Strep vs Mono: Differences Between Strep Throat and Glandular Fever

01Strep

Strep throat at a glance

• Bacterial infection (group A Streptococcus).
• Sudden onset of severe sore throat.
• Fever and swollen, tender glands at the front of the neck.
• White patches or pus on the tonsils.
• Usually no cough or runny nose.
• Most common in children aged 5 to 15.

See strep throat and tonsillitis vs strep.

02Mono

Mono (glandular fever) at a glance

• Viral infection, usually Epstein-Barr virus.
• More gradual onset.
• Very swollen tonsils, sometimes with a white coating.
• Swollen glands in the neck, often at the back, and elsewhere.
• Extreme tiredness, sometimes for weeks.
• Most common in teenagers and young adults.

03Differences

Key differences

• Cause: bacteria vs virus.
• Onset: sudden vs gradual.
• Tiredness: short-lived vs prolonged.
• Glands: front of the neck vs back of the neck and elsewhere.
• Spleen: not affected vs may be enlarged.
• Duration: days vs 2 to 4 weeks or longer.

04Overlap

Why they are easily confused

Both cause fever, sore throat and swollen tonsils with white patches. A person can even have both at the same time. Tests are the most reliable way to tell them apart.

05Tests

Tests

• Strep: rapid antigen test or throat swab culture.
• Mono: blood tests, including a full blood count, a monospot test and EBV antibodies; liver tests may be mildly abnormal.

Doctors also use scoring systems based on symptoms to decide whether to test or prescribe antibiotics for a sore throat.

06Strep treatment

Treatment of strep throat

When strep is likely or confirmed, antibiotics such as penicillin may be prescribed. They shorten symptoms slightly and reduce the risk of complications such as abscesses and rheumatic fever. Painkillers, fluids and rest help. People are usually no longer contagious 24 hours after starting antibiotics.

See home remedies for strep throat.

07Mono treatment

Treatment of mono

• Rest and gradual return to activity.
• Fluids and painkillers such as paracetamol or ibuprofen.
• Gargling salt water.
• Avoiding alcohol while the liver is affected.
• Avoiding contact sports and heavy lifting for at least 4 weeks.

Antibiotics do not help mono, and amoxicillin can cause a widespread rash in people with mono.

08Spleen

Mono and the spleen

Mono can enlarge the spleen, making it vulnerable to rupture with impact or strain. This is why contact sports, heavy lifting and vigorous exercise are avoided for at least 4 weeks, and longer in some cases on medical advice. Sudden severe pain in the upper left abdomen is an emergency.

09Contagious

How contagious are they?

Strep spreads through droplets and close contact; it is contagious until about 24 hours after starting antibiotics. Mono spreads mainly through saliva (hence “the kissing disease”) and can be passed on for weeks; avoid kissing and sharing cups or utensils.

10Complications

Complications

• Strep: peritonsillar abscess (quinsy), scarlet fever, rarely rheumatic fever or kidney inflammation.
• Mono: airway swelling, spleen rupture, hepatitis, prolonged fatigue.

11Fatigue

Recovering from mono fatigue

Tiredness after mono can last weeks or months. Gradually increasing activity, regular sleep, balanced meals and returning to school or work in stages help. If tiredness lasts more than a few months, see a doctor.

12Scarlet fever

Strep and scarlet fever

Some strep infections cause scarlet fever, with a rough, sandpaper-like rash, flushed cheeks and a strawberry tongue. It is treated with antibiotics and is most common in young children.

14Summary

Key points to remember

• Strep is bacterial, sudden and short-lived.
• Mono is viral, with prolonged tiredness and swollen glands.
• Tests distinguish them; antibiotics only help strep.
• With mono, avoid contact sports for at least 4 weeks.