Sore Throat

Sore throat, also known as throat pain, is characterised by pain or irritation of the throat. The primary causes of sore throat are viral infections, bacterial infections such as group A streptococcal infection (GAS), conditions like pharyngitis and tonsillitis, and sometimes dehydration, which leads to the throat drying up. Notably, the majority of sore throats are viral in origin, making antibiotics ineffective in these cases. Misuse of antibiotics in such scenarios is linked to increased antibiotic resistance.

Pharyngitis—inflammation of the back of the throat—caused by a virus is the most common cause of a sore throat.

Signs and Symptoms

A sore throat manifests through various discomforts, including a scratchy sensation, pain during swallowing, discomfort while speaking, a burning sensation, and sometimes swelling in the neck.

Diagnosis

The most prevalent cause of sore throat is acute viral pharyngitis, accounting for approximately 80% of cases. Other causes include bacterial infections like streptococcal pharyngitis, trauma, and tumours. In children, streptococcal pharyngitis accounts for 35-37% of sore throats. Gastroesophageal reflux disease (GERD) can also lead to sore throats due to stomach acid backing up into the throat.

The symptoms of viral and bacterial infections can be quite similar. Clinical guidelines recommend confirming the cause of a sore throat before prescribing antibiotic therapy, especially for children at high risk of complications. Group A streptococcus infection can be diagnosed through throat culture or rapid testing. Throat cultures, which involve growing a sample from the throat on a blood agar plate, are highly sensitive but take about 48 hours to yield results. Rapid tests, which detect GAS specific cell wall carbohydrates via immunologic reactions, offer quicker results (5-10 minutes) with about 95% specificity and 85% sensitivity.

Clinicians often rely on the patient's symptoms to make treatment decisions, with about two-thirds of adults and half of children in the US being diagnosed without testing for GAS. Clinical scoring systems like Centor's, McIsaac's, and feverPAIN help in assessing the likelihood of bacterial infection based on observed symptoms.

Management

Temporary relief for sore or scratchy throats can be achieved by gargling a saltwater solution (1/4 to 1/2 teaspoon of salt in 240 ml of water). Pain management can be addressed with non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen). Corticosteroids may slightly increase the likelihood of symptom resolution and pain reduction, but the minimal benefit must be weighed against potential risks.

Antibiotics can reduce pain, diminish headaches, and potentially prevent complications from sore throats, but their benefits must be balanced against the risk of antimicrobial resistance. There is limited evidence supporting the effectiveness of hot drinks in alleviating sore throat symptoms, and cold drinks might be beneficial in cases unrelated to colds, such as tonsillitis. Lozenges can also provide symptomatic relief.

Without active treatment, sore throat symptoms typically last between two to seven days.

Statistics

In the United States, sore throat-related complaints result in approximately 2.4 million emergency department visits annually.

Self-assessment MCQs (single best answer)

What is the most common cause of a sore throat?

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Which of the following is NOT a common symptom of a sore throat?

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What percentage of sore throats in children is caused by streptococcal pharyngitis?

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Which of the following diagnostic methods is highly sensitive but takes about 48 hours to yield results?

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Which clinical scoring system is NOT used to assess the likelihood of bacterial infection in sore throats?

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Which of the following is recommended for temporary relief of sore throat symptoms?

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What is a potential downside of prescribing antibiotics for viral sore throats?

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How long do sore throat symptoms typically last without active treatment?

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Which of the following is NOT a recommended method for managing sore throat pain?

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Approximately how many emergency department visits are due to sore throat-related complaints annually in the United States?

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