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09:10 AM

Is it Strep Throat or the Flu?

A Pediatrician's Guide to Tell the Difference

Your child’s throat is sore, has a headache and a fever.

Is it strep or the flu? Maybe, both?

Strep and flu are two very different things, although they may have similar symptoms at times.

First, let’s distinguish between the two.

The flu is a viral infection that impacts the nose, throat and lungs. A flu, or cold, can make the throat sore and scratchy

Strep is a bacterial infection. Strep causes the throat to be very sore and it becomes very painful to swallow and they typically don’t eat, or only eat very soft things. With a cold or flu, children usually eat fine or if not the reason is appetite not pain with swallowing.

They both can cause a fever, sore throat, chills, muscle aches and even nausea.

So how do you tell the difference?

Even for a pediatrician, it’s difficult to distinguish strep from the flu by a quick look inside a child’s throat. Studies have been done that shows that without the proper tests, physicians can’t tell the difference half the time.

Strep can cause white spots, but rarely does. Usually the throat is somewhat red and can have the red spots which are petechia. The body aches in strep are also less severe in strep and one of the defining symptoms of flu.

The only accurate way to diagnose strep is through a strep screen or a throat culture.

Strep throat symptoms include:

  • Red, sore throat with white patches
  • Headache
  • Swollen, sore glands in the neck
  • Fever
  • Red spots on the roof of the mouth
  • Painful, difficult swallowing
  • Chills
  • Fatigue
  • Nausea and possibly vomiting
  • Decreased appetite
  • Rash
  • Muscle aches, especially in the neck, and abdominal pains, especially in younger children
  • Swelling in back of mouth

We will take more tests to confirm the diagnosis that may include a throat culture, rapid DNA test or rapid antigen strep throat.

Most strep will get better in about a week to 10 days.

Your doctor will prescribe antibiotics to treat the infection. Although the symptoms may fade, the infection may remain. Please make sure to take all the antibiotics prescribed.

You may be surprised to find out that about 30 percent of people have strep in their throat at all times and it does not cause symptoms. To help reduce your child’s chances of strep, follow these tips:

  • Wash your hands
  • Don’t share food or drink
  • Avoid exposure to other people with strep
  • Replace your child’s toothbrush after starting antibiotics

Flu symptoms include:

  • Fever
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Body aches
  • Headache
  • Chills
  • Fatigue
  • Sometimes diarrhea and vomiting

We advise everyone to get the flu shot. However, if you or your child are sick with the flu, stay home, rest and avoid contact with other people. The Centers for Disease Control and Prevention recommends staying home for at least 24 hours after the fever is gone (except for medical care or other necessities). The fever should be gone without the use of fever-reducing medicine.

In some cases of the flu, you may be prescribed antiviral drugs that are prescription medicines. These aren’t sold over-the-counter and you can only get them with a prescription. The drugs aren’t antibiotics which fight against bacterial infections (strep for instance), but they fight against the virus.

You may hear someone say that their child got strep and flu at the same time. This can happen, but it’s very uncommon. Both are increase in the winter months, and symptoms such as sore throat, fever, etc. can overlap, which is likely why children are being treated for both.

Strep and flu two are entirely different things. Colds and flu always cause a sore throat, but strep is never the cause of cold symptoms.

So if your child has cold symptoms and a sore throat and gets tested for strep, it could be a false positive or it could just be a coincidence. For instance if your child has a cold or flu, then they go to the doctor or to school and are exposed to someone with strep throat. Now he or she has both. But they aren’t related.

And remember because they are different, they would each have to be treated differently and separately.

I hope this helps. We’ve been asked a lot about it lately. Stay healthy.

Doctor photo

Dr. Bradley Mercer is pediatrician at Cook Children's Pediatrics (Fort Worth).

To learn more about him and his practice, click here.

Comments 1 - 4 (4)
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Kafilat Anifowose
you nail it.

Janet V
My daughter was just sick with strep she had the flu shot this year so they didn’t bother to take a flu test two days later I got sick I’ve had strep lots of times before this time it was horrible I didn’t get my flu shot this year so they gave me both tests I had strep and the flu and considering I never have been the first one sick I only get sick after people in my house do I had to catch both from her
Sadly my 10yr old son tested positive for both strep and Influenza A today. He is just miserable and I'm watching him closely. We live in Wisconsin. We've heard this combo is running rampant, meaning a few others (different schools, no contact) have had same diagnosis last week.
John O.
yep, having both at the same time can definitely happen, because my daughter has both right now. Took her to doctor for flu symptoms, flu test was "very positive". They did throat swab which was negative in the office, but they sent to lab and it came back positive for strep. Crazy.