Sore throat: what you need to know

Sore throat is very common and is usually caused by infection with any one of a large number of viruses or less commonly bacteria.

Occasionally, sore throat can have other causes such as allergies, excessively dry air (e.g. from air conditioning), irritants (e.g. tobacco smoke, pollution), voice strain or gastro-oesophageal reflux disease (where acid from the stomach rises into the oesophagus (food pipe) and throat).

Many illnesses ranging from the common cold to glandular fever cause sore throat as a symptom.

Symptoms

Sore throat is so common that most of us know what it feels like - usually pain or irritation in your throat that’s often worse when you swallow. Your throat may feel scratchy and you may also have a hoarse voice.

A sore throat may be accompanied by sniffles, a cough and feeling weak and feverish. Occasionally children may have nausea and vomiting with a sore throat.

If bacteria or viruses infect the tissues at the back and sides of the throat, the body produces antibodies to fight off the infection. This process may cause the lymph nodes (‘glands’) in the neck to swell and become tender.

Most people are over the infection within 7 days; many people find that their sore throat goes away much sooner than this.

Causes

Most sore throats are caused by colds and flu, which are viral infections. Sometimes a bacterial infection such as strep throat (caused by infection with Streptococcus pyogenes) will cause a sore throat. Strep throat is more common in children than adults.

Other infections that can result in a sore throat include:

Hay fever (allergic rhinitis), smoking or exposure to smoking and dry indoor air (due to air conditioning or heaters) are other common causes of sore throat. Sore throat can also be due to gastro-oesophageal reflux - the reflux of acidic stomach contents up your food pipe.

Tests and diagnosis

Your doctor will ask about your symptoms and examine you, looking at the back of your throat for redness, and enlarged or inflamed tonsils. Your tonsils may have white patches or pus on them if they are infected. They will also feel your neck for enlarged or tender lymph nodes (glands).

Your doctor may recommend blood tests or a throat swab. Blood tests that may be ordered include a full blood count (FBC) to check your white cell count or a mono spot test for glandular fever.

Throat swabs involve a cotton swab being brushed over the back of your throat. This can be uncomfortable, but it is done very quickly. The swab is then sent to a laboratory and can be tested for bacteria and viruses. There are also test kits for rapid detection of group A Streptococcus that can give a result within minutes.

Sore throat treatments

Most sore throats are caused by a viral infection and get better on their own, but treatments are available to help you feel better while your body fights the infection. Bacterial throat infections may need treatment with antibiotics to help you get better faster and avoid complications. If your sore throat is not caused by an infection, treatment will depend on the cause.

Self care for sore throat

Give your body a hand to heal itself by trying the following.

  • Resting as much as you can. Take time off work and do not send your child to school or daycare if they have a sore throat.
  • Drinking plenty of fluids (don’t worry if you don't feel like eating much for a couple of days). Children and adults may find ice-blocks refreshing.
  • Drinking warm water with honey and lemon can be soothing for a sore throat.
  • Gargling with a glass of warm water with half a teaspoon of salt in it at least twice a day (older children and adults only).
  • Taking medicated sore throat lozenges or anaesthetic sprays may help, but are not recommended for young children. They are available from chemists.

Pain relief for sore throat

Pain relief for sore throats should be considered. Taking pain relievers will allow you to eat and drink more comfortably and has the added benefit of reducing fever if this is a problem.

Paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help relieve the pain of a sore throat. Your doctor may recommend paracetamol combined with ibuprofen for a sore throat that is not relieved by paracetamol or ibuprofen alone. Paracetamol plus ibuprofen is now available in Australia in a single tablet. This combination medicine may be a suitable alternative to cold and flu medicines containing codeine, which were previously readily available in pharmacies in Australia, but are now prescription-only along with all medicines that contain codeine.

Aspirin can also help relieve a sore throat, but medicines containing aspirin must not be used by children under 16 years who have had a fever, especially if the child also has symptoms of influenza or chicken pox. This is because aspirin can cause a serious condition called Reye syndrome in children. People with peptic or duodenal ulcers, bleeding conditions or who are taking anticoagulant medicine (such as warfarin) should not take aspirin or ibuprofen.

For people with a very sore throat, one or 2 doses of corticosteroid medicine is sometimes prescribed to reduce the severity of symptoms and help you feel better faster. This may be an option if your throat is so sore that it makes swallowing difficult.

Antibiotics and sore throat

Most people do not need antibiotics for sore throats. That’s because most sore throats are caused by viruses, which are not affected by antibiotics.

Antibiotics can help shorten the duration of symptoms in certain cases, for example if it’s suspected that you have a specific bacterial infection. However, antibiotics are associated with side effects such as nausea, diarrhoea and rash. Your doctor will weigh up the pros and cons of antibiotics in your particular case.

If your doctor does prescribe antibiotics, make sure you complete the whole course, even if your symptoms clear up before you have finished the antibiotics. This reduces the risk of bacteria becoming resistant to the antibiotics.

Antibiotics and strep throat

If you have strep throat - a Streptococcus pyogenes (also called group A streptococcus) bacterial infection of the throat - your doctor will usually recommend treatment with antibiotics. Antibiotics can treat the bacterial infection causing the fever and sore throat, and also prevent possible serious complications that can occur with this infection.

Complications of untreated strep throat include spread of the bacteria (for example causing an ear infection or tonsillitis) and scarlet fever (a bright red rash over the skin caused by a toxin produced by the bacteria).

Rare but potentially serious complications that can result from the body’s immune response to the streptococcal infection include:

  • post-streptococcal glomerulonephritis (inflammation of the kidneys that can cause long-term kidney damage); and
  • rheumatic fever (an inflammatory reaction which can affect the heart, joints, brain and skin and can cause long-term heart problems).

When to see your doctor

Seek immediate medical attention if you or your child have had a sore throat and any of the following symptoms develop, which could indicate a life-threatening condition:

  • difficulty breathing or noisy breathing;
  • neck stiffness rather than throat pain;
  • a lot of difficulty swallowing water or saliva;
  • a muffled voice;
  • drooling;
  • trouble opening your mouth;
  • a rash or bruising;
  • joint aches; or
  • signs and symptoms of dehydration, such as dry mouth and passing less urine than usual.

You should also see a doctor if you or your child have any of the following:

  • a high fever (higher than 38 degrees Celsius);
  • a fever that doesn’t get better within 24-48 hours;
  • no easing of the sore throat after 7 days (adults) or 2 days (children);
  • tender or enlarged neck glands (lymph nodes);
  • ear pain; or
  • other medical problems which affect how your body can heal itself, such as diabetes or immune disorders.

These features may mean that it is more likely that you have a bacterial infection like strep throat that may need treatment with antibiotics.

References

1. Acute pharyngitis and/or tonsillitis (published November 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2017 Nov. https://tgldcdp.tg.org.au (accessed Feb 2018).
2. Mayo Clinic. Sore throat (updated 8 Aug 2017). https://www.mayoclinic.org/diseases-conditions/sore-throat/symptoms-causes/syc-20351635 (accessed Feb 2018).
3. BMJ Best Practice. Acute pharyngitis (updated Dec 2017). http://bestpractice.bmj.com/topics/en-us/5 (accessed Feb 2018).
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