Sore throat

Sore throats are normally caused by bacterial, or viral, infections.

Sore throats are a common condition, with most people having at least two, or three, every year. They tend to be more common among children and teenagers. This is because young people have not built up immunity against many of the viruses and bacteria that can cause sore throats.

Most sore throats are not serious and pass within 3-7 days without the need for medical treatment. Over-the-counter (OTC) painkillers, such as acetaminophen, can usually be used to relieve the symptoms of a sore throat.

Causes

Common conditions that are caused by an infection and which often include a sore throat as a symptom include:

  • the common cold,
  • influenza (flu), and
  • glandular fever

The infection that causes sore throats can cause inflammation and swelling in:

  • your oropharynx (the area at the back of your throat), and
  • your tonsils (the two lumps of tissue either side of your throat).

An infection of the tonsils is known as tonsillitis.

Possible causes of infection include the bacteria known as streptococcus (this condition is often called 'strep throat').

Less commonly, sore throats can have non-infectious causes. These include:

  • irritation caused by cigarette smoke, or alcohol
  • gastro-esophageal reflux (a condition that causes acid to leak upwards from the stomach into the esophagus)
  • hay fever, and
  • in very rare cases, cancer

Diagnosis

If you have a sore throat, a clinical diagnosis of the condition is usually not required, unless your symptoms do not improve after two weeks.

If you do need to visit your doctor, they will ask you about your symptoms and examine your throat.

Blood tests may also be carried out if your doctor suspects that you have infectious mononucleosis (glandular fever).

Prevention

As sore throats are caused by bacterial, or viral, infections, they can be difficult to prevent.

If you smoke, giving up will reduce irritation to your throat, and strengthen your defenses against infection.

Your doctor, or pharmacist, will be able to provide you with help and advice about giving up smoking.

Symptoms

Signs and symptoms

Signs of a sore throat include:

  • swollen tonsils, and
  • enlarged and tender glands in your neck.

Symptoms of a sore throat include:

  • a painful, tender feeling at the back of your throat, and
  • discomfort upon swallowing

If you have a sore throat, you may also experience a number of other symptoms that are associated with common infectious conditions, such as:

  • a high temperature
  • aching
  • headache, and
  • tiredness

When to make an appointment to see your doctor

If you have a sore throat, you should make an appointment to see your doctor if:

  • your symptoms do not improve after two weeks
  • you have frequent sore throats that do not respond to painkillers, such as acetaminophen, ibuprofen, or aspirin, or
  • you have lowered immunity due to an illness, such as HIV, or through treatments such as chemotherapy, or steroid medication.

When to seek urgent medical advice

You should seek urgent medical advice if you:

  • have a persistent fever - a temperature that is above 38C (100.4F).

It is important that the cause of your temperature is investigated because it may be the result of a more serious condition, such as epiglottitis (a bacterial infection that, if left untreated, can cause breathing difficulties), or quinsy (an abscess between the back of the tonsil and the wall of the throat).

When to seek emergency medical advice

You should phone 911 and ask for an ambulance if you:

  • have difficulty breathing
  • have difficulty swallowing saliva and fluids, or opening your mouth, or
  • start drooling

People at risk from complications

Some people are more at risk than others of developing complications from a sore throat, and may need additional treatment.

You should see your doctor at the first sign of infection if:

  • you have a condition that affects your immune system, such as HIV
  • you are taking an immunosuppressant medicine
  • you are taking antithyroid medication, such as carbimazole
  • you are taking a disease -modifying anti-rheumatic medicine (DMARDs), or
  • you are currently undergoing a course of immunosuppressive medication

Treatment

Sore throats are not usually serious, and the condition will often pass within 3-7 days.

For treating sore throats, over-the-counter (OTC) painkillers (analgesics) such as acetaminophen, aspirin, or ibuprofen, are usually recommended.

However, you should not take aspirin, or ibuprofen, if you have (or have had in the past) stomach problems, such as a peptic ulcer, or if you have liver, or kidney problems. Paracetamol should be used instead.

Children under 16 years of age should also not take aspirin. Instead, acetaminophen, or ibuprofen, should be used.

Analgesics should be taken regularly for 48 hours after the onset of your symptoms. However, you should not exceed the recommended, or prescribed, dose.

If you, or someone in your family, have a sore throat, the tips outlined below may also help.

  • Avoid food or drink that is too hot because this could irritate your throat
  • Eating cool, soft food and drinking cool, or warm, liquids, may help to relieve symptoms.
  • Adults and older children may find that sucking lozenges, hard sweets, or ice cubes, can provide additional relief from their symptoms.
  • Avoid smoking and smoky environments
  • Regularly using a mouthwash of warm, salty water may help to reduce any swelling, or pain.

Antibiotics are not recommended

The use of antibiotics is not usually recommended for the treatment of sore throats. This is because:

  • most sore throats are not caused by bacteria
  • even if your sore throat is caused by bacteria, antibiotics have proven to be no more effective in treating these cases than acetaminophen, and may cause unpleasant side effects, and
  • over-using antibiotics to treat minor ailments can make them less effective in the treatment of life-threatening conditions.

Antibiotics are usually only prescribed for treating particularly severe cases of sore throat. However, they may also be prescribed if:

  • you have a condition, such as HIV, that increases your risk of developing complications from infection
  • you are taking a medicine, such as an immunosuppressant, that increases your risk of developing complications from infection
  • you have a history of heart disease, or rheumatic fever, or
  • you experience repeated infections caused by the streptococcus bacteria

A ten day dose of an antibiotic called phenoxymethylpenicillin is usually prescribed in these circumstances. It is important to finish the dose even if you feel better. If you are allergic to penicillin, another antibiotic, called erythromycin, may be used.

Tonsillectomy

If your child has repeated infections of the tonsils (tonsillitis), a tonsillectomy may be considered. A tonsillectomy is a surgical procedure where the tonsils are removed from the throat.