Overview
Only about 10% of adult sore throats are strep — the rest are viral. Strep throat needs antibiotics to prevent rheumatic fever and shorten illness; viral does not. The CENTOR criteria help decide who needs a rapid strep test.
Symptoms to watch for
- Sudden severe sore throat
- Pain with swallowing
- Fever over 101°F
- Tender, swollen neck lymph nodes
- White patches or exudate on tonsils
- No cough, no runny nose (points toward strep)
What else could this be?
- Viral pharyngitis — cough, runny nose, hoarseness
- Mononucleosis — enlarged spleen, prolonged fatigue
- COVID-19 or flu
- Post-nasal drip
How it's diagnosed
Rapid strep test (throat swab) at a lab near you. CENTOR score: fever + tender nodes + tonsillar exudate + absence of cough (each = 1 point) helps decide who to test.
Treatment
Penicillin or amoxicillin for 10 days is first-line. Cephalexin or azithromycin for penicillin-allergic patients. Symptoms improve within 24–48 hours of starting antibiotics.
When to book a visit
Book if you have fever with severe sore throat and no cough — a video visit can order the rapid strep and prescribe if positive.
Book online todayFrequently asked
Can I get antibiotics without testing?
Sometimes — for a very high CENTOR score during outbreaks, clinicians may treat empirically. Testing is preferred when practical.
How contagious is strep?
Very — until you've been on antibiotics 24 hours. Stay home from work/school.