Viral infections like the flu, mono, COVID-19, common cold, and even hand, foot, and mouth disease often mimic strep throat by causing severe sore throats, fever, and swollen tonsils with white spots, but they are caused by viruses, not the strep bacteria, and require different treatment. While strep comes on suddenly with painful swallowing and no cough, viral infections typically develop more gradually, often with cough, runny nose, and body aches.
Viral illnesses that can cause sore throat that may be mistaken for strep throat include:
Rheumatic Fever
It can develop if strep isn't properly treated early on and can cause nosebleeds, abdominal pain, heart problems, swelling, and twitching.
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.
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.
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.
Infectious mononucleosis causes a sore throat, enlarged lymph nodes, and fatigue. The throat may appear red and the tonsils covered with a whitish material. Mononucleosis and severe streptococcal tonsillitis appear quite similar.
Strep infection may lead to inflammatory illnesses, including: Scarlet fever, a streptococcal infection characterized by a prominent rash. Inflammation of the kidney (poststreptococcal glomerulonephritis) Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin.
This might be due to a tonsil infection, a sinus blockage, or temporomandibular joint (TMJ) dysfunction. The nerves that serve the throat also branch into the ears, so it's common for inflammation on one side of the throat to create the sensation of earache on the same side—even if the ear is healthy.
Amoxicillin is a first-choice antibiotic for middle ear infections in adults and children. Antibiotic ear drops can cure an outer ear infection (swimmer's ear). But some people need to take antibiotics by mouth to get rid of the infection.
Strep can spread to the sinuses (sinusitis), middle ear (otitis media) and tonsils (tonsillitis). In other cases, complications might include: Retropharyngeal abscess: An infection behind the pharynx. Infection of lymph nodes in the neck.
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.
Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain. It occurs mainly in children between the ages of 5 to 15. It's an autoimmune disease that occurs after an infection with strep (streptococcus) bacteria. Strep infections include strep throat and scarlet fever.
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.
Pillow ear (or ear pain from sleeping) is discomfort, soreness, or pain in the outer ear caused by prolonged pressure, typically from sleeping on your side on a pillow that's too firm or unsupportive, compressing the ear cartilage and reducing blood flow. It can also be exacerbated by head misalignment, certain pillow fills, or underlying issues like piercings or conditions like Chondrodermatitis Nodularis (CNH).
Bacterial infections related to a sore throat are most often caused by Streptococcus pyogenes, the common reason for strep throat. 5 While most cases of strep infections usually cause a sore throat on both sides, your pain may only be on one side of the throat. These infections are usually treated with antibiotics.
Pharmacists can offer advice on a range of illnesses, such as coughs, colds, sore throats, ear infections and aches and pains. They can also give advice about medicines.
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.
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.
Adults tend to present with an acute-onset sore throat and fever. M pneumoniae presents in an atypical fashion for bacterial pharyngitis. Patients may experience symptoms similar to a viral upper respiratory infection, like a nonexudative sore throat, coryza, headache, ear pain, and a prolonged cough.
While strep tests are generally reliable, false negatives can occur—especially with rapid antigen tests—if the bacterial levels are too low to detect. In such cases, a follow-up throat culture may be recommended for confirmation.
The Epstein-Barr virus causes mono and spreads through saliva, while bacteria cause strep throat and spread through infected droplets. Symptoms of mono include extreme tiredness and swollen lymph nodes, whereas strep throat often causes a sudden sore throat and fever.
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.
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.