Tonsillitis vs. Strep: What’s the Difference?
Medically reviewed by Sameena Zahoor, MD
Tonsillitis and strep throat are common contagious infections of the throat that share symptoms. Although they can sometimes be caused by the same bacteria, they're different conditions.
Tonsillitis occurs when a virus or bacterium causes an infection in the tonsils (the soft tissue lumps at the back of the throat). Strep throat occurs when a certain type of bacteria known as Streptococcus causes an infection in the throat area, which can also include the tonsils.
While both illnesses cause a sore throat and other overlapping symptoms, treatment will depend on the underlying cause of the infection. This article provides an overview of strep vs. tonsillitis and the primary differences between them.
Symptoms
Tonsillitis and strep throat share many symptoms. With both infections, you'll likely notice a painful sore throat as the main symptom.
Tonsillitis
Tonsillitis symptoms may vary based on whether the cause of the infection is a virus or bacterium. In general, most people report experiencing:
Swollen, red tonsils that may have a white coating
Fever and chills
Snoring
Pain while swallowing or difficulty swallowing
Swollen glands (lymph nodes) on the sides of the neck or jaw area
Bad breath
Tonsillitis that’s caused by a virus—which is the most common type of tonsillitis—may also come with viral symptoms, such as a cough, runny nose, hoarseness, and pink eye (conjunctivitis).
Complications of Tonsillitis
In some cases, the infection can break out of the tonsil and spread into the space around it, forming a swollen, painful sore called a peritonsillar abscess. When this happens, you may also experience:
Severe throat pain
Muffled voice
Drooling
Difficulty opening your mouth
Strep Throat
There are several telltale signs of strep throat, including:
Sore throat that may appear red with white patches
Fever and chills
Headache
Difficulty or pain while swallowing
Swollen glands (lymph nodes) in the front of the neck
Small red spots (petechiae) on the roof of the mouth
In addition, some people might also experience symptoms like nausea, vomiting, fatigue, body aches, and generally feeling unwell.
Complications of Strep Throat
It's essential to diagnose and treat strep infections, as serious complications can occur if untreated and bacteria spread to other parts of the body. Some of these complications include:
Abscesses in the tonsils or neck
Swollen lymph nodes in the neck
Sinus infection
Ear infection
Rheumatic fever
Causes
There are several potential causes of tonsillitis and one main cause of strep throat. Both infections develop after person-to-person contact with the virus or bacterium, which triggers an inflammatory response from the body's immune system.
Tonsillitis
Most tonsillitis cases happen when a person comes into contact with certain viruses. Other tonsillitis cases are caused by bacteria, usually the same one that causes strep throat.
Some of the most common germ culprits include:
Epstein-Barr virus, which causes mononucleosis (mono)
Herpes simplex virus, which causes genital herpes and oral herpes
Measles virus
Group A Streptococcus bacteria, which also causes strep throat
Related: Tonsillitis, Snoring, and Sleep Apnea
Strep Throat
A type of bacteria known as group A Streptococcus causes several different respiratory and skin infections, including strep throat.
Streptococcus is easily transmitted through contact with bodily fluids of an infected person, even when there aren't any visible symptoms. This includes activities like:
Breathing in droplets of bacteria from a cough or sneeze
Sharing personal items like silverware or a toothbrush
Touching a contaminated surface
The bacteria that cause strep throat is less commonly transmitted through food or water.
Diagnosis
If you're noticing symptoms that indicate tonsillitis or a strep throat infection, it's wise to see a healthcare provider for a diagnosis.
The healthcare provider will start by asking about your medical history and symptoms before performing a physical exam to check for signs of infection. This usually includes:
Viewing the back of your throat with a lighted instrument
Looking inside your ears and nose
Pressing gently on the lymph nodes (glands located on the sides of your neck) to assess swelling
From there, a throat culture may be ordered to determine whether Streptococcus is present. This involves using a long cotton swab to gather saliva and cells from the back of your throat, which may be uncomfortable and trigger your gag reflex for a few seconds. This sample will be sent to the lab to detect any bacteria. Results can take several minutes or a couple of days, depending on the type of test used.
Treatment
The type of treatment recommended by your healthcare provider will depend on the underlying cause of the infection.
Tonsillitis
Treatment for tonsillitis will depend on whether the infection was caused by a virus or bacterium, as follows:
Viral tonsillitis: Treatment will focus on easing your symptoms until the infection clears up on its own, usually within three to 14 days. This includes getting plenty of rest, staying hydrated, gargling with salt water, and taking OTC medications such as Tylenol (acetaminophen) or Advil (ibuprofen) for fever and pain.
Bacterial tonsillitis: Antibiotics will be prescribed. You’ll also be recommended to get plenty of rest, drink fluids, and take OTC medications to help relieve any symptoms like pain or fever.
Recurrent Tonsillitis
People who get chronic (long-lasting) or recurrent (happening over and over again) tonsillitis may be candidates for a tonsillectomy. This outpatient procedure involves surgically removing the tonsils since recurrent infections can lead to other health complications.
Strep Throat
Because strep throat is a bacterial infection, it can be treated with antibiotics.
Antibiotics are prescription medications that can kill off bacteria or stop them from growing. They also work to drastically shorten the period of time that a person with strep throat is contagious, which helps reduce the spread of germs from person to person.
Antibiotics can be taken orally (by mouth in pill form) for anywhere from five to 14 days, or given intravenously (through a vein in the arm) if the infection is severe.
Common antibiotics prescribed for strep throat include:
Amoxicillin
Cephalexin
For people allergic to penicillin, clindamycin, azithromycin, and clarithromycin may be recommended.
In addition, home remedies like resting, drinking plenty of fluids, gargling with salt water, using throat lozenges, and taking OTC medications for pain or fever may also be used to help keep you comfortable while the antibiotics do their job.
It’s important to take antibiotics exactly as your healthcare provider prescribes for the full length of time, even if you start to feel better after a few days. Stopping antibiotics too soon can lead to bacterial infections coming back, getting worse, or spreading to another area of the body.
Tonsillitis vs. Strep
A simple breakdown of the similarities and differences between tonsillitis and step throat is as follows:
Similarities
Sore, red, and swollen throat symptoms
Common in younger age groups
Contagious through person-to-person contact
Differences
Tonsillitis can be caused by a virus or bacteria, while strep throat is exclusively caused by bacteria.
Tonsillitis (when viral) is treated with OTC remedies, while strep throat is treated with prescription antibiotics.
Tonsillitis (when viral) may also come with viral symptoms like a cough, while strep throat can cause flu-like symptoms such as nausea or vomiting.
When to See a Healthcare Provider
Call your healthcare provider or seek urgent medical care if you notice symptoms such as:
A persistent sore throat that doesn't get better after two days
A throat infection that keeps coming back
Difficulty swallowing or breathing
Swelling in the mouth or throat
Feeling very weak
Fever over 101 degrees Fahrenheit (38.33 degrees Celsius)
Additionally, if you are prescribed antibiotics but do not start feeling better within two days of starting them, go ahead and give your provider a call.
Summary
Tonsillitis and strep throat are sometimes referred to interchangeably, but they’re technically different infections. Tonsillitis occurs when a virus or bacterium causes the tonsils to swell, while strep throat happens when a specific bacteria causes swelling in the throat area.
Both infections come with similar symptoms, such as sore throat, difficulty swallowing, headache, and fever, and are transmitted easily from person to person. Antibiotics are the recommended treatment option for strep throat and cases of bacterial tonsillitis. Viral tonsillitis is treated with OTC remedies.
Frequently Asked Questions
Which is worse, tonsillitis or strep throat?
In general, experts say strep throat cases tend to be more severe than tonsillitis. Both infections can range from mild to severe, depending on the individual case.
Is tonsillitis as contagious as strep throat?
This can depend on factors like whether you're at an increased risk of contracting an infection and your exposure level to someone else who's sick. Strep throat, along with the viruses and bacteria that cause tonsillitis, are all highly contagious. To be safe, keep your hands washed and avoid sharing personal items.
What is the main difference between tonsillitis and strep throat?
Strep throat is caused by a specific type of bacteria and causes inflammation in the general throat area. Tonsillitis can be caused by several different types of viruses and bacteria and results in inflammation in the tonsils.
