Sore throat

What is a sore throat?

Sore throat (pharyngitis) is very common. It is usually caused by an infection in the throat.

Patient picks for Sore throat

Ear, nose and throat

What causes tonsillitis?

Tonsillitis is a very common condition, especially in children. Tonsillitis means inflammation (pain, swelling, and redness) of the tonsils - they are found at the back of the mouth and form part of your immune system which fights off infection.

by Dr Doug McKechnie, MRCGP

Ear, nose and throat

Tonsillitis

Tonsillitis is an inflammation of the tonsils. It is usually caused by a viral infection. Less often the cause is a bacterial infection. It is most common in children, but adults can be affected too.

by Dr Pippa Vincent, MRCGP

Sore throat symptoms

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).

• Tiredness.

• Swollen glands in your neck.

• Pain when you swallow.

How to get rid of a sore throat

Not treating

Not treating a sore throat is an option as many throat infections are mild and soon get better without treatment.

Have enough to drink

This is 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.

Painkillers

Paracetamol or ibuprofen can help 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

These 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

These 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.

Sore throat causes

You may 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 the separate leaflet called Tonsillitis for more details.

How long does a sore throat last?

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.

Do I need any tests for a sore throat?

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 for a sore throat?

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.

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 alternative scoring system is called FeverPAIN - it uses very similar features.

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.

If you do need antibiotics, the one usually prescribed is phenoxymethylpenicillin. If you are allergic to penicillin you may be treated with erythromycin or clarithromycin.

When is a sore throat serious?

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.

Possible complications

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)

Glandular fever is caused by the Epstein-Barr virus. It tends to cause a severe bout of tonsillitis in addition to other symptoms. See the 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

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 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.