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Is it strep or a sore throat? Take this quiz.

Oct 10, 2017 By Amanda Angelotti
Man with a sore throat drinking a glass of water

We’ve all had a sore throat and wondered whether we should just rest and gargle or schlep to the doctor’s office to see if we need antibiotics. Strep throat, or Streptococcal pharyngitis, is a bacterial infection that can be treated with antibiotics to shorten the duration of symptoms and prevent complications, and it’s most common in young, school-age children. When an adult gets a sore throat, 90 percent of the time it’s caused by a common cold or virus that antibiotics don’t help. But they both hurt and make you feel awful, so how do you tell the difference?

Health care providers use an algorithm called the Centor Criteria to make the call. It’s our quick-and-easy way to figure out the likelihood that someone with a sore throat has a bacterial infection that should be tested and treated. It’s just not usually shown to consumers, and it’s filled with jargon meant for doctors and nurses — until now.

Do you have a sore throat? Take the quiz below, add up your points, and find out what your primary care provider would do next.

Is it strep or a sore throat?

1) How old are you?

  • 3-14 years old (1 point)
  • 15-44 years old (0 points)
  • 45 years or older (-1 point)

2) Do you have white pus (“exudate” in medical jargon) on your tonsils? (1 point)

Have a friend or family member take a look with a flashlight, or open wide and look in the mirror. I won’t post it here because it’s kind of icky, but if you want to know what pus on your tonsils really looks like, check out this Google Image Search for “tonsillar exudate.

3) Do you have swollen, tender lymph nodes on the front sides of your neck? (1 point)

Lymph nodes make immune cells. They swell up and can become tender when they’re hard at work making white blood cells to fight infections. This happens to your lymph nodes on either side of your Adam’s apple when you have an upper respiratory infection (URI).

4) Do you have a fever? That’s over 100.4°F or 38°C. (1 point)

It’s common to have low, temporary fevers with viral URIs like the common cold. A higher fever that lasts longer than a couple days is more likely to be caused by a bacterial infection like strep. If you haven’t checked your temperature but you’re pretty sure you have a fever, that counts, too.

5) Do you have a cough? (0 points if yes, 1 point if no)

If you do, it’s much more likely to be caused by a cold virus giving you sinus congestion that’s draining into your throat. You’re more likely to have strep if you don’t have cough symptoms with your sore throat.

Total up your points. If you got a 3, 4 or 5, you meet Centor Criteria. This doesn’t mean you have strep throat — it means you should be tested for strep in the office.

Centor Criteria for Strep throat testing

Treating Strep Throat

The treatment for strep throat is penicillin, usually taken for 10 days (ask your provider about alternative antibiotics if you’re allergic to penicillin). Taking an antibiotic for strep alleviates your symptoms and makes you less contagious. It also lowers your risk of developing a more serious throat infection or a very rare complication called rheumatic fever, which primarily affects the heart and joints.

Here are some reasons you might not want to take antibiotics, even if you have a strep infection:

  • You’re a healthy adult and you’d prefer to avoid antibiotics. If you rest and drink plenty of fluids, your immune system can actually handle a strep infection on its own. You’ll get through it more comfortably if you treat your symptoms with over-the-counter medications suggested below.
  • You want to avoid common side effects of antibiotics such as upset stomach, diarrhea, and, if you’re female, yeast infections. Antibiotics can do quite a number on the helpful bacteria in your body.

If you do start antibiotic treatment, remember to take every single dose of the medication all the way to the end, even if you start feeling better earlier, in order to prevent the bacteria from developing resistance to the antibiotics.

Managing your symptoms

Treating your symptoms often doesn’t mean taking antibiotics. Whether your upper respiratory infection is viral like the common cold or bacterial like strep, the same rules apply symptom control:

  • For sore throats, fever, headaches, and body aches: Take acetaminophen (Tylenol) or an anti-inflammatory pain reliever like ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin as directed. Special note: Never give aspirin to kids under 18 due to the risk of developing Reye’s Syndrome.
  • For congestion or sinus pressure caused by a head or chest cold: Try steam inhalation, nasal irrigation with a neti pot, over-the-counter nasal steroids like fluticasone (Flonase), or a strong decongestant like real pseudoephedrine (show your ID at the pharmacy counter to get it).Read more about how to soothe your symptoms  in Our Definitive Guide to Cold and Flu.
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Amanda Angelotti

Amanda Angelotti, MD, works in clinical operations for One Medical. She writes educational content for patients and designs clinical guidelines and protocols for our health care providers. Before joining One Medical, she worked in tech product management and communications. Amanda completed her medical degree at UCSF.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.