Sore Throat

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A sore throat can arise from many different causes and is often the first sign of illness. Sore throats have a variety of causes, such as:

  • viruses (such as colds or mono)
  • bacteria (such as strep)
  • smoking
  • polluted air
  • dry indoor air
  • mouth breathing
  • muscle strain from yelling
  • stomach acid

Sore throat can also be a symptom of hay fever and other allergies.

Strep throat vs. viral sore throat

Strep throat is caused by a type of bacteria called group A strep (GABHS). The pain of strep throat often feels the same as sore throats caused by other bacteria or by viruses. The important difference is that strep infections caused by GABHS may cause rare but serious complications such as heart damage or rheumatic (scarlet) fever.

The vast majority of throat infections are viral and therefore not strep. Approximately 5 to 15 percent of throat infections are caused by strep bacteria. Some bacterial infections require antibiotics, whereas the best treatment for viral sore throat is rest and liquids.

Symptoms

Symptoms of sore throat may include:

  • swollen, red tonsils, often with a white or light-colored coating
  • swollen lymph nodes
  • body aches
  • fever
  • headache

Cold symptoms such as a runny nose or cough may also occur.

Testing

If symptoms associated with a bacterial infection are present, a strep throat culture may be performed. In this procedure, a clinician swabs the tonsils and sends the sample to a laboratory where it is tested for GABHS bacteria. Test results are usually available within one to two days. If symptoms are consistent with those for a viral infection, a throat culture is not needed.

If a throat culture is positive for GABHS, you will be contacted by a clinician.

Other kinds of strep bacteria may also be present in culture, but these do not necessarily need antibiotics. Depending on the severity of illness, the clinician may want to further discuss symptoms and appropriate treatment.

Treatment

Regardless of the cause of the sore throat, observe the following treatment guidelines:

  • Rest more and exercise as able.
  • Drink at least 8 ounces of liquids every two hours to help soothe the throat and reduce nasal congestion. If a fever is present, more fluids are needed to replace those lost because of elevated body temperature.
  • Avoid dry air, if possible. Humidifiers, which add moisture to the air, can ease sleep and reduce nasal irritation.
  • Refrain from smoking. Smoking irritates inflamed throats and nasal tissue.
  • Do not drink alcohol. Alcohol decreases the body’s resistance to the infection and may interact with medications.
  • Eat a well-balanced diet, including fruits, vegetables, and grains.
  • Sip hot water mixed with honey and lemon. The honey coats and soothes the throat, while the lemon helps clear away the mucus.
  • Use phenol-containing lozenges and sprays: these are particularly effective sore throat pain relievers.
  • Gargle with warm salt water (1 teaspoon salt in 1 cup hot water) three to four times a day. This may help ease sore throat pain and clear throat mucus.
  • Acetaminophen and ibuprofen: Use according to label directions for relief from sore throat pain and associated fever. If symptoms are severe, alternate acetaminophen (650 mg) and ibuprofen (400 mg) every two hours. If under the age of 19, do not use aspirin or products containing salicylate, unless recommended by a health care provider. Do not exceed 4000 mg daily of acetaminophen or 2400 mg daily of ibuprofen.
  • Decongestants: Phenylephrine or pseudoephedrine (must be purchased directly from the pharmacist) may help if the sore throat is caused by mucus drainage, but these medications can also cause sleeplessness and decreased appetite.

Safe use of antibiotics

Antibiotics should be avoided if use of them is unnecessary and taken only when prescribed. Overuse of antibiotics can give rise to bacterial strains that are resistant to antibiotics and therefore more difficult to treat. Antibiotics can also lead to other problems such as yeast infections or diarrhea. Rarely, people experience allergic reactions to antibiotics. When taking antibiotics, remember to:

  • Inform the clinician of any allergies and all medications currently being taken.
  • Take antibiotics according to the instructions and for the full time specified, even if symptoms subside before treatment is completed. Patients who stop earlier are more likely to relapse or develop complications.
  • Contact a clinician if any side effects occur during treatment.

Prevention

To avoid catching or passing illnesses that can lead to a sore throat, follow these health measures:

  • Wash hands often.
  • Avoid touching the eyes, nose, and mouth.
  • Cough or sneeze into a tissue and then throw it away.
  • Eat healthily and stay well-rested.
  • Avoid close contact with people who are sick.
  • Don’t smoke and avoid exposure to secondhand smoke.
  • Stay indoors as much as possible on high pollution days.

When to contact a clinician

Most sore throats disappear within five to seven days. Few require medical care. Some serious diseases, however, can cause a sore throat. Contact a clinician if any of the following is experienced with sore throat:

  • fever above 101°F
  • increased difficulty swallowing or breathing
  • persistently large and painful lymph nodes in the neck
  • very red and enlarged tonsils despite the use of antibiotics
  • severe headache
  • stiff neck
  • skin rashes
  • bruised skin

[HU 442: updated 01/08]