Sore throat

A sore throat, medically termed pharyngitis, is a common symptom characterized by pain, scratchiness, or irritation in the throat. It often worsens when swallowing and may be accompanied by other symptoms depending on the underlying cause. While most sore throats are benign and self-limiting, they can sometimes be a sign of bacterial infection requiring medical treatment.

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Causes of Sore Throat

1. Viral Infections (most common cause)

   • Common cold (rhinovirus, coronavirus)

   • Influenza virus

   • Epstein-Barr virus (mononucleosis)

   • Adenovirus

   • COVID-19 (SARS-CoV-2)

2. Bacterial Infections

   • Streptococcus pyogenes (Group A Streptococcus) – the main cause of strep throat

   • Neisseria gonorrhoeae (gonococcal pharyngitis)

   • Corynebacterium diphtheriae (diphtheria – rare in developed countries)

3. Allergies

   • Pollen, dust, mold, pet dander

   • Postnasal drip causing throat irritation

4. Environmental Factors

   • Dry air

   • Pollution

   • Tobacco smoke

5. Other Causes

   • Gastroesophageal reflux disease (GERD) – stomach acid irritates throat

   • Mouth breathing during sleep

   • Throat or laryngeal tumors (rare, but important to consider if persistent)

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Symptoms

• Pain, scratchiness, or raw feeling in the throat

• Difficulty or painful swallowing (odynophagia)

• Red, inflamed tonsils, sometimes with white patches or pus

• Hoarseness or change in voice

• Fever, headache, body aches (more common with bacterial causes)

• Swollen lymph nodes in the neck

• Runny nose, cough, sneezing (often viral)

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Diagnosis

• History and physical examination: key to differentiating viral from bacterial causes.

• Throat swab/culture: gold standard for diagnosing strep throat.

• Rapid antigen detection test (RADT): provides quick results for strep.

• Blood tests: may be done for mononucleosis (monospot test).

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Treatment

General Symptomatic Relief

• Adequate hydration

• Warm saline gargles

• Throat lozenges

• Humidifiers to moisten dry air

• Rest

Medications

1. Analgesics / Antipyretics (for pain and fever relief)

   • Paracetamol (Acetaminophen): 500–1000 mg every 4–6 hours as needed (maximum 4 g/day).

   • Ibuprofen: 200–400 mg every 6–8 hours as needed (maximum 1200 mg/day OTC; up to 3200 mg/day if prescribed).

2. Antibiotics (only if bacterial cause confirmed, especially Group A Strep)

   • Penicillin V: 250–500 mg orally every 8–12 hours for 10 days.

   • Amoxicillin: 500 mg orally every 8 hours or 875 mg every 12 hours for 10 days.

   • For penicillin-allergic patients:

     • Azithromycin: 500 mg orally on day 1, then 250 mg once daily on days 2–5.

     • Clarithromycin: 250–500 mg orally every 12 hours for 10 days.

     • Clindamycin: 300 mg orally every 8 hours for 10 days.

3. Antivirals

   • For influenza-associated sore throat:

     • Oseltamivir: 75 mg orally twice daily for 5 days.

     • Zanamivir: 10 mg (two inhalations) twice daily for 5 days.

   (Note: Antivirals are only useful if started within 48 hours of flu symptoms.)

4. Adjunct Therapies

   • Antihistamines (loratadine, cetirizine) for allergy-related sore throat.

   • Proton pump inhibitors (omeprazole, esomeprazole) for GERD-related throat irritation.

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When to Seek Medical Attention

• Sore throat lasting more than 7–10 days

• High fever (>38.5°C / 101.3°F)

• Difficulty breathing or swallowing

• Severe pain with inability to open mouth (possible abscess)

• Blood in saliva or phlegm

• Lump in the neck that persists

• Rash along with sore throat (possible scarlet fever)

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Prevention

• Handwashing to reduce viral and bacterial transmission

• Avoid sharing utensils or drinks with infected individuals

• Avoid smoking and exposure to secondhand smoke

• Manage allergies and GERD effectively

• Stay up to date with vaccinations (e.g., influenza, COVID-19, diphtheria)