Is It Strep? How to Spot the Difference

Imagine this: across just eight GP clinics in Victoria, more than 722,000 visits were analysed – and antibiotics were prescribed in two‑thirds of all sore throat cases, even though Australian guidelines suggest only a minority actually need them for a bacterial throat infection like strep.

That’s a huge gap between what we think needs antibiotics and what really does. It’s also a sign that many of us aren’t confident telling a simple viral sore throat from something more serious – like strep throat.

In this article, we’ll walk through:

• The difference between a regular sore throat and strep throat
• The key strep symptoms to watch for
• Bacterial infection symptoms and red flags that mean you should see a doctor urgently
• When antibiotics genuinely help – and when they don’t
• How telehealth (including getting antibiotics online in Australia) fits in safely
• When your sore throat might actually be related to sexual health, not strep

We’re writing this from an Australian perspective – our climate, our health system, our guidelines – as part of our mission at NextClinic, a local telehealth service providing online medical certificates, prescriptions, specialist referrals and GP telehealth consultations to adults across Australia.

Whether you’re scrolling at 2 am trying to self‑diagnose, wondering if you’re okay to send the kids to school, or debating if you should ask for antibiotics online, this guide is for you.

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Why Are Sore Throats So Common in Australia?

If it feels like everyone around you has a sore throat every second week, you’re not entirely wrong.

• Adults get on average 2–4 upper respiratory tract infections (URTIs) a year, and young children can get about double that.
• URTIs – which include common colds, sore throats, and sniffly noses – make up almost 6% of all Australian GP visits.

Most of these sore throats are caused by viruses – the same family of germs behind colds, flu and COVID‑19. Viral infections don’t respond to antibiotics, and they usually settle on their own in about a week.

But a proportion of throat infections are caused by bacteria, especially Group A Streptococcus (often shortened to “Strep A” or “GAS”). These are the ones we’re more concerned about, because:

• They can be more severe in the short term
• They sometimes need antibiotics
• They can (rarely) lead to serious complications like rheumatic fever and kidney disease, especially in certain at‑risk groups in Australia.

So, how do you know if you’re dealing with a harmless viral sore throat… or strep?

What Exactly Is Strep Throat?

Strep throat is a bacterial throat infection caused by Streptococcus pyogenes, also known as Group A Streptococcus (GAS).

A few key facts:

• Strep throat mainly affects school‑aged children (5–15 years) but can occur in adults too.
• Strep A bacteria are spread through respiratory droplets (coughing, sneezing, close contact) and sharing things like cups or utensils.
• Strep A causes about one‑third of sore throats in children, but only around 1 in 10 sore throats in adults. In other words, most adult sore throats are not strep.

Why do doctors care about strep?

Because – if left untreated – strep throat can (rarely) lead to:

• Scarlet fever (a rash with a classic “sandpaper” feel)
• Rheumatic fever, which can damage heart valves
• Kidney inflammation (post‑streptococcal glomerulonephritis)

These complications are uncommon in most urban, non‑Indigenous Australian populations, but they’re a much bigger issue in some Aboriginal and Torres Strait Islander communities and certain high‑risk groups. Australian infectious diseases and rheumatic fever guidelines specifically recommend stronger treatment and follow‑up in these high‑risk communities.

Strep Throat vs Sore Throat: Everyday Clues

Let’s break down strep throat vs sore throat from a typical viral infection.

"Important: No checklist replaces a doctor’s judgment or a throat swab. These are clues, not a firm diagnosis."

Features that lean towards strep throat

Classic strep symptoms often include:

• Sudden onset of a very sore throat (often over hours, not days)
• Painful swallowing (it really hurts to eat or drink)
• Fever, usually 38°C or higher
• Red, swollen tonsils, sometimes with white patches or streaks of pus
• Swollen, tender glands in the front of the neck
• Little or no cough
• Headache and body aches
• Sometimes tiny red spots on the roof of the mouth
• In children, tummy pain, nausea or vomiting

You might feel generally “hit by a truck” – wiped out, hot, and miserable.

Features that lean towards a viral sore throat (cold or flu)

Viral throat infections often look more like:

• Gradual onset over a couple of days
• Runny or blocked nose
• Cough
• Sneezing
• Hoarse voice or loss of voice
• Red, scratchy throat but less dramatic swelling or pus
• Low‑grade fever or none at all
• Maybe red, watery eyes or mild diarrhoea (especially in kids)

If you’re blowing your nose non‑stop, coughing, or sounding croaky, a viral sore throat is more likely than pure strep.

Age matters

• School‑aged kids (5–15) with sudden sore throat + fever + no cough are more likely to have strep.
• Adults still get strep, but far more of their sore throats are viral or due to irritation (smoke, reflux, talking loudly, dry air).

Bacterial Infection Symptoms & Red Flags You Shouldn’t Ignore

Sometimes a throat infection – whether viral or bacterial – can become more serious.

Signs that your throat infection might be bacterial

These don’t prove it’s strep, but they raise the suspicion of a bacterial throat infection:

• High fever (≥ 38°C) that’s not settling with simple pain relief
• Very severe throat pain, out of proportion to a typical cold
• Visible pus or white patches on the tonsils
• Swollen, very tender lymph nodes in the front of the neck
• No cough, or minimal cough
• Ill contacts with confirmed strep throat

Doctors sometimes use clinical scoring systems (like the Centor/McIsaac score) that combine these types of features to estimate the chance of strep. Based on your score, they might:

• Recommend watchful waiting and self‑care
• Do a throat swab or rapid strep test (if available)
• Prescribe antibiotics if strep is very likely or confirmed

Emergency red flags – call 000 or go to ED

Regardless of whether you think it’s strep or “just a sore throat”, seek urgent medical care (not just telehealth) if you or someone else has:

• Trouble breathing, noisy breathing, or stridor (a high‑pitched noise)
• Drooling or inability to swallow saliva
• A muffled “hot potato” voice (sounds like talking with a mouth full of hot food)
• Severe neck stiffness or inability to move the neck
• Severe difficulty swallowing – can’t keep fluids down
• Severe, one‑sided throat pain with a very swollen tonsil and uvula pushed off to the side (may be a peritonsillar abscess)
• Very high fever, confusion, or looking extremely unwell
• A rapidly spreading rash plus sore throat and fever

These can indicate complications such as peritonsillar abscess, retropharyngeal abscess, or epiglottitis, which need urgent, in‑person care and possibly hospital treatment.

Telehealth is great for initial assessment and advice, but if a doctor suspects any of these emergencies, they’ll send you straight to ED.

Can You Tell at Home If It’s Strep Throat?

Short answer: not reliably – but you can spot patterns that help you know when to seek help.

Why self‑diagnosis is tricky

• Viral and bacterial sore throats can have overlapping symptoms
• You can have white patches in viral infections too
• Some people carry Strep A in their throat without symptoms; a positive test doesn’t always mean it’s the main problem

In some countries (like the US), rapid strep tests are widely used in clinics. In Australia, their use has been more limited but is increasing in some practices, partly to reduce unnecessary antibiotics by confirming which sore throats are truly strep.

Doctors may:

• Make a clinical diagnosis based on symptoms and exam
• Use a point‑of‑care test (rapid strep) if available
• Or send a throat swab to the lab if the result will alter management (for example, in a high‑risk patient or when rheumatic fever is a concern)

At home, you can’t do these tests yourself in a reliable, medically accepted way.

What you can do is:

• Track your fever, symptom duration and severity
• Pay attention to red flags (see above)
• Use telehealth or in‑person GP review to decide if further tests or treatment are required

Do You Always Need Antibiotics for a Throat Infection?

No – and this is where a lot of confusion (and over‑prescribing) happens.

Viral vs bacterial: only one responds to antibiotics

• Viral sore throat: antibiotics do nothing – your body’s immune system clears the virus.
• Bacterial sore throat (like strep): antibiotics can help, but they’re not always essential in otherwise healthy, low‑risk people.

Australian paediatric guidelines and infectious diseases recommendations are clear:

• Viral pharyngitis is the most common cause of sore throat.
• Even for strep, empiric antibiotics are not required for most patients who are not at high risk of acute rheumatic fever.

When antibiotics do matter

Your doctor may recommend antibiotics if:

• You have confirmed strep throat, especially if:
  • You’re in a high‑risk group for rheumatic fever (e.g. some Aboriginal and Torres Strait Islander communities, certain Pacific Islander or Māori populations, or people with existing rheumatic heart disease)
  • You’re very unwell, or the infection is severe
• There’s evidence of a suppurative complication (like peritonsillar abscess)
• You have strep throat in a setting where preventing spread to others at high risk is crucial (for example, certain households or institutional outbreaks)

In those situations, antibiotics can:

• Modestly shorten symptom duration
• Reduce the risk of some serious complications
• Help limit spread in high‑risk contexts

Why being cautious with antibiotics matters

Overusing antibiotics has consequences:

• Side effects: rash, diarrhoea, nausea, thrush, and in rare cases serious allergic reactions.
• Antibiotic resistance: bacteria evolve so that common antibiotics no longer work, which is a major global health threat.

Australia has one of the higher rates of antibiotic prescribing among similar countries – around 19 million antibiotic prescriptions a year, and nearly half the population dispensed at least one course in a single year.

Research from Victorian GP practices shows that:

• Antibiotics were prescribed in 66% of sore throat visits, even though national criteria suggest only 19–40% of tonsillitis/pharyngitis cases would typically meet guideline indications.

That’s a lot of unnecessary antibiotics – and a big reason Australian experts emphasise antibiotic stewardship when dealing with sore throats, colds and coughs.

What About Throat Infections Related to Sexual Health?

This might surprise you, but not all bacterial throat infections are about strep.

Certain sexually transmitted infections (STIs) can infect the throat after oral sex, including:

• Gonorrhoea
• (Less commonly) chlamydia and other organisms

Throat (oropharyngeal) gonorrhoea often has no symptoms, but when it does, it can cause:

• A sore or dry throat
• Sometimes visible pus on the tonsils

If you’ve had unprotected oral sex and develop a persistent sore throat – especially if you also have genital or rectal symptoms – it’s important to consider an STI check, not just strep. Testing involves simple throat and/or urine swabs and is widely available at GPs and sexual health clinics.

This is particularly relevant for:

• People with multiple partners
• Men who have sex with men
• Anyone in a network or area where STIs are on the rise

If you’re worried about this angle, mention your sexual history honestly when you speak to a doctor – including during a telehealth consultation. This helps us choose the right tests and not just automatically assume “strep throat vs sore throat”.

Self‑Care for a Sore Throat (Viral or Mild Bacterial)

Regardless of the cause, a lot of the day‑to‑day management is similar.

Based on Australian advice from Healthdirect and hospital guidelines, self‑care can include:

• Rest – your immune system works better when you’re not run down
• Plenty of fluids – water, warm teas, broths (avoid dehydration, especially with fever)
• Salt‑water gargles (for adults and older kids who can gargle safely)
• Simple pain relief like paracetamol or ibuprofen (if suitable for you)
• Avoiding cigarette smoke and other throat irritants
• Throat lozenges or sprays for short‑term relief (not for young children due to choking risk)
• Soft, cool foods like yoghurt, jelly or icy poles if swallowing is painful

If you’re in the thick of winter and battling more than one respiratory illness, you might like our posts on winter health checklists and flu season prep – they go into more detail on staying well and supporting your immune system during the colder months.

When Should You See a Doctor About a Sore Throat?

See a GP or telehealth doctor promptly if:

• Your sore throat lasts more than 3–5 days or is getting worse
• You have a fever above 38°C
• Swallowing is painful enough that you’re struggling to eat or drink
• You have large, tender lumps in your neck
• You’ve had repeated sore throats over a short period (possible recurrent tonsillitis or strep)
• You have underlying conditions (like diabetes, immune suppression) that make infections riskier
• You’re worried it might be strep, an STI‑related throat infection, or something more serious

Go to ED or call 000 if you notice the emergency red flags

We covered these above, but they’re worth repeating: difficult or noisy breathing, drooling, not being able to swallow, severe neck stiffness, extreme illness, confusion, or rapidly worsening one‑sided throat pain all need immediate in‑person assessment.

How Telehealth Fits In – And How We Can Help

For many sore throats, telehealth is an ideal first step, especially if you’re too unwell (or too contagious) to sit in a waiting room.

At NextClinic, our Australian‑registered doctors can:

• Take a detailed history of your strep symptoms vs viral features
• Ask guided questions to look for bacterial infection symptoms and red flags
• Provide self‑care advice tailored to your situation
• Decide whether you likely have:
  • A simple viral sore throat
  • Possible strep throat
  • Tonsillitis that may need antibiotics
  • Another condition like sinusitis or bronchitis (we have a separate deep‑dive on those)
• Issue online prescriptions (including antibiotics, if clinically appropriate) as e‑scripts sent straight to your phone
• Provide online medical certificates for work or study if you need time off to recover
• Arrange specialist referrals (e.g. to an ENT specialist) if your throat infection is recurrent or complicated

All of this is done by phone, from 6 am to midnight AEST, seven days a week, for adults aged 18+. You only pay if a doctor reviews and approves your request (for services like certificates and prescriptions).

If you’re specifically looking to renew regular medicines or request certain acute scripts, our dedicated online prescription service explains how our pricing works and what’s suitable for telehealth.

"Important: If we’re worried about red‑flag symptoms, we’ll always recommend in‑person care or ED. Telehealth is a tool, not a replacement for emergency services."

Quick Recap: Strep Throat vs “Just” a Sore Throat

Here’s a simple way to think about it:

You’re more likely to be dealing with strep throat if:

• Your sore throat came on suddenly and severely
• You have fever (≥ 38°C)
• You have no cough, but painful swallowing and tender neck glands
• Your tonsils look very red, swollen, maybe with white patches
• You’re in the 5–15 age group, or have close contact with kids with confirmed strep

You’re more likely to have a viral sore throat if:

• It came on gradually after a few days of feeling off
• You have a runny or stuffy nose, cough, or hoarse voice
• Your fever is mild or absent
• Several people in the household have similar “cold‑like” symptoms
• Things are starting to improve by day 3–4, even if slowly

You might need a doctor (and possibly antibiotics) if:

• Your symptoms are severe, prolonged, or clearly worsening
• You have signs of bacterial infection (high fever, very painful swallowing, pusy tonsils, swollen tender glands)
• You’re in a high‑risk group for complications
• There’s a concern about STI‑related throat infection

When in doubt, getting medical advice is always reasonable – and telehealth can make that faster and more convenient.

FAQs About Strep Throat and Sore Throats in Australia

1. Can adults get strep throat?

Yes. Adults can get strep throat, but it’s less common than in kids. Overall, only a small fraction of adult sore throats are due to Strep A – many are viral or related to factors like smoking, reflux, or voice strain.

2. How long is strep throat contagious?

Without treatment, you can remain contagious for 2–3 weeks. Once you start the right antibiotics, you’re generally considered non‑infectious after about 24 hours, as long as you’re feeling well enough to be around others. This is why schools and childcare centres often require children with confirmed strep throat to stay home for at least 24 hours after starting antibiotics.

3. Can I get antibiotics online in Australia without talking to a doctor?

No reputable service in Australia should supply antibiotics without a proper medical assessment by a doctor or nurse practitioner. However, that assessment can safely be done via telehealth for many straightforward cases.

At NextClinic, our doctors review your symptoms and medical history first, then decide whether antibiotics are appropriate. If they are, we send an e‑script to your phone that you can use at any pharmacy. If antibiotics aren’t in your best interest, we’ll explain why and focus on other ways to help you feel better.

4. My sore throat keeps coming back. Should I worry?

Recurrent sore throats can have several causes:

• Recurrent strep infections (especially in children)
• Chronic tonsillitis
• Environmental irritation (e.g. smoking, dust, air‑conditioning)
• Reflux disease
• Less commonly, STIs or other conditions

If you’re getting frequent sore throats, especially with significant time off work or study, it’s worth seeing a GP for a deeper look. A telehealth doctor can help you decide whether you need ENT referral, blood tests, or imaging.

Bringing It All Together – And Your Next Step

Sore throats are unbelievably common in Australia – most are viral and self‑limiting, some are bacterial, and a small number are linked to sexual health issues or more serious illnesses.

You’ve learned how to:

• Tell the everyday differences between strep throat vs sore throat from a common cold
• Recognise key strep symptoms and bacterial infection symptoms
• Spot red flags that need urgent care
• Understand why antibiotics are essential sometimes but overused in many sore throat cases
• See how telehealth and online antibiotics in Australia fit into safe, modern care
• Recognise when to think about STI testing instead of assuming it’s just strep

Now it’s over to you.

This week, choose one practical step to apply:

• Maybe it’s resisting the urge to demand antibiotics the next time you have a mild viral sore throat.
• Maybe it’s booking a telehealth consultation rather than putting off care because you’re too busy (or too tired) to get to a clinic.
• Maybe it’s organising an STI check if your sore throat history and sexual health line up with that risk.
• Or even just learning the red flags and sharing them with your family so everyone knows when a sore throat isn’t “just a sore throat”.

Whichever strategy you choose, we’d love to hear from you.

Tell us in the comments: What’s one thing you’ll do differently next time you or someone in your household has a sore throat?

References

• Burden of antimicrobial prescribing in primary care attributable to sore throat: a retrospective cohort study of patient record data - PMC
• NextClinic: Online Medical Certificates, Instant Scripts and Telehealth Consults
• RACGP - AJGP (Australian Journal of General Practice)
• Sore throat (pharyngitis) - symptoms, treatments and causes | healthdirect
• Strep throat fact sheet | NHMRC
• Strep Throat Symptoms and Related Conditions | Ausmed
• RACP | Evolve | Australasian Society for Infectious Diseases
• Pharyngitis / Sore Throat – My GP Notes
• Clinical Practice Guidelines : Sore throat
• RACGP - AJGP (Australian Journal of General Practice)
• New tests at GP clinics aim to reduce antibiotic use and fight antimicrobial resistance - ABC News
• Case study: Reducing antibiotic resistance - NPS MedicineWise
• Gonorrhoea | Better Health Channel
• The Winter Health Checklist: Stay One Step Ahead of Seasonal Sickness | NextClinic
• Online Doctors: Telehealth Consultations at NextClinic
• Sinus Infection or Bronchitis? | NextClinic
• Online Medical Certificate | NextClinic
• $29.90 Online Prescription Service | NextClinic

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