What else can a sore throat be besides strep? Understanding other causes

September 24, 2025 •

4 min read

According to the CDC, most sore throats are caused by viruses. While many people jump to the conclusion of strep throat, it is less common than you might think, especially in adults. So, what else can a sore throat be besides strep?

Quick Summary

Beyond a bacterial infection like strep, a sore throat is most often caused by viruses like the common cold or flu, but can also stem from allergies, acid reflux, or environmental irritants. The distinction often comes down to accompanying symptoms and their duration.

Key Points

Viral vs. Bacterial: The majority of sore throats are caused by viruses like the cold or flu, not bacteria like strep.
Hidden Irritants: Non-infectious causes such as allergies, postnasal drip, and acid reflux (GERD) are also common culprits for a sore throat.
Key Differences: A cough and congestion often accompany a viral sore throat, whereas strep throat typically involves a high fever and swollen tonsils with white patches but no cough.
Home Remedies: Most viral sore throats can be managed with rest, fluids, warm salt water gargles, and lozenges.
When to See a Doctor: Seek medical care for severe symptoms, persistent pain lasting over a week, or signs indicating strep throat or another serious condition.

Viral Infections: The Most Common Culprits

For both adults and children, viral infections are the most frequent cause of a sore throat. Unlike bacterial infections, these do not respond to antibiotics, and the treatment focuses on managing symptoms until the virus runs its course.

The Common Cold and Flu

These widespread viruses are major players in causing throat discomfort. A sore throat from a cold often presents alongside other classic symptoms like a runny nose, sneezing, and coughing. The flu typically involves a more severe sore throat, accompanied by a fever, body aches, and fatigue.

Mononucleosis (Mono)

Caused by the Epstein-Barr virus, mono can create a severe, persistent sore throat that can sometimes mimic strep throat, complete with swollen tonsils and white patches. Other symptoms include extreme fatigue and swollen lymph nodes.

COVID-19

In many cases, a sore throat is one of the initial symptoms of COVID-19, often along with a cough and fever. A test can confirm the diagnosis, but for otherwise healthy individuals, mild to moderate symptoms typically resolve on their own.

Non-Infectious Causes of a Sore Throat

If your sore throat lingers without the typical signs of infection, the cause may be non-infectious. These can include a variety of environmental, dietary, and lifestyle factors.

Allergies and Postnasal Drip

Seasonal or perennial allergies can trigger an overproduction of mucus, leading to postnasal drip. This drainage irritates the back of your throat, causing a persistent scratchy or sore feeling. A sore throat from allergies is often accompanied by sneezing, a runny nose, and itchy eyes, and may be worse in the morning due to overnight buildup.

Acid Reflux (GERD)

When stomach acid flows back into the esophagus, it can cause a burning sensation known as heartburn. If the acid travels up to the throat, it can cause chronic irritation, leading to a persistent sore throat, hoarseness, and a feeling of a lump in the throat. This is often worse when lying down and can cause throat pain that is most noticeable upon waking.

Dry Air

Breathing dry indoor air, especially during the winter or in a heated home, can dry out the throat and make it feel rough and scratchy. Using a humidifier, especially at night, can help add moisture back into the air.

Environmental Irritants and Vocal Strain

Exposure to tobacco smoke, air pollution, chemical fumes, or even just talking loudly or yelling for extended periods can strain the vocal cords and lead to a sore throat. Avoiding these irritants and resting your voice are key to recovery.

How to Differentiate the Causes

Distinguishing between a viral infection, strep throat, and other causes often comes down to looking at the bigger picture of your symptoms. Use the following comparison to help narrow down the possibilities, but always consult a healthcare professional for an accurate diagnosis.


Symptom	Viral Sore Throat	Strep Throat	Allergies/Postnasal Drip	Acid Reflux (GERD)
Onset	Gradual onset over a few days	Sudden onset	Often seasonal or triggered by allergen exposure	Can be chronic, often worse after meals or at night
Accompanying Symptoms	Cough, runny nose, congestion, sneezing	High fever, headache, body aches, swollen lymph nodes, no cough	Sneezing, runny nose, watery/itchy eyes	Heartburn, hoarseness, sensation of a lump in the throat
Throat Appearance	Mild redness or swelling	Red, swollen tonsils with white patches or pus, tiny red spots on roof of mouth	General inflammation and irritation from drainage	Redness and irritation, often without white patches
Common Treatment	Rest, fluids, pain relievers	Antibiotics prescribed by a doctor	Antihistamines, avoiding triggers, saline nasal rinses	Dietary changes, elevating head during sleep, antacids

When to Seek Medical Attention

While many sore throats resolve on their own with home care, some require a doctor's evaluation. You should see a doctor if your sore throat persists for more than a week, or if you experience any of the following:

A high fever (102°F or higher)
Severe throat pain or difficulty swallowing
Swollen or tender lymph nodes in your neck
White patches or pus on your tonsils
A rash
Hoarseness lasting more than two weeks

Seek emergency medical care immediately if you have trouble breathing, severe swelling in your neck or face, excessive drooling, or a muffled voice, as these can be signs of a medical emergency.

Conclusion: Finding the Right Cause for Lasting Relief

For most people, a sore throat is a temporary symptom of a cold or other minor ailment that will clear up with time and rest. However, understanding the less obvious causes—from allergies and acid reflux to vocal strain—can help you address the root of the problem more effectively. If you're unsure of the cause or your symptoms are severe, don't hesitate to consult a medical professional for an accurate diagnosis and appropriate treatment plan. For more general health information, visit the Centers for Disease Control and Prevention.

Frequently Asked Questions

Yes, allergies are a common cause of sore throats due to postnasal drip. When your body reacts to allergens, it produces excess mucus that can drip down and irritate the back of your throat.

Strep throat is caused by bacteria and is often characterized by a high fever, sudden onset, and painful swallowing without a cough. A viral sore throat, caused by a virus, typically comes with a cough, congestion, and more gradual symptom development.

A sore throat caused by acid reflux (GERD) can be chronic and is often worse in the morning or after eating. It may also come with symptoms like heartburn, a sour taste in your mouth, or a sensation of a lump in your throat.

A viral sore throat typically improves within five to seven days. If your sore throat lasts longer than a week or if symptoms are severe, you should see a doctor to determine the cause.

Yes. Dry indoor air, especially during colder months, can cause your throat to feel dry and scratchy, leading to a sore throat. Using a humidifier at night can help.

You should see a doctor if your sore throat doesn't improve after a week, is accompanied by a high fever, or includes symptoms like difficulty breathing, trouble swallowing, or swollen lymph nodes.

Effective home remedies include gargling with warm salt water, drinking warm fluids like tea with honey, sucking on lozenges, and getting plenty of rest.