How are viral and bacterial causes of pharyngitis (sore throat) differentiated?

Updated: May 06, 2020
  • Author: John R Acerra, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

It is difficult to distinguish viral and bacterial causes of pharyngitis on the basis of history and physical examination alone. Nevertheless, the following factors may help rule out or diagnose GAS pharyngitis:

  • GAS infection is most common in children aged 4-7 years

  • Sudden onset is consistent with GAS pharyngitis; pharyngitis after several days of coughing or rhinorrhea is more consistent with a viral etiology

  • Contact with others who have GAS or rheumatic fever with symptoms consistent with GAS raises the likelihood of GAS pharyngitis

  • Headache is consistent with GAS infection

  • Cough is not usually associated with GAS infection

  • Vomiting is associated with GAS infection, though not exclusively so

  • Recent orogenital contact suggests possible gonococcal pharyngitis

  • A history of rheumatic fever is important


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