Several viruses and at least one major bacterium are circulating right now that can cause a sore throat. The most common culprits in the current 2024–2025 respiratory season are influenza, rhinovirus/enterovirus (the common cold), COVID-19, and group A strep. Which one you’re dealing with depends on your other symptoms, and knowing the difference matters because only one of these responds to antibiotics.
Influenza Is Peaking Hard This Season
Influenza hit its highest point of the season during the first week of February 2025, when nearly 32% of lab specimens came back positive. The flu commonly starts with a sore throat alongside sudden fever, body aches, chills, and fatigue. Unlike a cold, the flu tends to knock you flat. Sore throat from the flu usually improves within a few days as the other symptoms take center stage, particularly the deep fatigue and muscle pain that can linger for a week or more.
Common Cold Viruses Are Everywhere
Rhinovirus and enterovirus, the bugs behind most common colds, circulate nearly year-round with two annual spikes. The fall peak hit 30.4% positivity in late September 2024, and a spring wave reached 22.3% in May 2025. A cold-related sore throat typically shows up as the first symptom, followed within a day or two by a runny nose, sneezing, and mild congestion. Cough may develop later. Fever is uncommon in adults with a cold, which is one of the easiest ways to tell it apart from the flu.
Most cold-related sore throats improve within a week without treatment. Over-the-counter pain relievers, warm liquids, and lozenges can help while you wait it out.
COVID-19 Still Causes Sore Throats
SARS-CoV-2 continues to circulate, though at lower levels than during earlier pandemic waves. The virus peaked at 17.9% positivity in August 2024, dropped through the fall, then saw a smaller winter bump of 6.7% in early January 2025. Since the Omicron variant became dominant, sore throat has been one of the most reported symptoms. In a large English study comparing Omicron to the earlier Delta variant, 53% of people with Omicron reported sore throat, compared to 34% with Delta. That made sore throat the second most common Omicron symptom after runny nose.
COVID sore throats often come with fatigue, headache, congestion, and sometimes a dry cough. Loss of taste and smell, once a hallmark of earlier variants, is much less common now. If you’re unsure whether your sore throat is COVID or a cold, a home rapid test can help sort it out, though tests are most reliable a few days after symptoms begin.
Strep Throat Is the One That Needs Antibiotics
Group A Streptococcus, the bacterium behind strep throat, remains a significant concern. Invasive group A strep infections in the U.S. more than doubled between 2013 and 2022, rising from 3.6 to 8.2 cases per 100,000 people. While most strep throat cases aren’t invasive (meaning the infection stays in the throat rather than spreading to other body systems), the overall increase signals that these bacteria are very much in circulation.
Strep throat looks and feels different from a viral sore throat. The classic signs are a sudden, severe sore throat with pain when swallowing, fever of 101°F or higher, swollen lymph nodes in the front of your neck, and white patches or streaks on your tonsils. What’s notably absent is cough, runny nose, and congestion. If you have those cold-like symptoms, strep is much less likely.
Doctors use a simple scoring system to gauge the likelihood of strep: one point each for fever at or above 100.4°F, no cough, swollen front neck lymph nodes, and swollen or pus-covered tonsils. A score of 3 or 4 makes strep likely enough to test for. The rapid strep test is very reliable when it’s positive, but it can occasionally miss cases, so a negative rapid test sometimes gets followed up with a throat culture. If strep is confirmed, a course of antibiotics clears the infection and helps prevent rare but serious complications like rheumatic fever.
Adenovirus: The One With Eye Symptoms
Adenovirus is a less talked-about but widespread cause of sore throat, particularly in children and young adults. It causes a distinctive combination of pharyngitis (throat inflammation), swollen neck lymph nodes, and conjunctivitis, the red, watery eyes that earn it the nickname “pharyngoconjunctival fever.” If your sore throat came with pink, irritated eyes, adenovirus is a strong possibility.
The incubation period ranges from 2 to 14 days, and the virus can linger in your system for weeks even after you feel better. There’s no specific treatment. Like other viral sore throats, it resolves on its own, though the eye symptoms can be particularly annoying.
Mycoplasma Pneumoniae Is on the Radar
Mycoplasma pneumoniae, the bacterium behind “walking pneumonia,” has been drawing increased attention from the CDC. This pathogen typically causes a milder illness than its name suggests: low-grade fever, a persistent dry cough, sore throat, and fatigue that comes on gradually rather than hitting all at once. The CDC has noted an unusual uptick in infections among very young children (under age 4), a group historically less affected. While Mycoplasma sore throats are generally mild, the cough can drag on for weeks.
Allergies Can Mimic an Infection
Not every sore throat going around is actually an infection. Seasonal allergies cause postnasal drip, where mucus from your sinuses drains down the back of your throat and irritates it. This tends to be worst in the morning and improves as the day goes on. The biggest clue that allergies are behind your sore throat: itchy, watery eyes. That symptom essentially doesn’t occur with colds, flu, or COVID. You also won’t have a fever with allergies, and the sore throat tends to feel scratchy rather than painful.
How to Tell What You Have
Your other symptoms are the best guide to figuring out what’s behind your sore throat. Here’s a quick comparison:
- Sore throat with sudden fever, body aches, and exhaustion: likely the flu
- Sore throat with runny nose, sneezing, no fever: likely a cold (rhinovirus)
- Sore throat with fatigue, congestion, and headache: possibly COVID, worth testing
- Severe sore throat with fever, no cough, swollen glands, white patches on tonsils: likely strep, needs a test
- Sore throat with red, watery eyes and swollen neck glands: possibly adenovirus
- Scratchy throat with itchy eyes, worse in the morning: likely allergies
Most viral sore throats resolve within a week. Strep throat is the main one where getting tested and treated makes a real difference. If your sore throat is unusually severe, lasts longer than a week, or comes with a high fever that won’t break, those are signs worth getting checked out.