Sore Throat

A sore throat is pain, scratchiness, or irritation in the throat that often worsens when swallowing. While most sore throats are caused by viral infections and resolve on their own, some require medical treatment, particularly if caused by strep bacteria or other serious conditions.

Quick Facts

  • Very common symptom
  • Usually viral cause
  • Most resolve in 3-7 days
  • Strep needs antibiotics
  • Can affect all ages

⚠️ Seek Emergency Care Immediately For:

  • Severe difficulty swallowing or breathing
  • Drooling or inability to swallow saliva
  • High fever (over 103°F/39.4°C) with throat pain
  • Swelling of neck or tongue
  • Stiff neck with sore throat
  • Muffled or "hot potato" voice
  • Unable to open mouth fully
  • Severe headache with throat pain
  • Chest pain or heart palpitations
  • Signs of dehydration

These symptoms may indicate epiglottitis, severe abscess, or other life-threatening conditions.

Understanding Sore Throat

The throat (pharynx) is a muscular tube that carries food to the esophagus and air to the windpipe and lungs. When the throat becomes inflamed due to infection, irritation, or injury, pain receptors are activated, resulting in the discomfort we know as a sore throat.

Sore throats can affect different areas including the pharynx (pharyngitis), tonsils (tonsillitis), or voice box (laryngitis). The location and severity of pain, along with accompanying symptoms, help determine the cause and appropriate treatment.

While most sore throats are minor and self-limiting, it's important to distinguish between common viral infections and bacterial infections like strep throat, which require antibiotic treatment to prevent complications such as rheumatic fever or kidney problems.

Types of Sore Throat

Viral Pharyngitis

  • Most common type (70-85%)
  • Gradual onset
  • Often with cold symptoms
  • No antibiotics needed
  • Self-limiting
  • Contagious

Strep Throat

  • Bacterial infection
  • Sudden onset
  • Severe pain
  • Fever common
  • Needs antibiotics
  • Very contagious

Tonsillitis

  • Inflamed tonsils
  • Red, swollen tonsils
  • White patches possible
  • Difficulty swallowing
  • Bad breath
  • May need removal

Laryngitis

  • Voice box inflammation
  • Hoarse voice
  • Voice loss possible
  • Dry cough
  • Tickling sensation
  • Usually viral

Common Causes

Viral Infections (Most Common)

  • Common cold: Rhinoviruses, coronaviruses
  • Flu (influenza): Types A and B
  • Mononucleosis: Epstein-Barr virus
  • COVID-19: SARS-CoV-2 virus
  • Croup: Parainfluenza viruses
  • Herpangina: Coxsackievirus
  • Measles: If unvaccinated
  • Chickenpox: Varicella-zoster

Bacterial Infections

  • Group A Streptococcus: Causes strep throat
  • Group C and G strep: Less common
  • Gonorrhea: Oral transmission
  • Chlamydia: Throat infection
  • Diphtheria: Rare in vaccinated populations
  • Whooping cough: Bordetella pertussis

Irritants and Environmental Factors

  • Dry air: Especially in winter
  • Pollution: Smoke, chemicals
  • Allergies: Postnasal drip
  • Acid reflux (GERD): Stomach acid irritation
  • Voice strain: Yelling, singing
  • Mouth breathing: Dries throat
  • Tobacco smoke: Direct irritation
  • Alcohol: Dehydrating effect

Other Causes

  • Tumors: Throat, tongue, or voice box
  • HIV infection: Chronic sore throat
  • Peritonsillar abscess: Complication of tonsillitis
  • Epiglottitis: Medical emergency
  • Foreign body: Fish bone, etc.
  • Kawasaki disease: In children

Associated Symptoms

Sore throat often occurs with other symptoms that help identify the cause:

  • Fever: Often with bacterial infections
  • Swollen lymph nodes: Tender neck glands
  • Headache: Common with infections
  • Cough: Usually indicates viral cause
  • Runny or stuffy nose: Viral upper respiratory infection
  • Hoarse voice: Laryngitis involvement
  • Ear pain: Referred pain from throat
  • Body aches: Flu or mono
  • Skin rash: Scarlet fever, viral exanthem
  • Nausea or vomiting: Especially in children
  • Bad breath: From infection or tonsil stones
  • Difficulty opening mouth: Peritonsillar abscess

Signs Suggesting Strep Throat

Common Strep Symptoms

  • Sudden onset sore throat
  • Pain when swallowing
  • Fever over 101°F
  • Red, swollen tonsils
  • White patches on tonsils
  • Tiny red spots on palate

Strep Usually LACKS

  • Cough
  • Runny nose
  • Hoarseness
  • Conjunctivitis
  • Oral ulcers
  • Diarrhea

Diagnosis and Testing

Medical History

  • Symptom onset and duration
  • Fever presence and pattern
  • Associated symptoms
  • Sick contacts
  • Previous strep infections
  • Current medications

Physical Examination

  • Throat inspection
  • Tonsil examination
  • Lymph node palpation
  • Ear examination
  • Skin rash check
  • Abdominal palpation (spleen)

Diagnostic Tests

  • Rapid strep test: Results in minutes
  • Throat culture: Gold standard, 24-48 hours
  • Complete blood count: If mono suspected
  • Monospot test: For mononucleosis
  • COVID-19 test: If symptoms suggest

Treatment Options

Home Remedies

  • Warm salt water gargle
  • Throat lozenges
  • Honey and lemon
  • Warm liquids (tea, soup)
  • Cold treats (popsicles)
  • Humidifier use

Over-the-Counter

  • Acetaminophen
  • Ibuprofen
  • Throat sprays
  • Numbing lozenges
  • Cough drops
  • Antihistamines if allergies

Prescription Medications

  • Antibiotics for strep
  • Steroids for severe swelling
  • Antiviral medications
  • Stronger pain relievers
  • Magic mouthwash
  • Antifungals if thrush

General Care

  • Rest your voice
  • Stay hydrated
  • Get plenty of sleep
  • Avoid irritants
  • Eat soft foods
  • Don't smoke

Natural and Home Treatments

  • Salt water gargle: 1/2 teaspoon salt in warm water
  • Honey: Natural antibacterial properties
  • Ginger tea: Anti-inflammatory effects
  • Chamomile tea: Soothing and anti-inflammatory
  • Apple cider vinegar: Diluted gargle
  • Marshmallow root: Mucilage coats throat
  • Sage: Traditional remedy
  • Licorice root: Soothing properties
  • Slippery elm: Coating effect
  • Steam inhalation: Moistens throat

Prevention Strategies

  • Hand hygiene: Frequent washing
  • Avoid touching face: Reduces infection risk
  • Don't share items: Cups, utensils, towels
  • Stay home when sick: Prevent spread
  • Cover coughs/sneezes: Into elbow
  • Disinfect surfaces: Phones, doorknobs
  • Maintain humidity: 30-50% indoor
  • Avoid smoke: Cigarettes, pollution
  • Manage allergies: Reduce postnasal drip
  • Stay hydrated: Keeps throat moist
  • Get vaccinated: Flu shot annually

When to See a Doctor

See a Doctor Within 24-48 Hours For:

  • Sore throat lasting more than 2 days
  • Fever over 101°F (38.3°C)
  • Swollen, tender lymph nodes
  • White patches on tonsils
  • Rash with sore throat
  • Known strep exposure
  • Difficulty swallowing liquids
  • Ear pain with sore throat
  • Blood in saliva or phlegm
  • Recurring sore throats

Potential Complications

From Untreated Strep Throat

  • Rheumatic fever (heart damage)
  • Post-streptococcal glomerulonephritis (kidney)
  • Scarlet fever
  • Peritonsillar abscess
  • Ear infections
  • Sinus infections

Related Conditions

Cough

Often accompanies viral sore throats but usually absent in strep.

Fever

Common with both viral and bacterial throat infections.

Ear Pain

Throat pain can radiate to ears due to shared nerve pathways.

Allergies

Postnasal drip from allergies commonly causes throat irritation.