Patient Information for Sore Throat with Negative Strep Test
What Your Negative Test Means
Your negative rapid strep test reliably rules out streptococcal infection, and you do not need antibiotics—your sore throat is almost certainly caused by a virus that will resolve on its own within 3–7 days. 1, 2
- The rapid strep test has a specificity of ≥95%, meaning false-positive results are extremely rare, and a negative result is sufficient to exclude bacterial infection in adults 1, 3
- You do not need a follow-up throat culture or any additional testing 1, 2
- Approximately 70% of patients with sore throat receive unnecessary antibiotics, but only 5–10% of adults actually have strep throat 3
- Antibiotics would only shorten your symptoms by 1–2 days at most, while exposing you to side effects and contributing to antibiotic resistance 3
Home Care Measures
Take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) for pain and fever relief—these are the only proven treatments for viral sore throat. 1, 2
- Pain relief: Ibuprofen 400–600 mg every 6–8 hours or acetaminophen 650–1000 mg every 6 hours as needed 1, 3
- Throat lozenges may provide additional comfort 3
- Adequate hydration helps maintain comfort and prevents dehydration from fever 3
- Rest allows your immune system to fight the viral infection 3
What Does NOT Work
- Antibiotics will not help and may cause side effects 1, 2
- Zinc gluconate is not recommended 1
- Herbal treatments and acupuncture have inconsistent evidence 1
- Corticosteroids are not routinely recommended 1
Expected Timeline
- Most viral sore throats resolve within 3–7 days without any treatment 3
- Symptoms typically peak at 2–3 days, then gradually improve 3
- You are contagious for the first 2–3 days of illness 3
When to Go to the Emergency Room
Seek emergency care immediately if you develop any of these warning signs:
Airway Emergency (Call 911)
- Difficulty breathing or shortness of breath 3
- Drooling or inability to swallow your own saliva 3
- Muffled or "hot potato" voice (suggests peritonsillar abscess) 3
- Stridor (high-pitched breathing sound) 3
- Severe difficulty opening your mouth (trismus) 3
Severe Systemic Infection
- High fever >103°F (39.4°C) that does not respond to acetaminophen or ibuprofen 3
- Severe neck stiffness with inability to touch chin to chest (possible meningitis) 3
- Confusion or altered mental status 3
- Severe headache with fever and neck stiffness 3
- Rash that does not blanch when pressed (petechiae or purpura) 3
Dehydration
- Inability to drink fluids for >12 hours 3
- Dark urine or no urination for >8 hours 3
- Severe dizziness or lightheadedness 3
When to Return to Your Doctor (Non-Emergency)
Call your doctor's office during regular hours if:
- Symptoms worsen significantly after 3–4 days instead of improving 3
- Sore throat persists beyond 7 days 3
- You develop new symptoms such as ear pain, sinus pressure, or productive cough 3
- You develop a new rash 3
- Fever returns after initially improving 3
Common Pitfalls to Avoid
- Do not demand antibiotics—they will not help viral infections and may cause diarrhea, yeast infections, and allergic reactions 1, 2
- Do not stop taking pain relievers too early—consistent use for the first 2–3 days provides better symptom control than sporadic dosing 3
- Do not expose others unnecessarily—you are contagious for the first 2–3 days, so practice good hand hygiene and avoid close contact 3
- Do not assume family members need testing or treatment—asymptomatic household contacts should not be tested or treated, even if you were initially concerned about strep 1, 3
Why You Don't Need Antibiotics
- Your negative test means the infection is viral, not bacterial 1, 2
- Viral infections do not respond to antibiotics 1, 3
- The primary reason to treat strep throat is to prevent rheumatic fever, which only occurs with bacterial strep infection—not with viral pharyngitis 1, 3
- Antibiotics do not prevent other complications like ear infections or sinus infections in viral sore throat 1