Do I have strep throat or tonsillitis?
May 14, 2013 3:41 AM   Subscribe

Do I have strep throat or tonsillitis?

Last night, I started having tonsil pain. I took a look and they are swollen and covered in yellow...stuff. Can it be strep throat if it's yellow? Or is it most likely tonsillitis? Does the presence of whatever that is mean that it is for sure a bacterial thing? I will be going to the doctor in a couple of hours, I just don't like the idea of taking antibiotics for something viral.

I don't have a fever and other than the fact that I'm in pain, I feel fine.
posted by DeltaForce to Health & Fitness (13 answers total)
They culture for strep, that's how they know.
posted by chesty_a_arthur at 3:51 AM on May 14, 2013 [2 favorites]

As chesty_a_arthur mentioned, your doctor will culture your throat, so there will be proof that you have strep before you start taking antibiotics. (You're lucky that this isn't one of those illnesses where doctors have to guess what you have.)

Does it hurt when you swallow? (That's probably strep). Is a more general type of sore throat? (That's probably something else.)
posted by Kololo at 4:21 AM on May 14, 2013

Strep throat IS tonsillitis, when the tonsillitis is caused by a bacterial Streptococcus infection. I got your drift, just wanted to clarify (in case your doctor gives you the sideeye). The question is really is this tonsillitis viral or bacterial? And yes, you'll be cultured. I've noticed a distressing shift lately, especially at urgent care, towards offering antibiotics before the culture comes back positive, but you certainly don't have to take them until it does.
posted by telegraph at 5:10 AM on May 14, 2013 [1 favorite]

It could also be mono.
posted by srboisvert at 5:56 AM on May 14, 2013

You can ask for a rapid strep test before/in addition to a throat culture. (I think doctors usually give these by default if they suspect strep.) If the rapid test comes back negative, it could still be bacterial - just probably not strep.
posted by Metroid Baby at 6:29 AM on May 14, 2013

This is one of those things where you have to go to the doctor. If it is strep throat, you'll need medication, and also, it's contageous, so don't go out there infecting folks.
posted by Ruthless Bunny at 7:48 AM on May 14, 2013

Minute clinics can test for strep in about 15 min, and then quickly prescribe antibiotics.
posted by lstanley at 7:48 AM on May 14, 2013

If your doctor does a RapidStrep and it's negative, it may be worth asking for a proper culture. RapidStrep tests are notoriously inaccurate.
posted by PorcineWithMe at 8:38 AM on May 14, 2013

You have tonsillitis, which just means an inflammation of the tonsils. The question is, what's causing the tonsillitis: strep, or something else (probably a virus)?

They will do a throat culture to find out. I have been given antibiotics even when the cause was determined to be viral, however; the docotor explained this was to prevent a secondary infection.
posted by spaltavian at 8:44 AM on May 14, 2013

Best answer: That you report both tonsillar swelling *and* exudates gives you a score of at least 2 according to the Centor criteria, a set of four criteria designed to stratify risk of bacterial versus viral pharyngitis. Those criteria are:

  • Absence of cough
  • Tonsillar exudates
  • History of fever
  • Tender anterior cervical adenopathy.

    From Wikipedia:
    The point system is important in that it dictates management. Guidelines for management state:

  • 0 or 1 points - No antibiotic or throat culture necessary (Risk of strep. infection less than 10%)
  • 2 or 3 points - Should receive a throat culture and treat with an antibiotic if culture is positive (Risk of strep. infection 32% if 3 criteria, 15% if 2)
  • 4 or 5 points - Treat empirically with an antibiotic (Risk of strep. infection 56%)

    The presence of all four variables indicates a 40 - 60% positive predictive value for a culture of the throat to test positive for Group A Streptococcus bacteria. The absence of all four variables indicates a negative predictive value of greater than 80%. The high negative predictive value suggests that the Centor Criteria can be more effectively used for ruling out strep throat than for diagnosing strep throat.
  • Given that you meet at least two of these criteria, it may be a good idea to see your doctor for a physical exam and maybe a culture or rapid test. Antibiotics will be useless against viral pharyngitis, but they could help shorten the duration of your symptoms if they are actually caused by bacteria.
    posted by The White Hat at 8:51 AM on May 14, 2013 [2 favorites]

    Strep is the infecting bacteria, tonsillitis is the location a bacteria infects. It sure sounds like you have an infection. If it's bacterial, antibiotics will help. If it's viral, they won't. In my experience, when I had strep, it was quite painful - stabbing me in the throat painful - and my throat was very red. Going to the doc is a good idea, and being clear that you don't want antibiotics unless they're needed is also a good idea. I hope yo uget better soon.
    posted by theora55 at 9:16 AM on May 14, 2013

    These are good answers, and high fives to White Hat for busting out the Centor criteria!

    I would just point out that the criteria have nothing to do with whether your throat hurts or how much it hurts - all sore throats/tonsillitises hurt, strep or not. Also, I've mentioned this here before, but whether you absolutely need to go to the doctor to find out if it's strep, or to get antibiotics, is actually somewhat controversial in medicine. Some (especially folks in Europe) would argue that for most cases, testing and treating for strep is not necessary/cost effective.
    posted by treehorn+bunny at 4:51 PM on May 14, 2013

    Response by poster: Update: Was indeed strep, test came back positive. Antibiotics cleared it right up.
    posted by DeltaForce at 5:34 PM on August 5, 2013

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