Strep vs Cold Symptoms: How to Tell Them Apart - StrepCareGuide

A sore throat can come from a cold or from strep throat, and the two can feel alike on the first day. They are very different illnesses, though. A cold is caused by a virus, while strep throat is a bacterial infection caused by group A Streptococcus. Knowing which one you likely have helps you decide whether to get tested, because strep is treated with antibiotics and a cold is not.

This page is educational and is not a diagnosis.

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The short answer

A cough, runny nose, hoarse voice or pink eye point toward a virus such as a cold. The CDC lists these as signs that a sore throat is likely viral, not strep.
A sore throat that starts suddenly, with fever, pain when swallowing and red, swollen tonsils is more typical of strep throat, especially without cough or runny nose.
Only a test can confirm strep. Symptoms overlap, so a rapid strep test or throat culture is the deciding step.

Symptoms side by side

Symptom	Strep throat	Common cold
How it starts	Sore throat often starts suddenly	Symptoms usually peak within 2 to 3 days
Sore throat	Often painful, especially when swallowing	Common, along with other symptoms
Fever	Common	Possible; usually low grade in older children and adults
Runny or stuffy nose	Usually absent	Common
Cough	Usually absent	Common
Sneezing	Not typical	Common
Hoarse voice	Usually absent	Can happen
Tonsils	Red and swollen, sometimes with white patches	Not a typical sign
Tiny red spots on the roof of the mouth	Can occur	Not a typical sign
Neck glands	Often swollen and tender	Not a typical sign
In children	May also cause headache, stomach pain, nausea or vomiting	Headache and mild body aches can occur
Cause	Group A strep bacteria	More than 200 viruses (rhinoviruses are the most common)
Antibiotics	Yes, when strep is confirmed by a test	No; antibiotics don’t help colds

Why symptoms alone aren’t enough

Most sore throats are caused by viruses, not bacteria. According to the CDC, group A strep causes about 20% to 30% of sore throats in children and 5% to 15% in adults. Because a cold and strep can share symptoms like sore throat, fever and headache, clinicians confirm strep with a test before prescribing antibiotics:

Rapid strep test: a throat swab tested in the office, with results in minutes.
Throat culture: a swab sent to a lab, with results in 1 to 2 days. The CDC recommends a culture to follow up a negative rapid test in children and teens over age 3, because a rapid test can miss strep.

The American Academy of Pediatrics advises that antibiotics should not be given for a sore throat unless a test shows strep. Learn more in our strep throat test guide and how doctors diagnose strep throat.

Who is more likely to have strep

Strep throat is most common in children 5 through 15 years old, although anyone can get it.
It is rare in children younger than 3.
Crowded places such as schools and daycare can increase the risk of spreading it.

When to get tested

Consider contacting a healthcare provider about a strep test if:

You or your child has a sore throat with fever and no cough or runny nose
Swallowing is painful and the tonsils look red, swollen or have white patches
Neck glands are swollen and tender
Someone at home or school was recently diagnosed with strep

Get medical care right away for trouble breathing, trouble swallowing liquids, drooling, or signs of dehydration. See when strep throat becomes an emergency.

Care for a cold vs strep

A cold usually lasts less than a week, although some symptoms can last 10 to 14 days. Rest, fluids and symptom relief are the usual care, and antibiotics will not help.
Strep throat is treated with antibiotics such as penicillin or amoxicillin. Take the full course as prescribed, even after you feel better. Contact your provider if symptoms don’t improve within 24 to 48 hours of starting treatment.

Related guides

Medical sources

This information is for education only and does not replace advice from a qualified healthcare provider.