This article originally ran February 8, 2023, and was updated December 9, 2025.
You wake up with a sore throat—but is it a symptom of the cold or flu, or could it be strep throat?
Most of the time, sore throats are caused by viruses, but strep throat is an infection in the throat and tonsils caused by a specific bacteria: group A Streptococcus, or group A strep.
Although strep throat is more prevalent in children, adults get it too: Up to 3 in 10 children with a sore throat have strep, and about 1 in 10 adults with a sore throat have strep, according to the Centers for Disease Control and Prevention (CDC).
So how can you tell for sure? UNC Health family medicine physician Sarah Ruff, MD, explains what you need to know.
1. Strep throat causes symptoms beyond sore throat.
The most common signs of strep throat are a red, sore throat, difficulty swallowing, swollen tonsils and fever. Sometimes, strep causes white spots on the tonsils, but not always. People with strep may have swollen lymph nodes in the neck and may experience vomiting, nausea, headaches and stomach pain, though these symptoms are more common in children than adults.
“A lot of times, kids don’t complain of a sore throat,” Dr. Ruff says. “They say their belly hurts, and they may throw up. If they have a fever too, it could be strep.”
If your child has a sore throat and a rash, it could be scarlet fever, also caused by group A strep.
Strep throat generally does not cause a cough or a runny or stuffy nose, which are usually signs that your sore throat is caused by a virus.
2. Strep throat is very contagious.
You can get strep throat from someone who is sick or who is a carrier of the bacteria (but doesn’t have symptoms) by breathing in their respiratory droplets. This happens when an infected person coughs, sneezes or talks near you.
You can also get strep if you touch something that contains infected droplets and then touch your mouth or nose, or if you drink from the same glass or eat from the same plate or utensils as someone who is infected. Once you wash any glasses, utensils and plates with soap and hot water, they are safe for others to use.
It usually takes two to five days for symptoms of strep throat to start after you’ve been exposed.
3. Basic infection prevention measures can help you avoid strep throat.
The same precautions that help you avoid colds, flu and other respiratory viruses can help reduce your risk for strep throat.
Wash your hands often and thoroughly, especially after you cough or sneeze. Cover your mouth with a tissue; if you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
If you can’t wash your hands, use an alcohol-based hand sanitizer. If you’re going to be in a crowd, consider wearing a mask. Eat healthy foods and get enough rest.
If you do get strep throat, stay home while you are sick. It’s typically OK to be around others when you haven’t had a fever for 24 hours (without taking a fever reducer like acetaminophen) and have taken antibiotics for at least 24 hours, Dr. Ruff says.
If you are around someone who is sick, consider wearing a mask and make sure you wash your hands often, especially before eating or preparing food.
4. If you suspect strep, get tested.
Of the common infections that circulate in the winter, strep throat is the only one that requires treatment with antibiotics, which can help you avoid complications from the illness. But you can’t determine by yourself whether you have strep or another illness.
If you have symptoms, see your doctor or visit an urgent care clinic right away for a rapid strep test, in which a provider swabs the back of your throat.
If your doctor suspects you have strep even if the rapid test is negative, they may send your sample to a lab for more definitive results.
5. Strep throat is treated with antibiotics.
Because strep is a bacterial infection, antibiotics should help you feel better within a couple of days. Antibiotics reduce the amount of time you have symptoms and how long you are contagious.
“If you don’t feel better within 48 hours after starting an antibiotic, you should get back in touch with your doctor,” Dr. Ruff says. “You might need a different antibiotic, or you may have another infection on top of strep.”
Take antibiotics exactly as directed. Even if you feel better, you need to take the entire prescription to make sure all of the bacteria have been killed.
If you don’t have strep, your illness probably is caused by a virus, and viruses do not respond to antibiotics.
Sometimes people with strep throat become dehydrated because it hurts to swallow. Be sure to drink fluids as you recover.
6. Although uncommon, strep bacteria can cause more serious problems.
Complications of strep throat are not common but do happen. Patients can develop sinus infections, ear infections, or abscesses (pockets of pus) around the tonsils or in the neck. More serious complications include rheumatic fever, which affects the heart, joints, brain and skin, as well as a rare kidney disease.
Strep bacteria also can cause very serious illness if the infection develops in other parts of the body, such as the blood or muscle tissue.
One way to help prevent these serious infections is to make sure everyone in the household is up to date on flu and chickenpox vaccines, because these infections can increase the risk of infection with invasive group A strep bacteria.
Advice If You or Your Child Has Strep Throat
Although strep can make anyone feel miserable, most of the time it’s easy to treat and people feel much better quickly.
Dr. Ruff shares this advice:
- If you have a fever for more than five days, see your doctor.
- If you are on an antibiotic and don’t feel better within 48 hours, call your doctor.
- If you are diagnosed with one illness, don’t assume that’s all that is wrong. Ask your doctor about additional tests for other infections going around in your community.
If you or your child is sick with a sore throat, talk to your doctor, or find one near you.