A sore throat (pharyngitis) 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 a week.
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.
- A mild cough.
- A high temperature (fever).
- A headache.
- A feeling of wanting to be sick (nausea).
- Swollen glands in your neck.
- Pain when you swallow.
Sore throat causes
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.
Sore throat treatment
- Not treating is an option as many throat infections are mild and soon get better without treatment.
- Have enough 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. If necessary, you can alternate and take both. Note: some people with certain conditions may not be able to take ibuprofen, so always read the packet label. It is very important not to take more than the dose advised on the packet.
- Lozenges can be bought in pharmacies or supermarkets. Some people find these helpful to soothe a sore throat. You may also find sucking boiled sweets, ice and ice lollies can be soothing.
- Other gargles and sprays can be bought at pharmacies to help to soothe a sore throat. However, there is not very much evidence about how effective they are and they do not shorten the illness.
Do I need any tests?
Not usually. Occasionally a swab from the back of your throat is done to send to the laboratory to see which type of germ is causing your sore throat. This is not done routinely however. It might be needed if you are not getting better after treatment, or if your infection keeps coming back.
Blood tests are not routinely needed for sore throats but are occasionally necessary for people who take certain medications which can affect the immune system. Also a blood test may be needed if glandular fever (infectious mononucleosis) is suspected.
Do I need an antibiotic medicine?
Usually you will not need an antibiotic. 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. See separate leaflet called Why Wasn't I Prescribed Antibiotics? for more detail.
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. If this looks likely, you may be given a "delayed prescription". This means you should not start taking the antibiotic straightaway. However, if you are getting worse, or if your symptoms have not started to improve in 2-3 days then you can pick up the prescription without having to go back to the doctor.
An antibiotic may be advised if the infection is severe or if it is not easing after a few days. It may also be needed 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 for sore throats.
Clinical Editor's note
Dr Hayley Willacy suggests you read the recently released NICE guidelines which advise healthcare professionals on when an antibiotic should be considered - see Further Reading and References, below. It concludes that most people with a sore throat won’t be offered antibiotics because a sore throat will usually get better without antibiotics whether it is a bacterial or viral infection; antibiotics make little difference to how long a sore throat lasts and antibiotics can cause side effects, like diarrhoea. An antibiotic might help when a sore throat is caused by a streptococcal bacterial infection (‘strep’ throat). Healthcare professionals should ask people about their symptoms to help them decide if they would benefit from 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 things to look out for include the following.
Glandular fever (infectious mononucleosis)
Glandular fever 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 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
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 adults who smoke).
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. Other medication, such as chemotherapy for cancer, or certain tablets called disease-modifying antirheumatic drugs (taken for rheumatoid arthritis), can also affect the way your immune system copes with infection. If you are taking one of these types of medication and develop a sore throat, see your doctor urgently. They will arrange an immediate blood test.
The 'take home' message is ... see a doctor if symptoms of a sore throat are severe, unusual, or do not ease within one week. 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 and references
Sore throat (acute): antimicrobial prescribing; NICE Guideline (Jan 2018)
Sore throat - acute; NICE CKS, July 2015 (UK access only)
Management of sore throat and indications for tonsillectomy; Scottish Intercollegiate Guidelines Network - SIGN (April 2010)
Spinks A, Glasziou PP, Del Mar CB; Antibiotics for sore throat. Cochrane Database Syst Rev. 2013 Nov 511:CD000023.
I worried about the white spots on my tonsils since spots lasts for 5 days now. I am taking pencilline 1 gm 2 times daily with no improvemnt. I have swollen lymph nodes for more than 45 days untill...Sefo
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