Sore Throat (Adults): Strep vs Viral — When to Test, When to Treat
What usually causes a sore throat?
Most adult sore throats are viral. A minority are Group A Strep (GAS)—the one where antibiotics help.
How do we tell if it could be strep?
We start with history/exam patterns (e.g., fever, tonsillar exudates, tender anterior nodes, no cough). The more these are present, the higher the chance of strep and the more useful testing becomes. Clinicians often summarize this with the Centor/McIsaac approach.
Do I need a rapid strep test (RADT)?
• Clear viral symptoms (cough, runny nose, hoarseness, mouth sores)? No test.
• Intermediate likelihood (some strep features, no strong viral picture)? Yes—RADT.
• Adults with negative RADT typically do not need a backup culture.
If it’s strep, do I always need antibiotics?
Yes—if you have confirmed strep throat (positive RADT/culture). Antibiotics shorten illness modestly, lower contagiousness, and prevent rare complications.
What does TeleDirectMD prescribe for confirmed strep?
Penicillin V or amoxicillin are standard first-line. If you can’t take penicillins, options may include cephalexin (if no anaphylaxis history) or clindamycin/macrolide depending on local resistance and allergy details. We tailor to your risks and drug interactions.
Practical symptom relief
Fluids, rest, acetaminophen/ibuprofen for pain/fever, salt-water gargles, lozenges, humidified air. Avoid sharing utensils; change your toothbrush after 24–48h of effective antibiotics.
When to be seen in person right away
Trouble breathing, drooling, inability to swallow, severe neck swelling, trismus, or rapidly worsening pain (concern for peritonsillar abscess). Any rash with antibiotics needs reassessment.
TeleDirectMD model (adult-only)
We assess strep likelihood, order testing when appropriate, prescribe only with confirmation, and give a tight return plan.
Practical plan (copy/paste)
· If we suspect strep: arrange RADT (and start antibiotics only if positive).
· Supportive care: acetaminophen/ibuprofen, warm fluids, salt-water gargles.
· Stay home for 24h after starting antibiotics (to reduce spread).
· Recheck if worse at 48–72h or any red flags.
Myth vs Reality
· Myth: White spots = strep. → Reality: Exudates can be viral; testing guides treatment.
· Myth: Adults need backup throat cultures. → Reality: Not routinely after a negative RADT.
· Myth: Z-Pak is best for strep. → Reality: Penicillin/amoxicillin are first-line.
· Myth: Antibiotics cure sore throat faster for everyone. → Reality: Only confirmed strep benefits.
Evidence & Further Reading (Last verified: August 22, 2025)
· IDSA — Group A Streptococcal Pharyngitis Guideline
· CDC — Clinical guidance for strep throat
AAFP — Common Questions About Streptococcal Pharyngitis
