A sore throat usually goes after a few days. Simple treatments that you can buy can ease symptoms until the sore throat goes. Usually, you only need to see a doctor if symptoms are severe, unusual, or if they do not ease within three to four days.
What is a sore throat?
Sore throat (pharyngitis) is very common. It is usually caused by an infection in the throat. Soreness in the throat may be the only symptom. In addition, you may also have a hoarse voice, mild cough, high temperature (fever), headache, feel sick, feel tired, and the glands in your neck may swell. It may be painful to swallow. The soreness typically gets worse over two to three days and then usually gradually goes within a week. In about one in ten cases the soreness lasts longer than a week. You may also develop a sore throat if you have a cold or flu-like illness.
Tonsillitis is an infection of the tonsils at the back of the mouth. Symptoms are similar to a sore throat, but may be more severe. In particular, fever and generally feeling unwell tend to be worse. You may be able to see some pus which looks like white spots on the enlarged red tonsils. See separate leaflet called Tonsillitis for more details.
What is the treatment for sore throat?
- Not treating is an option as many throat infections are mild and soon get better.
- Have plenty to drink to avoid lack of fluid in the body (dehydration). It is tempting not to drink very much if it is painful to swallow. You may become mildly dehydrated if you don't drink much, particularly if you also have a high temperature (fever). Mild dehydration can make headaches and tiredness much worse.
- Paracetamol or ibuprofen ease pain, headache, and fever. To keep symptoms to a minimum it is best to take a dose at regular intervals, as recommended on the packet of medication, rather than now and then. For example, take paracetamol four times a day until symptoms ease. Although either paracetamol or ibuprofen will usually help, there is some evidence to suggest that ibuprofen may be more effective than paracetamol at easing symptoms in adults. Paracetamol is usually the preferred first-line option for children, but ibuprofen can be used as an alternative. Note: some people with certain conditions may not be able to take ibuprofen, so always read the packet label.
- Other gargles, lozenges, and sprays that you can buy at pharmacies may help to soothe a sore throat. However, they do not shorten the illness.
Do I need an antibiotic medicine?
Usually not. Most throat and tonsil infections are caused by viruses, although some are caused by germs called bacteria. Without tests, it is usually not possible to tell if it is a viral or bacterial infection. Antibiotics kill bacteria, but do not kill viruses. However, even if a bacterium is the cause, an antibiotic does not make much difference in most cases. Your immune system usually clears these infections within a few days whether caused by a virus or a bacterium. Also, antibiotics can sometimes cause side-effects such as diarrhoea, feeling sick, rash, and stomach upsets.
Therefore, most doctors do not prescribe antibiotics for most cases of sore throat or tonsillitis.
Many doctors use a scoring system called the Centor score to decide whether a sore throat needs antibiotics. The features they look for are:
- Presence of pus on the tonsils.
- Tender lymph glands in the neck.
- Absence of cough.
- History of high temperature (fever).
If three or four of these are present it is more likely that the infection is caused by bacteria.
An antibiotic may be advised if the infection is severe, if it is not easing after a few days, or if your immune system is not working properly. (For example, if you have had your spleen removed, if you are taking chemotherapy, etc.) People with heart valve problems or who have had rheumatic fever may be prescribed antibiotics.
What things should I look out for?
In nearly all cases, a sore throat or tonsillitis clears up without leaving any problems. However, occasionally a typical sore throat may progress to cause complications. Also, a sore throat is sometimes due to an unusual, but more serious, illness. Therefore, for the sake of completeness, the sort of things to look out for include the following.
Sometimes the infection can spread from the throat or tonsils to other nearby tissues. For example, to cause an ear infection, sinus infection or chest infection.
Glandular fever (infectious mononucleosis)
Infectious mononucleosis is caused by the Epstein-Barr virus. It tends to cause a severe bout of tonsillitis in addition to other symptoms. See separate leaflet called Glandular Fever (Infectious Mononucleosis) for more details.
Quinsy (also known as peritonsillar abscess)
Quinsy is an uncommon condition where a collection of pus (an abscess) develops next to a tonsil, due to a germ (bacterial) infection. It usually develops just on one side. It may follow a tonsillitis or develop without having had tonsillitis. The tonsil on the affected side may be swollen or look normal, but is pushed towards the midline by the abscess next to the tonsil. Quinsy is very painful and can make you feel very unwell. It is treated with antibiotics, but also the pus often needs to be drained with a small operation.
Other uncommon causes of throat or tonsil infections
Other infections can sometimes cause a sore throat or tonsillitis. For example, a thrush infection of the throat, or certain sexually transmitted infections.
Non-infective causes of sore throat
An allergy such as hay fever can cause a sore throat. A sore throat can be the first symptom of throat cancer (but this is rare and mainly affects older smokers).
Medication that can suppress the immune system
Carbimazole is a medicine that is used to treat an overactive thyroid gland. If you are taking carbimazole and develop a sore throat then you should have an urgent blood test. This is because a sore throat may be the first warning of a serious side-effect to carbimazole (agranulocytosis - which is a low level of white blood cells). This serious side-effect needs urgent treatment. Agranulocytosis can occur as a side-effect of various other medicines.
The 'take home' message is ... see a doctor if symptoms of a sore throat are severe, unusual, or if they do not ease within three to four days. In particular, seek urgent medical attention if you develop:
- Difficulty in breathing.
- Difficulty swallowing saliva.
- Difficulty opening your mouth.
- Severe pain.
- A persistent high temperature (fever).
- A severe illness, especially when symptoms are mainly on one side of the throat.
Further reading & references
- Respiratory tract infections – antibiotic prescribing: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care; NICE Clinical Guideline (July 2008)
- Management of sore throat and indications for tonsillectomy; Scottish Intercollegiate Guidelines Network - SIGN (April 2010)
- Sore throat - acute; NICE CKS, July 2015 (UK access only)
- Spinks A, Glasziou PP, Del Mar CB; Antibiotics for sore throat. Cochrane Database Syst Rev. 2013 Nov 5;11:CD000023.
- Centor RM; When should patients seek care for sore throat? Ann Intern Med. 2013 Nov 5;159(9):636-7. doi: 10.7326/0003-4819-159-9-201311050-00012.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Jan Sambrook
Dr Helen Huins