Tonsillitis vs. Strep Throat: What Are the Differences?

Tonsillitis and strep throat are common conditions that cause throat pain. These terms may be interchangeable, but they are two separate conditions.

Strep throat is only caused by bacteria called group A Streptococcus. Tonsillitis can be caused by a strep infection, but it can also be caused by other bacteria and viruses.

This article will cover the differences between tonsillitis and strep throat and discuss their symptoms, causes, and treatments.

Symptoms

Tonsillitis and strep throat symptoms are very similar. They both cause throat pain, fever, difficulty swallowing, and swollen lymph nodes in the neck.

However, tonsillitis can also cause a white or yellow coating on the tonsils. Whereas strep throat is more likely to cause small, red spots called petechiae on the roof of the mouth.

Tonsillitis symptoms can include:

• Sore throat
• Difficulty swallowing
• Swollen tonsils
• Fever
• Swollen neck lymph nodes
• Bad breath
• White or yellow layer on the tonsils

If someone has tonsillitis from a viral infection, they may also suffer from common viral symptoms like cough, congestion, and runny nose.

Here is a list of strep throat symptoms:

• A sore throat that comes on quickly
• Fever
• Pain when swallowing
• Swollen lymph nodes around the neck
• Small, red spots on the roof of the mouth

Other strep throat symptoms, which are more common in children, include headache, nausea, vomiting, and stomach pain.

Causes

The primary difference between tonsillitis and strep throat is in what causes each. Both conditions are caused by an infection in the throat and surrounding tissues, but the infections differ.

Tonsillitis

Tonsillitis is typically caused by a viral infection. However, it can be caused by a bacterial infection, including the bacteria that causes strep throat, group A Streptococcus.

The most common viruses and bacteria that cause tonsillitis are:

• Group A Streptococcus
• Adenovirus
• Herpes simplex virus
• Epstein-Barr virus
• Measles virus
• Cytomegalovirus

Tonsillitis is not contagious, but the germs that cause it are. A person who has tonsillitis can pass on the germs that caused their illness but will not necessarily give someone else tonsillitis.

Strep Throat

Strep throat is only caused by the group A Streptococcus bacteria. However, strep bacteria can cause more than just strep throat. This bacteria is also the cause of infections like impetigo, rheumatic fever, necrotizing fasciitis, cellulitis, and several others.

Strep throat spreads through respiratory secretions or infected skin sores. When someone has been exposed to strep throat, it will take about three to five days for symptoms to develop.

Diagnosis

A healthcare provider will diagnose tonsillitis and strep throat in similar fashions with a few unique differences between the two.

Tonsillitis

Tonsillitis is inflammation of the tonsils, which several different viruses and bacteria can cause. A healthcare provider will diagnose tonsillitis by asking health history questions and performing a physical exam. Tonsillitis is primarily diagnosed by looking at the tonsils.

A healthcare provider may also perform a strep test if they think someone has a strep infection.

Strep Throat

A healthcare provider will diagnose strep throat by asking health history questions, performing a physical exam, and conducting a strep test.

There are two types of strep tests: a rapid strep test and a throat culture. A rapid strep test swabs the throat then processes the swab in the healthcare provider's office for a quick result.

A throat culture also involves swabbing the throat, but then the swab must go to a lab for processing. The results take longer but can also catch other infections that might have caused the sore throat.

In many cases, a healthcare provider will use a rapid strep test. If the result is positive, then the provider will not use a throat culture. However, if it is negative and the healthcare provider still suspects strep throat, then the swab goes in for a throat culture.

Treatment

Treatment for tonsillitis and strep throat aims to treat the underlying conditions. Each illness may need different therapies.

Tonsillitis

Tonsillitis treatment is based on whether the illness is the result of bacteria or viruses, how sick the patient is, how long the illness is expected to last, and the patient's preference.

Tonsillitis caused by bacteria will need an antibiotic to treat it. If the cause is viral, there is no specific treatment other than symptom management.

Over-the-counter medications like Advil (ibuprofen) and Tylenol (acetaminophen) can relieve symptoms. Resting, drinking plenty of fluids, gargling salt water, and using a humidifier are other ways to ease them.

Strep Throat

Strep throat is a bacterial infection, so antibiotics are the primary treatment. A healthcare provider will likely prescribe either penicillin or amoxicillin. These medications need to be taken as prescribed to work. If stopped too soon, the infection can come back.

Antibiotics should help within a day or two. If symptoms don't improve within 48 hours of starting antibiotics, contact a healthcare provider.

Home remedies for managing strep throat symptoms can also include:

• Resting or sleeping
• Drinking plenty of fluids
• Taking over-the-counter pain medication
• Sucking on throat lozenges
• Gargling salt water

Strep Throat Complications

Anyone who suspects they have strep throat should seek a diagnosis and prompt treatment. Although strep throat is a common illness, there are serious complications if it is not sufficiently treated. One serious complication of untreated strep throat is rheumatic fever. Rheumatic fever can affect the heart, brain, skin, and joints.

Other strep throat complications include:

• Post-streptococcal glomerulonephritis
• Sinus infection
• Ear infection
• Abscesses

Prevention

Preventing tonsillitis and strep throat may not always be possible. But there are several ways to help decrease the likelihood of getting sick and developing a sore throat.

Tonsillitis

There is no medication or vaccine to prevent tonsillitis. Here are a few ways to avoid tonsillitis:

• Stay away from anyone who is sick or has tonsillitis.
• Wash your hands frequently.
• Do not share food, toothbrushes, utensils, or drinks with anyone who is sick or has tonsillitis.
  

Strep Throat

No medication or treatment can prevent strep throat. However, there are a few steps that can help reduce the likelihood of catching it.

• Keep your distance from anyone with strep throat until they have been taking their antibiotics for 24 to 48 hours.
• Do not share utensils or toothbrushes with someone who has strep throat.
• Prevent reinfection with strep throat by throwing away toothbrushes two to three days after the illness begins and before the antibiotics are finished.

Summary

Tonsillitis and strep throat share many symptoms, such as sore throat, painful swallowing, and fever. The key difference between these two illnesses is that strep throat only results from the group A Streptococcus bacteria.

Strep may cause tonsillitis, but so can other bacteria and viruses. Strep throat is treated with antibiotics, whereas tonsillitis can be treated with antibiotics if it is caused by bacteria but may be treated with supportive measures like rest and fluids.

A Word From Verywell

If you have a sore throat that is not getting better after a couple of days, is severe, or is accompanied by other symptoms, then it's time to contact a healthcare provider. A healthcare provider will need to diagnose strep throat and then treat it with antibiotics. Tonsillitis may require medication depending on what is causing the illness.