Sore throat

Sore throats (pharyngitis) are very common and most people will get better with simple treatment, usually within a week.

What causes your sore throat?

A sore throat is most commonly an infection caused by:

  • A virus—viruses cause most sore throats. Those causing the common cold (rhinovirus) and the flu (influenza) are among the many viruses which case sore throat.
  • Bacterial infections—rarer than viral sore throats, mainly due to a bacterium called streptococcus.
  • Glandular fever—due to a virus called Epstein-Barr virus (EBV)

You catch the infection from someone else, usually via small droplets of fluid containing the virus when someone sneezes, coughs or speaks.

Less commonly, sore throats can be due to non-infectious causes such as:

  • Smoking and air pollution
  • Gastro-oesophageal reflux
  • Hayfever
  • Some blood disorders

Why do you get a sore throat?

A sore throat is a symptom of inflammation (redness, swelling and pain) in your upper respiratory tract:

  • You will develop discomfort on swallowing
  • You may develop swollen tonsils (tonsillitis)
  • The glands in your neck may become enlarged and tender (lymphadenopathy)

Associated symptoms

  • Fever/high temperature
  • Flu-like symptoms with muscle and joint aches and a headache
  • Symptoms of a cold such as a runny or blocked nose, a cough or painful ear(s)

What investigations do you need?

None usually. If your sore throat is recurrent, prolonged or you have issues with your immune system your doctor may do blood tests.

How do you treat a sore throat?

Your sore throat will usually get better within a week. Symptomatic relief can be gained by:

  • Drinking well (2–3 litres a day) and keeping hydrated—but avoid hot fluids as they may make it worse
  • Eating soft foods to reduce discomfort
  • Throat sprays or lozenges
  • Simple painkillers like paracetamol or ibuprofen for pain and fever
  • Gargling with salt water (or aspirin if you are at least 16 years old and have no allergies)

Do you need antibiotics?

Most cases of a sore throat do not need treatment with antibiotics. This is because:

  • Most cases are viral and so antibiotics do not work
  • In most cases your body’s immune system will deal with the infection
  • Unnecessary antibiotics will have no benefit to you but you may suffer unpleasant side effects
  • Overuse of antibiotics can lead to resistance and make them less effective in the future

You may be given antibiotics if:

  • You have a severe infection suspected of being bacterial
  • After simple measures your sore throat has not improved after a few days
  • You have had repeated streptococcal infection in the past
  • You have a weakened immune system due to medical problems like HIV or diabetes
  • You are on certain medication like chemotherapy or certain thyroid medication that can affect your immune system
  • You have a history of rheumatic heart disease

Antibiotics can cause gastrointestinal side effects like stomach cramps and diarrhoea. They can also interact with other medication such as the oral contraceptive pill so seek advice.

Will it get better?

Most sore throats will get better very quickly and you should start to feel better within a week. You need to seek medical advice if:

  • There are no signs of improvement after a few days
  • You are having difficulty in breathing
  • You cannot swallow food or fluids
  • You feel very unwell
  • You have a weakened immune system
  • You notice a lump in your neck
  • You have a persistent sore throat or painful swallowing for more than three weeks

What if it happens again?

Sore throats are very common and can be recurrent.  It is not unusual to have at least 2–3 episodes a year and in younger patients this can be more. See your GP if it is becoming problematic.

richardjn George Vasilopoulos