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When to worry about a sore throat

When to worry about a sore throat

Whether it's a sharp sting in the back of the throat when swallowing, or a constant ache that nothing seems to shift, one thing is certain: sore throats are the definitive pain in the neck. We look at the symptoms and causes of sore throats and when to worry.

But how do we know whether to pop a paracetamol and carry on, or call the doctor for something stronger?

They might all lead to a similar sensation, but there are a variety of possible causes for your 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 GP Dr Jeff Foster of TFJ Private GP Services. "But the most common cause is infection."

Although swollen glands may be 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 throat infection (bacterial or viral) 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 GP Dr Julie Coffey, of Uber Health Blog.

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Do I need antibiotics?

When we hear the word infection, we may automatically make the link to antibiotics - after all, these are meant to target infections, right? However, antibiotic treatment is only effective on infections with a bacterial cause; taking them when the cause is viral is not only pointless, it could weaken our already stressed immune system by eliminating good bacteria in the gut.

"If you don't need antibiotics (because they don't work at all against viral illnesses) you get zero benefit and risk side-effects. The most common are upsets with your digestive system - feeling sick or getting diarrhoea, and thrush, especially in women. Another risk that isn't discussed nearly enough is that antibiotics literally decimate the friendly bacteria in your gut. These are important for many aspects of our health, and ironically our immune system," explains Coffey.

In fact, 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 GPs use a scoring system called the Centor Score to decide if antibiotics are needed. The symptoms and signs your doctor would look for are:

  • Sore throat without a cough.
  • A history of fever.
  • Tender swollen glands on the front of your neck.
  • If you open your mouth and shine a torch at the back of your throat, white spots on your tonsils due to pus.

In the UK, unless you have three or all four of these symptoms, doctors don't prescribe antibiotics for otherwise healthy people 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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What treatments might help?

Unless your sore throat is severe, or accompanied by other worrying symptoms, it's worth trying a little self-care and riding out the storm. Taking paracetamol or ibuprofen to relieve pain and inflammation can be helpful, as can staying hydrated, or taking remedies such as gargles, lozenges or throat sprays, available from your pharmacist.

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

When should I seek medical attention?

Whilst the majority of sore throats can be resolved without visiting your doctor, in certain cases it's important to seek the advice of your GP. For example, if your sore throat doesn't improve after a week, if you develop a high temperature, or if 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.

"If your throat becomes swollen and you can't swallow, or if your tongue swells, you should seek urgent medical advice," says Foster. "Similarly, if you develop a rash, or stiff neck, begin drooling or have a high temperature that isn't resolved with paracetamol."

Urgent medical attention should also be sought if you develop a high-pitched sound whilst breathing, or have any difficulty in breathing.

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 intervention. In fact, according to National Institute for Health and Care Excellence (NICE) estimates, 85% of sore throats will resolve within a week, and 40% within just three days. However, if you're worried, if you exhibit any additional symptoms or if your sore throat is particularly persistent, it's worth seeking advice from your pharmacist or GP.

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