There are different agents that can cause a sore throat such as viruses, bacteria, fungi, irritants, allergens and sinus drainage. Any of these can cause as much of a sore throat as bacteria.
Strep, short for Group A Streptococcus, is a specific form of bacteria and is one of the most common bacteria to affect the tonsils.
If you have strep throat, you most likely will have a white covering over the tonsils and also may likely experience a headache and upset stomach. These symptoms are classic indicators of strep throat.
If you have a really bad sore throat without the headache and upset stomach, then it’s probably not strep throat. That being said, viruses usually don’t cause a white covering over the tonsils; if that occurs it’s probably a bacterial infection of some sort. Mononucleosis is the only virus that can cause the white covering.
The tonsils in the back of the throat have pockets in them; they’re what we call crypts. If someone has very well-defined pockets in their tonsils, that can harbor bacteria. Those people can be constant carriers for streptococcus and other bacteria.
If you have a sore throat, initially you can treat it at home to see if it’s just a virus. Rest and fluids are best. If you aren’t improving after roughly five days, or if the sore throat seems unusually severe or you have a compromised immune system, you should see your doctor who can examine the tonsils and determine if a white covering is present and possibly swab the throat.
Many doctor offices can do a rapid strep test, however in a child, it’s recommended that if the rapid strep test comes back negative, that it is still cultured out to be sure there’s not strep present.
If there is a white covering over the tonsils and the strep test is negative, your physician will likely prescribe an antibiotic because the white covering is consistent with being either Mononucleosis or bacteria.
Your doctor may prescribe an antibiotic based on the look of your tonsils and the length of time you’ve had your sore throat. If you are given an antibiotic, expect to feel better in 48 to 72 hours. If you’re not feeling better, then you should notify your doctor.
If you have a severe sore throat and your exam is not abnormal or you don’t respond to treatment, your physician may refer you to an ENT/Otolaryngologist who can use a scope to look further down into the throat to rule out any other issues.