Illnesses with strep-like symptoms (sore throat, fever, swollen glands) are often viral, including the common cold, flu (influenza), COVID-19, mononucleosis (mono), measles, and chickenpox, but can also be bacterial (like scarlet fever or tonsillitis) or other conditions like oral herpes. Viral causes don't respond to antibiotics, while bacterial ones might, so seeing a doctor for a proper diagnosis (often with a rapid strep test) is crucial.
Some common ones are rhinovirus (common cold), flu, adenovirus, and coronaviruses, like COVID-19. These typically lead to redness and rawness in the back of the throat. One virus that really mimics strep throat is the Epstein-Barr virus, the virus that causes mono.
Two frequent culprits, mononucleosis (mono) and strep throat, can look similar at first glance. Both cause throat pain, fatigue, and swollen glands, yet their causes and treatments couldn't be more different.
Sometimes viral illnesses cause a sore throat that may be mistaken for strep throat. These include common cold viruses, coronavirus disease 2019 (COVID-19), influenza (the "flu"), croup, mononucleosis (“mono”), measles, and chickenpox.
Yes, strep throat can cause ear pain through referred pain from shared nerves or by leading to a secondary ear infection, as the inflammation and bacteria can affect the connected ear, nose, and throat system, especially the Eustachian tubes. This discomfort often feels like pressure or soreness in the ear, and it's crucial to see a doctor for treatment, as untreated strep can cause complications, notes the American Family Care and other sources.
Sinus Infections (Sinusitis)
Sinus infections can create pressure that radiates pain to both the throat and ears. Postnasal drip irritates the throat, while blocked sinuses affect the Eustachian tube, leading to ear pain. Symptoms often include facial pressure, nasal congestion, and headache.
Strep throat accounts for only a small portion of sore throats. If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage.
Symptoms
Strep throat and COVID-19 can both cause a sore throat. Strep and COVID-19 have different origins, which also causes them to require different treatment strategies. It's possible to have strep and COVID-19 at the same time.
Chlamydia in the throat may also cause STD white spots on tonsils or in the back of the throat. If you have swollen tonsils and any other symptom that resembles a strep throat infection, it may be wise to still get tested for chlamydia.
Rheumatic fever is an autoimmune reaction to the strep bacteria. An autoimmune reaction is when the body attacks its own tissues. It can be prevented if strep throat is diagnosed right away and treated correctly with antibiotics. Rheumatic fever is not common in the U.S.
Viruses, like those that cause colds or flu, are the most common cause of sore throat. These viruses are not strep throat. Sore throat can be a symptom of strep throat, the common cold, allergies or other upper respiratory tract illness. Most sore throats will get better on their own within one week.
Changes in the bacteria themselves may also play a role. The emergence of a new variant of Strep A, the so-called M1UK variant, was first reported in 2019 and linked to a marked increase in invasive infections, seasonal scarlet fever surges, and expression of a superantigen toxin.
Sore Throat: Other Causes
Viral infections are a more common cause of sore throat than strep bacteria, so if strep tests are negative, a viral infection may be the culprit. Viral throat infections may include additional symptoms such as cough, runny nose or inflamed eyes.
Mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. Often, the lymph nodes in the neck are swollen and painful.
Severe Strep infections
Bloodstream infections (bacteremia). An infection that causes a rash, sore throat and a high fever (scarlet fever). Multi-organ infections (toxic shock syndrome). Inflamed tissues in your joints and heart (rheumatic fever).
June 26, 2025 – The new COVID-19 variant that now makes up about a third of U.S. COVID cases has a signature symptom: a painful sore throat that feels like "razor blades." "This 'razor blade sore throat' was reported as a common symptom in China," where the variant first emerged in May, said Matthew S.
“If the test is negative, the sore throat is most likely caused by a virus,” Dr. Duong says. There are two types of tests for strep throat: Rapid strep test: A rapid strep test involves swabbing the throat and running a test on the swab.
Strep throat is a respiratory infection of the upper respiratory tract, but it is not caused by a virus. Unlike COVID-19, RSV, and the flu, strep throat is a bacterial infection. It is caused by a group of bacteria called group A Streptococcus.
Symptoms of EBV infection can include:
The Epstein-Barr Virus (EBV) has different stage descriptions, but generally involves Primary Infection, Latency, Reactivation (Lytic Cycle), and sometimes a chronic phase, moving from initial infection to lifelong dormant presence, periodic awakening with new symptoms, and potentially chronic active infection, often seen as different phases within the illness of mononucleosis (mono) like incubation, acute, and convalescent stages.
Prodrome Stage
Symptoms of mono may not show up for four to six months after infection. This incubation period makes it difficult to know when the infection actually started. Symptoms that occur during this phase lasts from three to five days and include: Sore throat.
PANDAS Symptoms Checklist
Streptococcal pharyngitis, commonly known as "strep throat," is a bacterial throat infection caused by Streptococcus pyogenes (group A streptococcus). It typically presents with a sudden onset of sore throat, fever, pharyngeal inflammation, and tender cervical lymph nodes.
Invasive group A streptococcal (iGAS) disease Although rare, life-threatening GAS disease may occur when bacteria get into parts of the body where bacteria usually are not found, such as the blood or muscle. These infections are called invasive group A streptococcal (iGAS) disease.