Tonsillitis and strep throat are similar illnesses that affect the inside of the throat and surrounding tissue. Differences include how they affect the tonsils and surrounding areas.
Because tonsillitis and strep throat are so similar, it can be difficult to tell them apart.
One key difference is that tonsillitis involves inflammation of the tonsils, while strep throat involves a specific bacterium infecting the throat. This could also affect the tonsils.
A person could have strep throat with tonsillitis at the same time, and strep can also cause tonsilitis. However, a different bacterium could cause tonsillitis. Other germs, such as viruses, can cause this illness.
Most people who have a significant throat infection will need to see a doctor to find out whether they have tonsillitis or strep throat.
This article covers the similarities and differences between tonsillitis and strep throat, as well as what to do if either of these illnesses develop.
Tonsillitis means inflammation of the tonsils. The palatine tonsils are two small, oval shaped bumps located as one on both sides of the throat. They are the same pink color as the rest of the throat.
The tonsils are lymphatic system organs that are part of the immune system. The immune system helps the body fight off infections naturally. The tonsils stop germs from traveling further down the throat to the lungs. This is an important function in children, as their immune systems are still developing.
Strep throat, on the other hand, is short for streptococcal pharyngitis. This means inflammation of the throat due to the bacterium Streptococcus pyogenes. The medical term for the throat is the pharynx, and the tonsils are part of the pharynx.
The majority of tonsillitis cases occur due to a virus. For example, rhinovirus commonly causes viral tonsillitis. This is the germ responsible for the common cold.
Other viruses that can cause tonsillitis include:
- influenza A, which is a flu virus
- herpes simplex virus
- Epstein-Barr virus (mono)
Strep throat is
Both bacteria and viruses are organisms so small that people can only see them under a microscope. They can spread from person to person through respiratory droplets in a cough or a sneeze, as well as through the exchange of saliva.
Some ways to prevent exposure to these infectious organisms include:
- washing the hands frequently and thoroughly
- wiping down shopping carts before use
- not sharing cups or eating utensils with someone who is ill
- staying at home and resting if a fever occurs
- avoiding contact with people who are sick
Although they have similar symptoms, tonsillitis may be milder than strep throat.
Below is a side-by-side comparison of some tonsillitis and strep throat symptoms.
| Tonsillitis | Strep throat |
|---|---|
| ● sore throat ● swollen, red tonsils, sometimes with areas of pus ● swollen, tender lymph nodes in the neck ● painful swallowing ● fever ● headache ● runny nose ● postnasal drip ● bad breath ● cough | ● sudden onset of sore throat ● swollen, red tonsils, commonly with areas of pus ● swollen, tender lymph nodes in the neck ● painful swallowing ● fever ● headache ● abdominal pain ● nausea and vomiting |
Because a lot of the symptoms of tonsillitis and strep throat are very similar, it is often necessary to see a doctor to determine the cause of the sore throat.
A person should also see a doctor if any of the following symptoms occur:
- frequent or large amounts of drooling
- an inability to take in fluids
- difficulty breathing
- a high fever
- worsening fatigue or weakness
- difficulty turning, extending, or flexing the neck
- difficulty opening the mouth
A doctor will first examine a person’s throat, feeling over areas of the head and neck. However, they cannot always tell if it is GAS, a different bacterium, or a virus causing the infection just by looking at the throat and tonsils.
A rapid strep test, or a throat culture, can verify whether or not it is strep throat. A doctor can also do a rapid viral nasopharyngeal swab test to check for certain viruses.
First, they will swab the back of the throat and tonsils to collect a sample. They will then place the sample in a container and mix it with a solution to check for the presence of the strep throat bacterium. The test will signal whether or not a GAS bacterium is present. The results will generally be available on the same day.
In some cases, a rapid strep test result can be negative, but the doctor may still suspect that a person has strep throat. In these cases, the doctor will send a throat culture out to a laboratory. It can take up to 2 days to get the results back.
Acute tonsillitis commonly affects children aged 4–8 years and young adults aged 15–25 years.
A doctor will be able to make a diagnosis of tonsillitis based on a person’s symptoms and a physical examination of their throat.
The treatment options for strep throat and tonsillitis vary. The sections below outline these differences in more detail.
Strep throat
A doctor will treat strep throat using prescription medications called antibiotics. Most often, they will prescribe either penicillin or amoxicillin for treating strep throat.
A single benzathine penicillin G shot will treat strep throat. The shot may hurt for a few seconds, but it is an option for people who do not like or cannot tolerate taking medicine by mouth.
Other antibiotics, such as erythromycin, may be suitable for people who are allergic to penicillin. A cephalosporin antibiotic such as cephalexin might be an alternative to penicillin or amoxicillin.
If a person does not receive treatment for strep throat, some complications might occur. These may include:
- rheumatic fever, which is inflammation that involves the heart, joints, skin, and brain
- post-streptococcal glomerulonephritis, which refers to inflammation of the kidneys
- invasive GAS infection, which can involve a life threatening infection of the blood, deep muscle and fat tissue, or the lungs
A person should stay at home for at least 24 hours after taking antibiotics and until the fever has resolved.
Tonsillitis
A virus causes acute tonsillitis in most cases. The illness is usually self-limiting, meaning that the immune system will eventually fight it off.
Antibiotics will not work for viral tonsillitis because bacteria and viruses have very different mechanisms to survive and grow. Antibiotics are only able to target and stop bacterial infections.
Sometimes, tonsillitis can become chronic or even recurrent. In these cases, a doctor who specializes in treating illnesses of the ear, nose, and throat can help.
An ear, nose, and throat (ENT) surgeon may recommend a tonsillectomy to treat cases of chronic tonsillitis. This is a form of surgery wherein a health professional removes a person’s tonsils.
General management tips
Even though different germs cause tonsillitis and strep throat, some home treatment measures can help ease the symptoms of both. These include:
- taking acetaminophen or ibuprofen for pain and fever relief
- drinking plenty of fluids
- sipping warm drinks, such as tea made with honey and lemon
- sucking on ice chips, popsicles, or soothing throat lozenges
- using a room humidifier at night if the air in the bedroom is dry
- avoiding exposure to smoke and irritants, as these will irritate the throat
- avoiding citrus fruits such as orange and pineapple, as these may irritate the throat
- gargling with salt water every few hours, using half a teaspoon of salt mixed in water
People who wish to try a saltwater gargle should take a comfortable mouthful and gargle for several seconds before spitting it out.
Most people with strep throat or tonsillitis will eventually feel better without additional treatment.
Tonsillitis and strep throat are common illnesses that most often affect those aged 4–25 years.
Most cases will cause minor discomfort and resolve without complications within 1 week, but someone with strep throat will likely need antibiotic therapy.
If a person does not feel better after 1 week or notices that their symptoms suddenly worsen, they should contact a doctor.