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Cold or
strep throat?

How to tell the difference
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By Donna Alden-Bugden
May/June 2018

It's 6 a.m., and you have just awakened with a sore throat that feels like razor blades when you swallow. You were well yesterday, but now you have a fever, a headache and an aching body.

Should you go see your health-care practitioner, or is it just a nasty cold?

The answer to that question depends on the source of the problem. Here's why.

Generally speaking, sore throats are caused by either a virus or a bacterial infection. If your sore throat is caused by a virus, then you likely have a cold, and you probably don't need to see a health-care practitioner.

On the other hand, if your sore throat is caused by a bacterial infection, then chances are you have a condition called strep throat, caused by a bacteria called group A streptococcus (GAS). Left untreated, this form of strep can cause complications such as scarlet fever, kidney damage and rheumatic fever. In other words, if you have strep throat, you will need to see a health-care practitioner.

So how do you know if your sore throat is being caused by a virus or a bacterial infection? Good question.

Sore throats from colds will usually come on slowly. Symptoms include mild fever, a cough that may or may not produce some whitish phlegm, nasal stuffiness, sneezing, fatigue and/or a runny nose. You may also have eye redness and some body aches, but generally speaking you should be able to go about your day as usual. Although colds are a real nuisance, they are generally harmless and resolve in seven to 10 days.

Photo of a woman in pain touching her throat

Strep throat is different. A sore throat from a strep infection usually comes on suddenly (within hours or overnight). Symptoms include high fever, body aches, headache, fatigue, swollen lymph nodes in the neck, and an extremely painful sore throat (often described as razor blades when you swallow). In addition, your tonsils may appear bright red, quite swollen and have white patches on them. You may also have red spots on the roof of your mouth.

If you have these symptoms, you will need to visit a health-care practitioner. If you experience drooling or difficulty breathing, you should go to an emergency department.

It is worth noting that strep throat is not accompanied by certain cold symptoms, such as a cough or runny nose. The more cold symptoms you have, the less likely you have strep throat. It is also helpful to know that while strep throat can strike anyone at any age, it is more common among those between five and 15 years of age, and rare in people below the age of three or beyond the age of 40.

You can reduce your risk of developing a cold or strep throat by washing your hands, not sharing cups and utensils, and avoiding kissing someone with a cold or strep throat.

Treatments vary. For common colds, over-the-counter medication is available to manage your symptoms. For strep throat, antibiotics are used to prevent complications from strep throat, not necessarily to shorten the course of the illness.

Because strep throat can lead to other health issues, it is important to take it seriously.

Scarlet fever, for example, is a rash that develops with a fever after strep infection. It is usually harmless if antibiotics are given, but without treatment, the bacteria may move on to damage the kidneys and cause rheumatic fever, which can affect the heart, joints, nervous system and skin.

Although the more serious conditions associated with strep throat are rare (about three per cent of the 14 million people who contract strep throat each year go on to develop rheumatic fever), it is important to remember that the risk of these complications can be virtually eliminated by proper treatment. So, if you have symptoms of strep throat, see your health-care practitioner early. It may save your life.

Donna Alden-Bugden is a family nurse practitioner with the Winnipeg Regional Health Authority.