 As the symptoms of streptococcal pharyngitis overlap with other conditions , it can be difficult to make the diagnosis clinically . Coughing , nasal discharge , diarrhea , and red , irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat . The presence of marked lymph node enlargement along with sore throat , fever , and tonsillar enlargement may also occur in infectious mononucleosis . 
