Throat Herpes vs Strep Throat: How to Tell the Difference

Throat herpes and strep throat can mimic each other in the presentation of symptoms. There is an at-home strep test being developed, but it's not out yet. However, there are certain differences between herpes esophagitis and strep throat that give it away. The first difference, of course, is the causative organism: Strep throat is a bacterial in origin caused by a bacterium called Streptococcus pyogenes which belongs to Group A beta hemolytic Streptococci (GAS). Strep throat is considered to be the most common form of bacterial sore throat. Herpes esophagitis is a viral infection that is caused by a virus called herpes simplex virus (HSV), which is the second most common cause of viral esophagitis.


Throat Herpes vs. Strep Throat

There are also different risk groups for herpes esophagitis and strep throat. Strep throat often affects children between 5 and 15 years of age and is associated with transmission within crowds. Additionally strep throat has a seasonal variation, surging in winter and decreasing in summer. Herpes esophagitis affects mostly a specific group of patients including patients with history of chemotherapy treatment, hematological malignancy patients, HIV patients, and patients with autoimmune diseases. 


Strep throat and herpes esophagitis can both cause a sore throat. However, each one of them has distinguishing symptoms. Since herpes esophagitis is a disease of the esophagus it's characterized by marked dysphagia (difficulty in swallowing), odynophagia (painful swallowing), hematemesis (vomiting of blood), and less frequently, fever. Strep throat is distinguished by marked fever and enlarged, inflamed, and painful tonsils. 


Diagnosis of Throat Herpes vs. Strep Throat

Strep throat and herpes esophagitis also differ in the method of diagnosis. In addition to the different clinical algorithms based on the different symptoms mentioned above, physicians use a different set of investigations to mark strep throat from herpes esophagitis. For strep throat, physicians usually use a testing method called rapid antigen detection testing (RADT), which uses a throat swab to detect the presence of strep throat bacteria. An at-home test for strep is being developed now. To diagnose herpes esophagitis doctors look inside the esophagus using a small camera during a procedure called endoscopy to look at the tract of damage that the HSV virus caused inside the esophagus. Additionally, the doctors can use throat swabs to detect the virus using molecular methods and cultures. 


Treatment of Throat Herpes vs. Strep Throat

Strep throat and herpes esophagitis are treated differently. Although sore throats are generally self-limiting (do not require treatment), strep throat in particularly requires a course of treatment with oral antibiotics like amoxicillin. If not treated, Strep throat can lead to deadly complications in the heart and kidneys. On the other hand, herpes esophagitis can be treated with over the counter (OTC) painkillers to alleviate the pain. Additionally the doctors can add in some antiviral agents to treat herpes esophagitis. Herpes esophagitis can be treated within days, however in some cases it can lead to serious complications like esophageal perforation.


Although Strep throat and herpes esophagitis can mimic each other and can both cause sore throat, keeping an eye on the different symptoms of the two might help in differentiating between them, which will lead to quickly diagnosis and better chances of treatment.