Viral And Bacterial Sore Throats During The COVID-19 Pandemic

Every year, 11 million patients in the U.S. seek medical care for a sore throat (which is called pharyngitis.)  Since a sore throat is one of the hallmark symptoms of COVID-19, it’s worth taking a moment to learn about the differences between pharyngitis that’s caused by viruses (including COVID-19, the flu, and the common cold) and pharyngitis that’s caused by bacteria (including strep throat).

What is the difference between viral and bacterial pharyngitis (sore throats)?

For starters, a sore throat caused by viral pharyngitis is usually accompanied by other symptoms. These symptoms include a runny nose, a cough, watery eyes, and sneezing. 

On the other hand, a sore throat caused by bacterial pharyngitis is not accompanied by those symptoms. Bacterial pharyngitis typically only causes a sore throat, exudate (“white spots”) on the tonsils, swollen lymph nodes in the neck, and a fever.

Can you be tested and treated for bacterial pharyngitis?

The most concerning cause of bacterial pharyngitis is Group A Strep. If a patient does test positive for this form of strep, antibiotics are imperative.  Contrary to common belief, antibiotics aren’t necessary for the throat infection strep causes; they’re given because if left untreated, Group A Strep can spread to other parts of the body and cause damage to vital organs, including the heart and kidneys.

To determine if a patient’s symptoms warrant a rapid strep test, clinicians use the Centor Criteria, a four-point scoring system that indicates the likelihood of a bacterial infection. The four criteria are 1) fever  2) exudate on the tonsils 3) swollen lymph nodes in the neck and 4) absence of a cough. If a patient meets these criteria, a strep test is warranted.  If a patient does not meet these criteria, the likelihood of a bacterial infection is low, and a strep test is not indicated.

On average, rapid strep tests produce a result in less than 10 minutes, and they’re 95% accurate. If a rapid strep test is negative but the suspicion for a bacterial infection is high, a clinician can send a throat culture to the lab, which produces a result in a few days.

Approximately 10% of cases of pharyngitis are due to Group A Strep, which means 1 in 10 patients require antibiotics.  However, antibiotics are given to 70% of patients with pharyngitis, which means pharyngitis is one of the most common causes of antibiotic overuse. Antibiotics have no effect on viruses, and they can cause unnecessary side effects and lead to antibiotic resistance. 

Can you be tested and treated for viral pharyngitis?

If a patient does not meet the Centor Criteria for a strep test but does have symptoms that suggest a specific viral cause -- including mono, influenza, and COVID-19 -- tests for those infections can be performed and the proper treatment plan will be discussed by a provider depending on the results. At-home care such as rest, hydration, and soothing cough drops may be recommended if no other signs of infection are present.

An accurate diagnosis of pharyngitis is important because it identifies which patients will benefit from an antibiotic, and which patients will recover from pharyngitis without any intervention.

If you do develop a sore throat, it’s important to seek medical attention, especially if the pain gets worse or doesn’t clear up within 48 hours, to receive an accurate diagnosis, and determine which treatment is best for you.


Written by Sarah Thebarge, Physician Assistant