Strep throat or a virus? Symptoms, testing and when antibiotics help

Viruses cause most sore throats. Only about 1 in 10 adults and 3 in 10 children with a sore throat have strep throat.

These signs point to a virus, not strep:

• Cough
• Runny nose
• A hoarse or raspy voice
• Pink eye

• A sore throat that starts fast
• Pain when you swallow
• Fever
• Red, swollen tonsils, sometimes with white patches or streaks of pus
• Tiny red spots on the roof of the mouth
• Swollen glands in the front of the neck

Children may also have a headache, stomach pain, nausea or throwing up, or a rash (scarlet fever). Strep is most common in children 5 to 15 years old.

You cannot tell strep from a virus just by looking. A rapid strep test uses a swab of the throat and gives a result in minutes.

Antibiotics only help when strep is found. For a sore throat from a virus, they do not help and can cause side effects.

In children 3 and older, a negative rapid test should be checked with a throat culture. This test is done at a clinic or doctor's office. If your child has strep signs and a negative test, have your child seen in person.

Strep throat is treated with an antibiotic, most often for 10 days. Take every dose, even after you feel better. Stopping early raises the risk of rare but serious problems, such as rheumatic fever, which can harm the heart.

Stay home from work, school or daycare until you have no fever and you have taken the antibiotic for at least 12 to 24 hours.

To keep from spreading strep, wash your hands often, cover coughs and sneezes, and do not share cups or forks and spoons.

See a doctor in person if you or your child have a sore throat with any of these:

• Trouble swallowing
• Blood in your spit or phlegm
• Signs of dehydration, such as not drinking or peeing enough
• Joint swelling and pain
• A rash
• Symptoms that do not get better within a few days, or get worse

Also tell your doctor if you get sore throats again and again. A baby younger than 3 months with a fever of 100.4°F (38°C) or higher needs a doctor right away.

• Trouble breathing, or a high-pitched sound when breathing in
• Drooling, or not being able to swallow liquids
• A muffled 'hot potato' voice
• Trouble opening your mouth
• Bad swelling on one side of the throat
• A stiff neck

These can be signs of an abscess (a pocket of pus) or another serious problem.

If you are in Virginia or West Virginia, you can start a visit online at any time. Our strep visit is for adults and children 4 and older (with a parent or legal guardian) who have a positive home rapid strep test, plus a sore throat and fever with little or no cough. You send a clear photo of the positive test.

This visit never prescribes an antibiotic for a sore throat without a positive test. Without a positive test, our cold, flu and sinus visit is the place to start, but a child with strep signs and a negative test should be seen in person for a throat culture. The strep visit is also not for any of the emergency signs above, or for anyone with 4 or more strep infections in a year; that needs a visit with an ear, nose and throat doctor.

You answer a few questions on your phone or computer. There is no video call. A board-certified physician reviews your answers and photo. If an antibiotic is right for you, the doctor can send it to your pharmacy. If you need to be seen in person, the doctor will tell you.

Visits start at $59. You see the price before you pay, and you do not need insurance. A basic work or school note can be included if the doctor thinks it is right.