The difference between strep throat and tonsillitis

strep throat and tonsillitis

Tonsillitis and strep throat are similar diseases which affect the inside of the throat and the tissue around it.

Also, they share many of the same symptoms, including sore throat, headache, fatigue and fever.

It can be difficult to tell them apart because tonsillitis and strep throat are so similar.

One key difference is that tonsillitis involves tonsil inflammation, whereas strep throat involves a specific bacterium that infects the throat. This could affect the tonsils, too.


Tonsillitis means the tonsils are inflamed. The palatine tonsils are two thin, oval-shaped bumps situated on either side of the throat as one. These are the same rosy color as the rest of the neck.

The tonsils are lymphatic organs which form part of the immune system. The immune system actually helps the body fend off infections. The tonsils prohibit germs from spreading into the lungs further down the throat. For children this is an important function, as their immune systems are still growing.

In contrast, strep throat is short for streptococcal pharyngitis. Which means throat inflammation due to the Streptococcus pyogenes bacterium. The Pharynx is the medical term for the mouth.


Many cases of tonsillitis happen as a result of a virus. Rhinovirus, for example, is generally responsible for viral tonsillitis. This is the germ to which the common cold is responsible.

Other viruses with the potential to cause tonsillitis include:

  • influenza A, which is a flu virus
  • herpes simplex virus
  • Epstein-Barr virus

A type of bacterium, called group A Streptococcus (GAS), or S, also causes strep throat. Pyogenes; pyogenes. We often shorten the word to “strep.” Up to 30 percent of tonsillitis cases are also caused by this type of bacterium.

All bacteria and viruses are species that are so fragile that only under a microscope can we see these. In a cough or sneeze, they can spread from person to person through respiratory droplets, as well as through saliva exchange.

Several methods of avoiding exposure to such 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

Comparison of symptoms

Tonsillitis may be milder than strep throat, although they have similar symptoms.

Below is a side-by-side analysis of some signs of tonsillitis and the strep throat.

TonsillitisStrep 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

When to see a doctor

Because many of the symptoms of tonsillitis and strep throat are very similar, a doctor also has to be seen to determine the cause of the sore throat.

If any of the following symptoms arise, a person should see a doctor too:

  • frequent or large amounts of drooling
  • an inability to take in fluids
  • difficulty breathing
  • a high fever of 101°F (38.3°C)
  • worsening fatigue or weakness


A doctor should check a person’s throat first, checking over head and neck regions. You can’t always tell if it is GAS, another bacterium, or a virus that causes the infection just by looking at the throat and tonsils.

A quick strep check, or a throat culture, will confirm if it’s strep throat or not. A doctor may also do a quick nasopharyngeal swab test to check for some viruses.

Next, to collect a sample, they’ll swab the back of the throat and tonsils. They will then put the sample in a bottle and mix it with a solution to test for strep throat bacterium to be present. The check will show the existence of a GAS bacterium or not. Typically the tests will be on the same day.

A fast strep test result may be negative in some cases but the doctor may still believe that a person has strep throat. In such situations, the doctor will give a sample of the throat out to a laboratory. It may take up to 2 days for the results to return.

Strep throat is most common in school-age children, and is most often diagnosed by doctors in late winter and early spring.

Acute tonsillitis usually affects kids aged 4–8 and young adults aged 15–25.

A doctor will be able to make a tonsillitis diagnosis based on the symptoms and physical examination of a person’s throat.


Ways of treating strep throat and tonsillitis vary. These variations are discussed in more detail in the following sections.

Strep throat

A doctor uses prescription medicines called antibiotics to treat strep throats. Physicians will most often recommend either penicillin or amoxicillin to treat strep throat.

A shot of a single penicillin G benzathine can treat strep throat. The shot could hurt for a few seconds, but for people who don’t like or can’t tolerate taking medicine by mouth it is a choice.

Other antibiotics, such as erythromycin, may be suitable for individuals allergic to penicillin. The antibiotic with cephalosporin such as cephalexin could be an alternative to penicillin or amoxicillin.

If a person is not being treated for strep throat, there may be some complications. Those might 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 after taking antibiotics for at least 24 hours, and until the fever has resolved.


In most situations a virus causes acute tonsillitis. The disease is usually self-limiting, meaning the immune system will ultimately fight it off.

Antibiotics won’t work for viral tonsillitis because bacteria and viruses have very different survival and growth mechanisms. Antibiotics can only target bacterial infections and can stop them.

Tonsillitis can sometimes become chronic, or even recurring. A doctor who specializes in the care of head, nose, and throat disorders can aid in such cases.

A tonsillectomy may be recommended for treating cases of chronic tonsillitis. This is a form of surgery in which a health care practitioner removes tonsils from a person.

General management tips

While different germs cause tonsillitis and strep throat, certain steps of home treatment can help ease the symptoms of both. Including:

  • 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 8 ounces of water

People who wish to try a saltwater gargle will take several seconds of a nice mouthful and gargle before spitting it out.

Without additional treatment most persons with strep throat or tonsillitis will eventually feel better.


Tonsillitis and strep throat are common diseases most commonly affecting those aged 4–25.

Most cases will cause minor pain and resolve within 1 week without complications, but someone with a strep throat will definitely require antibiotic therapy.

If a person doesn’t feel better after 1 week or experiences a sudden worsening of their symptoms, they should contact a doctor.


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