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Tonsillitis vs Strep Throat: What Is the Difference?

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Tonsillitis refers to the inflammation of the tonsils caused by a virus or bacteria, while Strep throat is caused by group A Streptococcus bacteria. Read below.

Written by

Dr. Ssneha. B

Published At July 7, 2023
Reviewed AtJuly 7, 2023


The terms sore throat, strep throat, and tonsillitis are considered the same, and people treat the symptoms without being aware of what is wrong. These three conditions are not the same. Tonsillitis can occur without one having strep throat. On the other hand, tonsillitis can be caused by group A Streptococcus bacteria, which is the causative agent of strep throat, but tonsillitis can also occur due to other bacteria and viruses.

What Is Tonsillitis?

Palatine tonsils, or simply tonsils, are two small, oval-shaped bumps situated on either side of the throat and are a part of the immune system. The tonsils help to fight against infections. They obstruct the movement of microorganisms down the throat into the lungs, which is an important mechanism in children since the immune system is still developing. Inflammation of the tonsils is called tonsillitis. Tonsillitis can be either due to a bacterial or viral infection.

One of the symptoms of tonsillitis is a sore throat. This is usually common in young children between the ages of 5 to 15. It is common during winter and spring and can affect all age groups.

What Is Strep Throat?

Streptococcal pharyngitis is referred to as strep throat. Strep throat involves inflammation of the throat due to the bacteria Streptococcus pyogenes which belongs to group A streptococcus and is contagious. It is usually transmitted through the droplets of an infected person while sneezing, coughing, sharing foods and drinks, or through touching the surfaces previously touched by the infected person.

What Is the Difference in Causes of Tonsillitis and Strep Throat?

Tonsillitis is caused in the following ways:

  • Tonsillitis can be due to a virus or bacteria, but viral tonsillitis is the most common. The viruses that are responsible for causing the common cold and flu may also be responsible for causing tonsillitis.

  • Bacterial tonsillitis is caused by Streptococcus pyogenes which belong to group A streptococcus. These bacteria are responsible for causing strep throat as well.

  • Tonsillitis can be caused by bacteria other than Streptococcus pyogenes, like Staphylococcus aureus (MRSA), Chlamydia pneumoniae (chlamydia), and Neisseria gonorrhoeae (gonorrhea).

  • The viruses responsible for causing tonsillitis include influenza, coronavirus, adenovirus, Epstein-Barr virus, herpes simplex virus, and HIV.

Strep throat is caused in the following ways:

  • Streptococcus pyogenes is responsible for causing strep throat. These belong to group A Streptococcus.

  • Strep throat is exclusively caused by group A Streptococcus bacteria, and no other group of bacteria or virus seems to cause it.

  • Streptococcus is transmitted through sneezing, coughing, sharing things, and touching contaminated surfaces. The bacteria causing Strep throat rarely gets transmitted through food or water.

What Is the Difference in Symptoms of Tonsillitis and Strep Throat?

The symptoms of tonsillitis are as follows:

  • Sore throat.

  • Large, tender lymph nodes in the neck.

  • Difficulty or pain while swallowing.

  • Redness and swelling in the tonsils.

  • Fever.

  • Runny nose.

  • Postnasal drip.

  • Bad breath.

  • Cough.

  • Stiff neck.

  • Upset stomach.

  • Swollen, red tonsils, sometimes with white or yellow discoloration that is visible on or around the tonsils.

  • Headache.

The symptoms of strep throat are as follows:

  • Sore throat.

  • Large, tender lymph nodes in the neck.

  • Difficulty in swallowing accompanied by pain.

  • Small, red spots can be noticed on the roof of the mouth.

  • Fever, that is higher than in tonsillitis.

  • Body aches.

  • Nausea or vomiting, particularly in children.

  • Swollen, red tonsils with streaks of white-colored pus.

  • Headache.

What Are Not the Symptoms of Strep Throat?

If a child has the symptoms mentioned below, it could be due to a virus and not bacteria. Antibiotics will be ineffective in such instances.

  • Runny nose.

  • Cough.

  • Hoarseness of voice (a raspy voice).

  • Conjunctivitis or pinkeye (inflammation of the outer membrane of the eyeball and inner eyelid).

Who Is at Risk of Developing Tonsillitis and Strep Throat?

The following are at risk of developing tonsillitis and strep throat:

  • Young children between the age group of 5 to 15 can develop tonsillitis.

  • Young children at daycare or in school are often exposed to germs and hence have increased chances of contracting infections.

  • Adults who frequently use public transport and those living and working in cities are at greater risk of getting exposed to germs causing tonsillitis.

  • Strep throat is most common in early spring and fall.

How Are Tonsillitis and Strep Throat Diagnosed?

The physician will enquire about the history of the symptoms and makes a physical examination which includes:

  • Examining the back of the throat with a lighted instrument.

  • Viewing inside the ears and nose.

  • Gentle pressing of the lymph nodes (a small bean-shaped structure that is a part of the immune system) to determine if there is any swelling.

A throat culture may be suggested to detect the presence of Streptococcus. A culture sample is obtained with a cotton swab that collects saliva and cells from the posterior part of the throat. The procedure can cause discomfort and a gagging reflex for a few seconds. The sample is then checked for the presence of any bacteria in the laboratory.

How Are Tonsillitis and Strep Throat Managed?

The treatment for tonsillitis is as follows:

  • Tonsillitis caused by a virus can resolve on its own within 3 to 14 days. During this phase, it is advisable to take sufficient rest, consume plenty of water, gargle with salt water, and take over-the-counter medications like acetaminophen and ibuprofen to decrease fever and pain.

  • Tonsillitis caused by bacteria may require antibiotics to treat them. Antibiotics should be taken as per the doctor’s instructions.

  • In case of recurrent tonsillitis, or more extreme cases, the tonsils get enlarged to an extent such that breathing becomes difficult. In such cases, the doctor might recommend a procedure called tonsillectomy which involves the removal of tonsils.

The treatment of strep throat is as follows:

  • Since strep throat is caused by bacteria, the doctor will prescribe antibiotics. Antibiotics either hinder the growth of bacteria or kill them.

  • Antibiotics are usually given orally but can also be given intravenously (through a vein in the arm) in case of severe infections. Commonly prescribed antibiotics are Penicillin, Amoxicillin, and Cephalexin.

Home remedies common to tonsillitis and strep throat include:

  • Taking ample rest.

  • Using throat lozenges (solid forms of medicine that dissolve slowly in the mouth).

  • Staying hydrated by drinking plenty of fluids.

  • Gargling with saltwater.

  • A humidifier can be used to keep the air moist.

  • Citrus fruits should be avoided as these can irritate the throat.

  • Avoid exposure to irritants and smoke.

  • Taking over-the-counter medications for fever or pain.

Stopping the antibiotics abruptly or not completing the full course can lead to the recurrence of infections.

What Are the Similarities and Differences Between Tonsillitis and Strep Throat?

The similarities are as follows:

  • Red, swollen, and sore throat.

  • Common in young people.

  • Spreads from one person to another.

The differences are as follows:

  • Tonsillitis can be caused due to viruses or bacteria, while strep throat is caused exclusively by bacteria.

  • Viral tonsillitis can improve with over-the-counter medications, while strep throat requires prescription antibiotics.

  • The symptoms of viral tonsillitis include cough, while strep throat involves flu-like symptoms like nausea and vomiting.

What Are the Complications of Tonsillitis and Strep Throat?

In severe cases, tonsillitis and strep throat can cause the following complications:

  • Scarlet fever (a bacterial infection that develops in a few people with strep throat).

  • Kidney inflammation.

  • Rheumatic fever (a disease resulting from strep throat or scarlet fever that is inadequately treated).

When to Consult a Doctor?

A physician should be consulted in the following conditions:

  • Symptoms that last for more than 4 days that do not improve or have worsened.

  • Fever above 102.6 ℉ (39.2 ℃), difficulty in breathing, or drinking.

  • Increased pain that does not subside.

  • Frequent history of tonsillitis or strep throat.


Though certain symptoms of tonsillitis and strep throat are the same, they are different infections. Tonsillitis can occur due to viruses or bacteria that can enlarge and inflame the tonsils, while strep throat is caused by a particular bacteria that can cause inflammation in the throat. Antibiotics are required to treat strep throat and bacterial tonsillitis, while over-the-counter medications are sufficient to treat viral tonsillitis. In case the symptoms persist, it is better to consult a physician.

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Dr. Syed Peerzada Tehmid Ul Haque
Dr. Syed Peerzada Tehmid Ul Haque

Otolaryngology (E.N.T)


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