Sore Throat

What is a sore throat?

Sore throat (pharyngitis) is very common. It is usually caused by an infection in the throat. Soreness in the throat may be the only symptom. In addition, you may also have a hoarse voice, mild cough, fever, headache, feel sick, feel tired, and the glands in your neck may swell. It may be painful to swallow. The soreness typically gets worse over 2-3 days and then usually gradually goes within a week. In about 1 in 10 cases the soreness lasts longer than a week. You may also 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.

What is the treatment for sore throat and tonsillitis?

• Not treating is an option as many throat infections are mild and soon get better.
• Have plenty to drink. 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 fever. Mild dehydration can make headaches and tiredness much worse.
• Paracetamol or ibuprofen 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.
• Aspirin gargles may ease the soreness. (There is little research evidence that confirms this. However, it is a popular treatment and may be worth a try.) Dissolve some soluble aspirin in water and gargle for 3-4 minutes. You can do this 3-4 times a day. Swallow the aspirin after gargling for additional symptom relief, unless you are also taking ibuprofen tablets (in which case, spit our the aspirin after gargling). Note: children under 16 should not have aspirin.
• Other gargles, lozenges, and sprays that you can buy at pharmacies may help to soothe a sore throat. However, they do not shorten the illness.

Do I need an antibiotic?

Usually not. Most throat and tonsil infections are caused by viruses, although some are caused by 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.

An antibiotic may be advised if the infection is severe, if it is not easing after a few days, or if your immune system is not working properly (for example, if you have had your spleen removed, if you are taking chemotherapy, etc).

Things to look out for

In nearly all cases, a sort throat or tonsillitis clears away 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 sort of 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.

Infectious mononucleosis (glandular fever)

Infectious mononucleosis is caused by a virus (the Epstein-Barr virus). It tends to cause a severe bout of tonsillitis in addition to other symptoms. See separate leaflet called 'Glandular Fever' for more details.

Quinsy - also known as peritonsillar abscess

Quinsy is an uncommon condition where an abscess (a collection of pus) develops next to a tonsil due to a bacterial infection. It usually develops just on one side. It may follow a 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 smokers).

Medication such as carbimazole

Carbimazole is a drug 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. Agranulocytosis can occurs as a side-effect of various other drugs.

The 'take home' message is ... see a doctor if symptoms of a sore throat are severe, unusual, or if they do not ease within 3-4 days. In particular, seek urgent medical attention if you develop any difficulty breathing, drooling, a muffled voice, severe pain, difficulty swallowing or become very unwell.