Sore Throat (Pharyngitis)

What Is It?

A sore throat, also called a throat infection or pharyngitis, is a painful inflammation of the pharynx the back portion of the throat that includes the back third of the tongue, the soft palate (roof of the mouth) and the tonsils (fleshy tissue that are part of the throat's immune defenses). The most common cause of sore throat is infection with bacteria or a virus.

Because an infection of the pharynx almost always involves the tonsils, tonsillitis (inflammation of the tonsils) was once a common name for infectious pharyngitis.

Currently in the United States, infectious pharyngitis accounts for almost 10 million visits to doctors' offices each year, and sore throat is among the top 10 complaints of people who seek treatment in emergency rooms. In about 85 percent of cases, throat infection is caused by a virus. Although people who have the flu (influenza), cold sores (oral herpes simplex) or infectious mononucleosis ("mono") also commonly have a sore throat, these viral infections usually cause other telltale symptoms in addition to throat pain.

In regions that have warm summers and cool winters, viral pharyngitis typically peaks during the winter and early spring, a time when people often are close together in poorly ventilated rooms. In this environment, the viruses that cause pharyngitis spread easily in the droplets of coughs and sneezes and on dirty hands that have been exposed to fluids from a sick person's nose or mouth. In most people who are otherwise healthy, simple viral pharyngitis doesn't last long, goes away on its own and does not causes any long-term complications, although the short-term discomfort can be significant.

In cases of infectious pharyngitis that are not viral, the cause is almost always a bacterium usually a group A beta-hemolytic Streptococcus, which causes what is commonly called strep throat. Like viral pharyngitis, strep throat can spread quickly and easily within a community, especially during late winter and early spring. Unlike most forms of viral pharyngitis, however, untreated strep throat can lead to serious complications, such as glomerulonephritis (a kidney disorder) and rheumatic fever (a potentially life-threatening illness that can damage heart valves). A strep infection also has the potential to spread within the body, causing pockets of pus (abscesses) in the tonsils and in the soft tissue around the throat.

Symptoms

The main symptom of pharyngitis is a sore throat. In infectious pharyngitis, other symptoms vary depending on whether the infection is viral or bacterial (usually strep throat):

• Viral pharyngitis Sore throat often occurs with the following symptoms: redness in the throat, runny nose, stuffy nose, cough, hoarseness, redness of the eyes and, in children, diarrhea. In some cases, there can be a painful redness around the mouth, or small painful sores on the lips and inside the mouth.
• Strep throat With strep throat and other forms of bacterial pharyngitis, sore throat can be accompanied by any of the following symptoms: fever, pain when swallowing, a generally sick feeling (malaise), headache, redness and swelling in the throat, a coating on the tonsils or tongue, and swollen, tender lymph nodes (swollen glands) in the front of the neck. Children also can have nausea, vomiting and abdominal pain.

Because symptoms of viral and bacterial pharyngitis can overlap, it may be difficult for the doctor to distinguish between them based on symptoms alone. As a general rule, however, if you have a prominent cough and nasal symptoms you are more likely to have viral pharyngitis than strep throat.

In addition to viral and bacterial pharyngitis, an infection with fungi (Candida or "yeast") sometimes can cause throat pain, difficulty swallowing and white patches inside the mouth. This throat infection, commonly called thrush, usually affects infants and people with weakened immune systems. It is relatively rare among healthy older children and adults.

A sore throat that lasts for more than a couple of weeks may be caused by acid reflux from the stomach, breathing through the mouth in a dry environment, postnasal drip or, rarely, a tumor.

Diagnosis

After reviewing your symptoms, the doctor will ask if you might recently have been exposed to someone with strep throat or any other infection involving the throat, nose or ears.

After recording your temperature, your doctor will examine you, paying particular attention to your mouth, throat, nose, ears and the lymph nodes in your neck. If your doctor thinks you have strep throat, he or she may prescribe antibiotics without further testing. If there is some uncertainty, the doctor may want to do a strep test. A rapid strep test is done in your doctor's office, takes only a few minutes to do and detects 80 percent to 90 percent of all cases of strep throat. If this quick test is negative, but your doctor still believes you might have strep, your doctor will take a sample of your throat fluids for more intensive testing in a laboratory. Results will be available in 24 to 48 hours.

Expected Duration

If you have simple viral pharyngitis, your symptoms should go away gradually over a period of about one week. If you have strep throat, your symptoms should subside within two to three days after you begin taking antibiotics.

Prevention

While it's impossible to prevent all infections, you can help to decrease exposure and spreading:

• Wash your hands frequently, especially after blowing your nose or after caring for a child with a sore throat.
• If someone in your home has pharyngitis, keep his or her eating utensils and drinking glasses separate from those of other family members. Wash these objects thoroughly in hot, soapy water.
• If a toddler with pharyngitis has been chewing or sucking on toys, wash these objects thoroughly in water and disinfectant soap, then rinse well.
• Promptly dispose of any dirty tissues from runny noses and sneezes, and then wash your hands.
• Do not allow a child who has been diagnosed with strep throat to return to school or day care until he or she has been taking antibiotics for at least 24 hours and symptoms have improved.

Treatment

Because antibiotics do not work against viruses, viral pharyngitis usually is treated by treating the symptoms to make you feel more comfortable until your body's immune system defeats the infection. These measures include:

• Getting plenty of rest (either in or out of bed)
• Taking ibuprofen (Advil, Motrin), acetaminophen (Tylenol) or aspirin (in adults only) to relieve throat pain
• Drinking plenty of water to prevent dehydration
• Gargling with warm salty water to ease throat pain
• Drinking warm liquids (tea or broth) or cool liquids or eating gelatin desserts or flavored ices to soothe the throat
• Using a cool mist vaporizer to relieve throat dryness
• Using nonprescription throat lozenges (with or without zinc) or anesthetic throat sprays
• Taking nonprescription decongestants and antihistamines to relieve nasal congestion and runny nose
• Taking vitamin C supplements if recommended by your doctor

These measures will help to ease your discomfort if you have strep throat, but you also will have to take antibiotics to prevent complications. Your doctor will prescribe a 10-day course of penicillin or amoxicillin (Amoxil, Trimox and other brand names) to eliminate the strep bacteria. If you are allergic to penicillin, including amoxicillin, you may be given erythromycin (sold under several brand names) or one of the macrolides, such as azithromycin (Zithromax) or clarithromycin (Biaxin). It's important to take all the medication, even after you start to feel better.

When To Call A Professional

Call your doctor promptly if you have a sore throat along with any of the following symptoms:

• Painful swallowing that prevents you from drinking water or other clear fluids
• Difficulty breathing through your mouth
• Noisy breathing or excessive drooling
• Fever above 101 degrees Farenheit

Also, call your doctor if you have any type of throat discomfort that lasts for more than two weeks.

Prognosis

Overall, the prognosis is excellent. Almost all people with viral and strep pharyngitis recover completely without complications.

Additional Info

National Institute of Allergy and Infectious Diseases (NIAID)

Building 31, Room 7A-50

31 Center Drive MSC 2520

Bethesda, MD 20892-2520

Phone: (301) 496-5717

http://www.niaid.nih.gov/

National Center for Infectious Diseases

Office of Health Communication

Centers for Disease Control and Prevention

Mailstop C-14

1600 Clifton Rd., NE

Atlanta, GA 30333

Toll-Free: (888) 232-3228

http://www.cdc.gov/ncidod/

American Academy of Pediatrics (AAP)

141 Northwest Point Blvd.

Elk Grove Village, IL 60007-1098

Phone: (847) 434-4000

Fax: (847) 434-8000

http://www.aap.org/

American Academy of Otolaryngology Head and Neck Surgery

One Prince St.

Alexandria, VA 22314-3357

Phone: (703) 836-4444

http://www.entnet.org/