Pharyngitis: A Sore Throat

What Causes a Sore Throat?

Viral illnesses, such as a cold or the flu, are the most common causes of a sore throat. Bacterial infections, such as strep throat (streptococcal pharyngitis), are a less common cause. But, they tend to be more severe and need treatment with antibiotics. Left untreated, strep throat can cause complications such as rheumatic fever.

Allergies and post-nasal drip can cause a chronic sore throat. There also can be other, less common causes of throat pain and irritation that require a more thorough exam and diagnosis.

It’s important to seek medical care for a sore throat if:

• It doesn’t seem to be improving after 7 days
• It’s accompanied by a high fever (over 101°)
• You notice white spots or pus on your tonsils
• You are having difficulty swallowing or breathing
• They are frequent or recurring
• You have swelling around your neck and face or your glands are swollen

Most sore throats can be treated at home and will go away on their own. But, it’s important to get a proper diagnosis when you have any of the above symptoms or if you suspect strep throat.

How We Diagnose a Sore Throat

As Emergency Room physicians, our top priority is to make sure that your sore throat is not caused by a life-threatening condition. A life-threatening condition could include a peritonsillar abscess or a pocket of pus behind the throat. At ContinuEM, we have the ability to treat this specific condition by performing emergency drainage of the infection, if necessary. Another, more life-threatening condition includes a retropharyngeal abscess which could require surgery.

Viral illnesses are the most common cause of a sore throat. Sore throat can be caused by a variety of viruses such as the common cold, the flu, COVID, mono, etc. Viral infections are self-limiting, so antibiotic medications are not necessary or effective. Furthermore, overuse of antibiotics can lead to a risk of antibiotic resistance.

Bacterial infections are less common. However, they tend to be more severe and do require treatment with antibiotics. Bacterial infections are responsible for about 5% to 15% of sore throats in adults. Bacterial causes are more common in pediatric patients but still make up a minority of cases, about 30% of sore throats in children. The most common bacterial cause in pediatric patients and adult patients is a bacteria called Group A streptococcus (GAS). This is generally referred to as “strep throat”. But, especially in adults, we may also consider other bacterial causes.

At ContinuEM, we use a variety of methods to make an accurate diagnosis and determine the best path to treat you or a loved one. The most important method we use is a close physical exam. No single symptom can determine the cause of a sore throat. Even seeing lesions or white spots on the back of the throat does not necessarily mean that the cause is bacterial. We often rely on a clinical decision model called the Centor Criteria to decide the best treatment option.

The Centor Criteria is a four-point scoring system used to determine the likelihood that a bacterial pathogen is the cause of a patient’s sore throat. To do this, we examine patients for:

• Absence of cough
• Tonsillar exudates
• Fever
• Swelling and tenderness of the lymph nodes on your neck

Even if all four criteria are positive, there is only about a 50% chance that the cause is from a bacteria. But it’s a good indicator that we need to perform a rapid strep test, which will give a definitive diagnosis.

Treating a Sore Throat

The course of treatment depends on the underlying cause of your sore throat. If the cause is a bacterial infection such as strep throat, early antibiotic treatment can decrease symptoms within about a day. In children, appropriate antibiotic treatment may decrease the risk of complications such as rheumatic fever. Antibiotics also make you less contagious so you don’t spread the infection to others. We have different treatment options: injectable antibiotics or different oral antibiotics, if necessary. We can discuss the different benefits of each treatment option with you.

Antibiotics won’t help a sore throat caused by a virus. However, viral causes of a sore throat are self-limiting and will usually go away on their own within a few days. Antiviral medication can treat some viral illnesses (ie: the flu, COVID), which may reduce severity and duration of symptoms.

Caring For a Sore Throat At Home

Regardless of the cause, a sore throat is downright unpleasant. It makes everything feel more difficult: swallowing, eating, drinking, talking, sleeping. Fortunately, there are a variety of home remedies you can try that may decrease the pain and irritation of a sore throat:

• Gargling with warm salt water: dissolve ½ teaspoon of salt into a glass of warm water and gargle (do not swallow). You can do this every few hours. Salt water helps to loosen mucus and reduce inflammation. It can temporarily ease the pain in your throat.
• Over-the-counter pain relievers such as acetaminophen and ibuprofen can help decrease the intensity of pain caused by a sore throat.
• Lozenges: there are many over-the-counter options that can help bring temporary relief. Hard candy can also be used. (NOTE: do not give lozenges or hard candy to children aged 4 and under due to choking risk)
• Hydration: make sure you drink plenty of fluids to keep your throat from getting too dry. Warm or cold liquids may feel particularly soothing.
• Warm steam: taking a hot shower or simply turning on a hot shower and sitting in the bathroom can help loosen mucus and soothe pain. Sleeping with a cool-air humidifier might also be useful in the winter months.
• Rest: make sure to get plenty of rest so your body can fight off infection. As much as possible, try to rest your voice as well. Talking too much can cause irritation.

Although a sore throat is painful and unpleasant, these home remedies can help provide relief.

At ContinuEM, we do our best to provide you with an accurate diagnosis and treatment plan to help you manage the pain and discomfort associated with a sore throat. In most cases, a sore throat can be treated at home. But if you do need to seek medical care, ContinuEM might be a faster option than scheduling a visit with your normal doctor.