, can cause viral tonsillitis. Viral cases are usually mild and don’t require antibiotic treatment. Over-the-counter pain relievers and home remedies help ease the symptoms.

Bacterial tonsillitis usually causes more severe symptoms. Some bacterial infections can improve without antibiotics, but this isn’t always the case. Your doctor will determine what treatment is appropriate for you.

How long does strep throat last?

Strep throat usually goes away within a week when taking antibiotics. You’ll continue to be contagious until you’ve taken your antibiotics for at least 24 hours and are fever-free.

Strep throat can be contagious for longer when antibiotics aren’t used. You’re also at a higher risk for developing rheumatic fevers, including scarlet fever.

Is tonsillitis contagious?

Yes, tonsillitis is contagious. It spreads easily through the air or on surfaces. If you have tonsillitis, follow your doctor’s prevention guidelines to help stop the spread.

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