A sore throat is discomfort, pain, or scratchiness in the throat. A sore throat often makes it painful to swallow.

Sore throats are common. Most of the time the soreness is worse in the morning and improves as the day progresses.

Like colds, the vast majority of sore throats are caused by viral infections. This means most sore throats will NOT respond to antibiotics. Many people have a mild sore throat at the beginning of every cold. When the nose or sinuses become infected, drainage can run down the back of the throat and irritate it, especially at night. Or, the throat itself can be infected.

Some viruses can cause specific types of sore throat. For example, Coxsackievirus sometimes causes blisters in the throat, especially in the late summer and early fall. Mono and the flu can also cause specific viral throat infections.

Strep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic fever, antibiotics are given. Strep throat often includes a fever (greater than 101°F), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have a headache and stomach pain.

A sore throat is less likely to be strep throat if it is a minor part of a typical cold (with runny nose, stuffy ears, cough, and similar symptoms). Strep can't be accurately diagnosed by looking at the throat alone. It requires a laboratory test.

Sometimes breathing through the mouth will cause a sore throat in the absence of any infection. During the months of dry winter air, some people will wake up with a sore throat most mornings. This usually disappears after having something to drink.

In addition, allergies (allergic rhinitis) can cause a sore throat.

With a sore throat, sometimes the tonsils or surrounding parts of the throat are inflamed. Either way, removing the tonsils to try to prevent future sore throats is not recommended for most children.

• Breathing through the mouth (can cause drying and irritation of the throat)
• Common cold
• Viral pharyngitis
• Influenza
• Strep throat (caused by streptococcal bacteria)
• Infectious mononucleosis
• Fish, chicken bone, or other foreign substance stuck in the throat. (For emergency actions, see choking child or adult or CPR)
• Endotracheal intubation (tube insertion)
• Surgery such as tonsillectomy and adenoidectomy

Most sore throats are soon over. In the meantime, the following remedies may help:

• Drink warm liquids. Honey or lemon tea is a time-tested remedy.
• Gargle several times a day with warm salt water. (1/2 tsp of salt in 1 cup water.)
• Cold liquids or popsicles help some sore throats.
• Sucking on hard candies or throat lozenges can be very soothing, because it increases saliva production. This is often as effective as more expensive remedies, but should not be used in young children because of the choking risk.
• Use a cool-mist vaporizer or humidifier to moisten and sooth a dry and painful throat.
• Try over-the-counter pain medications, such as acetaminophen. DO NOT give aspirin to children.

Antibiotics are usually NOT wise in the absence of a positive strep test or throat culture.

Call your provider if there is:

• Severe difficulty swallowing or breathing
• Excessive drooling in a young child
• A fever, especially 101°F or greater
• Tender or swollen lymph glands in the neck
• Pus in the back of the throat
• A red rash that feels rough, and increased redness in the skin folds

Your health care provider will perform a physical examination. He or she may want to know some details about the sore throat, such as:

• How long has the sore throat been present?
• Have other family members had recent sore throats?
• Is the pain increasing, staying the same, or decreasing?
• Are you able to swallow saliva, fluids, and food?
• Is there excessive drooling (in infants)?
• Are you hoarse?
• Is it worse at night? Are you able to sleep?
• Are you breathing through your mouth?
• Is the soreness better in the morning? Better with moist air or mist? Better with medication?
• What other symptoms are also present -- noisy breathing, fever, wheezing, allergies, rash?
• Have you had a recent injury or surgery?
• Are there swollen lymph glands in your neck?
• Are there sores or pus in back of throat?
• Is there a sensation of gagging?
• What medications are you taking?
• What is your typical daily diet?

The following diagnostic tests may be performed:

• Complete blood count
• Monospot test (to rule out mononucleosis)
• Throat culture and rapid strep test

Treatment

Usually, treatment will be delayed until the culture results are known. Doctors will often begin treatment of a sore throat immediately if there is a family history of rheumatic fever, if the patient has scarlet fever, or if rheumatic fever is commonly occurring in the community at the time. Otherwise, antibiotics should NOT be given without a positive strep test (culture or rapid strep test).

When antibiotics are started, it is important to complete the entire course as directed, even after symptoms improve. Children can return to school or day care 24 hours after antibiotics are started.

For sore throat caused by infectious mononucleosis, rest and home treatment is recommended.

For sore throat caused by bacterial tonsillitis, antibiotic treatment may be recommended. Some tonsillitis is viral and will clear up without treatment (surgery is rarely necessary). Recurrent or persistent sore throats without bacterial infection may be due to allergies and require anti-allergy treatment.

Clean your hands frequently, especially before eating. This is a powerful way to help prevent many sore throat infections. You might avoid some sore throats by reducing contact with people with sore throats, but often these people are contagious even before they have symptoms, so this approach is less effective.

Not too long ago, tonsils were commonly removed in an attempt to prevent sore throats. This is no longer recommended in most circumstances.

A cool mist vaporizer or humidifier can prevent some sore throats caused by breathing dry air with an open mouth.

Wald ER. Diagnosing and treating strep throat. Fam Pract Manag. 2004; 11(2): 20.