When to worry about a sore throat

When dealing with a sore throat, how do we know whether to take a paracetamol or book an appointment with our doctor?

They might all lead to a similar sensation, but there are a variety of possible causes for your sore throat.

What causes a sore throat?

"Sore throats can have a number of causes - foreign bodies scratching, allergies, acid reflux, fungal infections (like thrush), swollen glands or even cancer,” explains Dr Jeff Foster of H3 Health. "But the most common cause is infection."

Although swollen glands are uncomfortable, they are rarely an indicator of something serious. In fact, more often than not, they're a good sign that your body is working to clear itself of infection.

"Any viral or bacterial throat infection can cause swollen glands in the neck. This is normal. In response to the infection the glands 'activate'. They get bigger as they produce more white blood cells which fight infection. They can get sore and tender when activated - but this is a healthy immune response," explains Dr Julie Coffey, of Uber Health Blog.

Do I need antibiotics for a sore throat?

When we hear the word infection, we automatically think of antibiotics. After all, these are meant to target infections, right? However, antibiotic treatment is only effective on bacterial infections. Taking them for a viral infection is pointless, and could weaken our already stressed immune system by harming good bacteria in the gut.

"Taking antibiotics for viral infections can be harmful to your health - you could also experience side effects," explains Coffey.

The most common of these side effects are:

• Digestive issues.

• Feeling sick or getting diarrhoea.

• Thrush - especially in women.

"Antibiotics could also damage the good bacteria in your gut. These are important for many aspects of our health, and ironically our immune system," she adds.

Only a small proportion of sore throats have a bacterial cause.

"Estimations are that in adults only 10% of sore throats are bacterial and need antibiotics," explains Foster. "This is higher in children, but still only 20-30% at the most."

Most doctors use a scoring system called the FeverPAIN Score to decide what the chances of having a strep throat are, to see if antibiotics are needed. The symptoms and signs your doctor would look for are:

• Fever in past 24 hours.

• Absence of cough or coryzal symptoms - runny nose.

• Symptoms less than or equal to 3 days.

• If you open your mouth and shine a torch at the back of your throat, white spots on your tonsils due to pus.

• Severe inflamed tonsils.

In the UK, unless you have three or four of these symptoms, doctors may not prescribe antibiotics, because it's highly likely to be due to a viral infection.

"Most sore throats are not helped by seeing a doctor," agrees Coffey. "A viral sore throat will usually settle within a week."

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Is your sore throat something more serious?

Everyone gets sore throats and to most, they're just a bore that passes within days. But sometimes sore throats can signal a serious infection that needs antibiotic treatment. And just occasionally they might have a most unlikely cause.

by Dr Sarah Jarvis MBE, FRCGP

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Epiglottitis

Epiglottitis is the term used to describe inflammation and swelling of the epiglottis which lies just behind the root of the tongue. It is usually caused by infection with a bacteria. The usual symptoms are a severe sore throat, pain or difficulty swallowing and a high temperature (fever). Breathing difficulties can occur. Prompt treatment is needed to ensure that enough oxygen can reach the lungs and usually includes antibiotics. If epiglottitis is treated quickly, the outlook is generally very good. Untreated, it can be life-threatening. Since immunisation against Hib was introduced, the number of children who develop epiglottitis in the UK has reduced dramatically.

by Dr Pippa Vincent, MRCGP

What treatments might help a sore throat?

Unless your sore throat is severe, or accompanied by other worrying symptoms, it's worth trying a little self-care and waiting it out. Taking paracetamol or ibuprofen to relieve pain and inflammation can help, as can staying hydrated - or taking remedies such as gargles, lozenges or throat sprays. These are all available to buy from your local pharmacist.

Home remedies such as gargling warm salt water and adding honey to a hot drink can also help soothe a sore throat.

With proper rest and care, most sore throats should improve without further intervention.

When should I seek medical attention for a sore throat?

Whilst the majority of sore throats can be resolved without visiting your doctor, in certain cases it's important to seek their advice or go to Pharmacy First. For instance - if your sore throat lasts longer than a week, you develop a high temperature, or your sore throat keeps coming back.

In addition, if your immune system is compromised - for example, due to cancer treatment, medication such as carbimazole or 'disease-modifying drugs', diabetes or HIV infection - it's important to get additional advice on the best course of treatment.

Although most are little more than a nuisance, in certain cases a sore throat may indicate a more serious problem.

Finally, if your sore throat lasts for more than three weeks and is not accompanied by an upper respiratory tract infection (common cold), it's important to seek medical advice.

It's reassuring to know, however, that in most cases, sore throats will resolve without additional investigation. In fact, according to the National Institute for Health and Care Excellence (NICE), 85% of sore throats will resolve within a week, and 40% within just three days. However, if you experience any additional symptoms or if your sore throat is particularly persistent, it's worth seeking advice from your pharmacist or doctor.