Carrie Madormo, RN, MPH, is a freelance health writer with over a decade of experience working as a registered nurse in a variety of clinical settings.

Benjamin F. Asher, MD, FACS, is board-certified in otolaryngology-head and neck surgery. For 30 years, he has worked at Group Health Cooperative of Puget Sound and the Dartmouth Hitchcock Clinic.

When you wake up with a sore throat, it can be challenging to figure out the cause. It could be strep throat, another infection, allergies, or even acid reflux.

Strep throat is a bacterial infection that causes swelling in the tonsils and usually peaks around age 7 or 8. Symptoms include a painful sore throat, fever, swollen neck glands, and white patches on the tonsils.  

A respiratory illness or environmental irritant could cause a sore throat. If your sore throat is due to strep throat you may require antibiotics to cure the infection and prevent complications. 

This article provides an overview of the common causes of a sore throat and explains how to determine if you have strep throat. 

There are several possible reasons for a sore throat. In infants, toddlers, and young children, a viral infection is the most common cause of sore throat. Both viral and bacterial causes of a sore throat are contagious and are spread through respiratory droplets in the air. 

Strep throat is a bacterial infection caused by group A Streptococcus. This infection causes tonsillitis (swelling of the tonsils). It leads to a very sore throat and painful swallowing. It also causes a fever over 102 degrees Fahrenheit, swollen glands in the neck, pus on the tonsils, and fatigue.

Respiratory illnesses like a cold or the flu (influenza) often cause a sore throat. The earliest signs of a cold virus are usually a sore throat and runny nose. Other symptoms may include coughing, sneezing, headache, and body aches. The flu virus causes a sore throat, fever, cough, runny nose, headache, body aches, and fatigue.  

Allergies occur when the body’s immune system overreacts to a trigger in the environment. Possible triggers may include outside allergens like pollen, grass, and trees. Indoor allergens may consist of dust and pet dander. Cigarette smoke and other irritants can also cause a sore throat. Symptoms of allergies may include a sore throat, runny nose, itchy eyes, stuffy nose, and fatigue.

Being exposed to dry air is irritating and may cause a sore throat. A study found that when 45 volunteers were exposed to a steady stream of cold, dry air into their throats, they experienced pain and irritation. The colder and dryer the air, the more pain and irritation participants reported.

Smoke irritates the sinus tissues and can lead to a sore throat. Chronic exposure to smoke may also cause a dry cough and difficulty breathing.  

Gastroesophageal reflux disease (GERD) occurs when the contents of the stomach flow back up the esophagus, causing a burning sensation in the chest. Laryngopharyngeal reflux (LPR) occurs when stomach contents flow up the larynx and pharynx, irritating the airway and causing a sore throat.

Common symptoms of strep throat include:

Strep throat can lead to serious complications when left untreated. See your healthcare provider if you notice any of the following symptoms:

Strep throat can be diagnosed with the following two tests:

Other symptoms include swollen neck glands, pus on the tonsils, and fatigue

Peaks in infants, toddlers, and preschoolers

Other symptoms include cough, runny nose, and hoarseness

Strep throat is a bacterial infection that requires treatment from a healthcare provider. In addition to antibiotic therapy, home remedies may provide some pain relief. 

Home remedies that may provide comfort include:

Strep throat is usually treated with antibiotics to shorten the duration and prevent complications. A possible complication of bacterial tonsillitis is rheumatic fever. Antibiotics for treating bacterial tonsillitis include penicillins, cephalosporins, macrolides, and clindamycin.

A sore throat caused by a virus or environmental irritant usually resolves on its own. Home remedies to try include:

Strep throat is a bacterial infection. It causes swelling in the tonsils. Symptoms may include a painful sore throat, fever, swollen glands, and white patches of pus on the tonsils. A sore throat may be caused by a viral infection or environmental irritant, which may also cause swelling of the tonsils. Strep throat can be diagnosed with a rapid strep test or throat culture. Strep throat is usually treated with antibiotics to shorten the duration and prevent complications. 

When you have a sore throat, it’s hard to know what to do next. You may wonder if you should take a COVID-19 test, ask your healthcare provider for a rapid strep test, or wait it out. Talk with your healthcare provider if you’ve had a sore throat for a few days. Pay attention to any other symptoms you’re experiencing, and rest as much as possible.

Strep throat is a bacterial infection that often requires treatment with antibiotics. A sore throat from strep throat is often more painful than a sore throat from viruses like a cold or the flu.

Strep throat can be diagnosed with a rapid strep test or throat culture. 

A fever is a common sign of strep throat. If you do not have a fever, your sore throat is likely caused by another infection or irritant. 

American Academy of Pediatrics. Strep throat, sore throat or tonsillitis: What’s the difference?

Centers for Disease Control and Prevention. Common colds: Protect yourself and others.

Centers for Disease Control and Prevention. Flu symptoms & diagnosis.

American College of Allergy, Asthma, & Immunology. Hay fever (rhinitis).

Renner B, Ahne G, Grosan E, Kettenmann B, Kobal G, Shephard A. Tonic stimulation of the pharyngeal mucosa causes pain and a reversible increase of inflammatory mediators. Inflamm Res. 2013;62(12):1045-1051. doi:10.1007/s00011-013-0663-7

Centers for Disease Control and Prevention. Wildfire smoke and COVID-19.

Campagnolo AM, Priston J, Thoen RH, Medeiros T, Assunção AR. Laryngopharyngeal reflux: diagnosis, treatment, and latest research. Int Arch Otorhinolaryngol. 2014;18(2):184-191. doi:10.1055/s-0033-1352504

Centers for Disease Control and Prevention. Pharyngitis (strep throat).

Johns Hopkins Medicine. The do’s and don’ts of easing cold symptoms.

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