strep throat or tonsillitis "Mom, my throat hurts."


This is a very common complaint among school-age children. Parents may wonder, is it time for antibiotics, or is this a virus that has to “run its course”? It’s difficult to determine the cause of a sore throat: It could be the result of anything from allergies to heartburn. However, two of the most common causes of throat pain are strep throat and tonsillitis. These two diseases have similar symptoms but are treated differently.

Tonsillitis is often caused by a virus, and antibiotics will not be effective against it. Strep throat is an infection that, if not treated, can cause serious problems that affect the heart and lungs.

So how can you tell the difference? Only a doctor can make an accurate diagnosis, but here are some helpful guidelines.


The tonsils are small tissues located at the back of the throat. When these become inflamed, it can indicate tonsillitis. Symptoms include:
  • Sore throat
  • Difficulty swallowing
  • Swollen tonsils
  • Tender lymph nodes. The lymph nodes are structures that filter harmful substances out of the body. Lymph nodes are located throughout the body, and during a case of tonsillitis, the lymph nodes on either side of the throat may be tender and enlarged.

If your child has continual problems with tonsillitis, your ear, nose and throat doctor may suggest removing the tonsils.

Strep Throat

Strep throat is more severe than tonsillitis, and it’s caused by a specific strain of bacteria called Streptococcus. If untreated, it can damage the kidneys or turn into rheumatic fever, a disease that damages heart valves. Strep throat symptoms include: 



  • A fever greater than 101 degrees 
  • White patches on the throat
  • Swollen lymph glands in the neck
  • Children with strep throat may have stomach pain and/or a headache.

Your ENT physician can perform a simple test to determine whether or not it is strep throat.

What are the main differences?

A side-by-side comparison shows the subtle differences between the two:


 Strep Throat                                    Tonsillitis

Fever above 101 degrees Rarely includes a fever
Is caused by bacteria May be caused by a virus or
bacteria, although viral tonsillitis is more common
Entire throat is inflamed Inflammation is focused on tonsils
White patches on the throat No white patches
Swollen lymph glands Swollen lymph glands
Must be treated with antibiotics Antibiotics are not effective
against viral tonsillitis
Rash (less common)  No rash
Is not usually accompanied by respiratory symptoms May be accompanied by a stuffy or runny nose and other respiratory symptoms
 Possible headaches No headaches

When to see YOUR ENT doctor

In general, a common cold lasts between five to seven days. If a sore throat is severe or persists longer than seven days, be sure to speak with your doctor.

Following are some additional signs that immediate medical help is needed:


  • Difficulty breathing or swallowing
  • Fever greater than 101 degrees 
  • Lump in the neck
  •  Joint pain
  • Blood in the saliva  
  • Earaches
  • Rash

Over-the-counter pain relievers may be used to help ease symptoms of a sore throat when used in conjunction with throat sprays. Remember: Aspirin should NOT be given to young children because it can cause Reye’s syndrome. Reye’s syndrome is a serious disorder that can cause brain damage and death.




American Academy of Pediatrics. “The Difference Between a Sore Throat: Strep and Tonsillitis.”

American Academy of Otolaryngology. "Sore Throat."

The Mayo Clinic. "Tonsillitis.”