Sore Throat Treatment

What is a Sore Throat?

A sore throat (pharyngitis) is a medical condition characterized by pain in the throat region.  This usually occurs as a result of infection due to viruses and bacteria.  One of the most important causes of a sore throat is strep throat. This disease is also called strep pharyngitis because it is caused by the bacteria group A streptococcus.  Patients with strep throat typically have a fever, tonsillar exudates (pus), anterior cervical lymphadenopathy, and absence of a cough.

Untreated strep pharyngitis may lead to kidney disease (post-streptococcal glomerulonephritis) and rheumatic fever.  Patients with infectious mononucleosis are at increased risk of developing splenic rupture.  Due to the importance of these conditions, it is critical that patients understand the causes, symptoms, and treatment of a sore throat.  By the end of this article, you will have the answers to these essential questions:

What causes a Sore Throat?

A sore throat (pharyngitis) is most often caused by infection.  The majority of infectious causes of a sore throat include viruses, such as adenovirus, rhinovirus, coronavirus, influence virus, parainfluenza virus, Epstein–Barr virus (EBV), and HIV (AIDS).  EBV is responsible for the conditioned called “mono,” or infectious mononucleosis.

Bacteria such as group A streptococcus can also cause pharyngitis.  Group A streptococcus is a gram-positive bacteria that tends to form lines and branched patterns.  This type of bacteria is especially worrisome because patients can develop rheumatic fever and kidney failure (post-streptococcal glomerulonephritis) if left untreated.  Bacteria such as gonorrhea and chlamydia may also cause pharyngitis in patients with risk factors such as sexual promiscuity.

All of these forms of a sore throat are contagious.

How common is a Sore Throat?

Sore throat and strep throat are very common conditions that are frequently evaluated in the primary care clinic.  Group A streptococcus causes approximately 5-15% of cases of a sore throat in adults and about 20-30% of cases in children in the United States.  In addition, strep throat usually affects children age 5-15 – it may be seen in adult populations as well.

What are the symptoms and signs of a Sore Throat?

Sore throat caused by viral upper respiratory infections often cause throat pain in association with the following symptoms:

  • Rhinosinusitis – runny nose, nasal congestion
  • Headache
  • Myalgia (muscle ache)
  • Low grade-fever
  • Sneezing
  • Cough

In contrast to viral infections, the most common symptoms of strep throat include:

  • High fever
  • Severe throat pain
  • Pain on swallowing
  • Swollen neck glands
  • Pus on the tonsils
  • Absence of a cough
  • Malaise

Your doctor will often evaluate for certain findings on your physical examination such as:

  • Elevated temperature
  • Tonsillar exudates
  • Tender anterior cervical lymphadenopathy
  • Splenomegaly – spleen enlargement (often seen in infectious mononucleosis)
  • Signs of rhinosinusitis – sinus congestion and pressure
  • Signs of pneumonia – chest pain, wheezing or crackles on chest examination

How is a Sore Throat diagnosed?

A sore throat is diagnosed based on symptoms and physical examination.  Your doctor will typically evaluate your risk of strep throat based on the presence of Centor criteria:

  • Fever
  • Tonsillar exudates
  • Cervical adenopathy
  • Absence of a cough

Depending on the number of criteria you meet - your doctor may order a rapid test for strep throat and/or infectious mononucleosis (mono-spot test).  They may also send your throat sample for bacterial culture.  If you have other flu-like symptoms, your doctor may consider evaluating for influenza virus with a nasopharyngeal swab.  Depending on your risk factors, they may also check for HIV and oral gonococcal/chlamydia infection.

Patients with a severe sore throat and atypical symptoms that suggest pharyngeal abscess may warrant a CT scan of the neck with intravenous contrast.

How is a Sore Throat treated?

If you have no evidence of strep throat, your doctor will usually recommend the use of Tylenol (acetaminophen) or NSAIDS (e.g., Advil, Aleve, Motrin, Naprosyn) as needed for mild pain or fever. They will also generally recommend rest and adequate fluid intake.

There are no specific recommendations for the treatment of viral pharyngitis as treatment is aimed at improving symptoms.  Patients with infectious mononucleosis (Mono) should avoid situations in which they could receive trauma to the spleen (e.g. contact sports) - Mono is a risk factor for splenic rupture.

Patients with positive strep throat results should be treated with antibiotics.  These typically include:

  • Penicillin V (oral)
  • Penicillin G (intramuscular)
  • Amoxil, Moxatag (amoxicillin)
  • Augmentin (amoxicillin-clavulanate)

Patients with severe pain may also require the short-term use of opiate analgesics such as:

  • Codeine
  • Tramadol
  • Vicodin (hydrocodone – acetaminophen)
  • Percocet (oxycodone – acetaminophen)

Sore Throat Patient Summary:

  • Sore throat (pharyngitis) is a very common symptom characterized by throat pain – it is usually caused by viral or bacterial infections.
  • There are a host of viruses that can cause pharyngitis: adenovirus, rhinovirus, coronavirus, influence virus, parainfluenza virus, Epstein–Barr virus (EBV), and HIV (AIDS).
  • Bacteria such as group A streptococcus can also cause pharyngitis. All of these forms of a sore throat are contagious.
  • Sore throat caused by viral upper respiratory infections often cause throat pain in association with the following symptoms: rhinosinusitis – runny nose, nasal congestion, headache, myalgia (muscle ache), low grade-fever, sneezing, and cough.
  • The most common symptoms of strep throat include high fever, severe throat pain, pain on swallowing, swollen neck glands, pus on the tonsils, the absence of a cough, and malaise.
  • Depending on the number of criteria you meet - your doctor may order a rapid test for strep throat and/or infectious mononucleosis (mono spot test).
  • They may also send your throat sample for bacterial culture. If you have other flu-like symptoms, your doctor may consider evaluating for influenza virus.
  • If you have no evidence of strep throat, your doctor will usually recommend Tylenol (acetaminophen) or NSAIDS (e.g. Advil, Aleve, Motrin, Naprosyn) as needed - they will also generally recommend rest and adequate fluid intake.
  • Patients with positive strep throat results should be treated with antibiotics. These typically include Penicillin V (oral), Penicillin G (intramuscular), Amoxil, Moxatag (amoxicillin), or Augmentin (amoxicillin-clavulanate).
  • Untreated strep pharyngitis may lead to kidney disease (post-streptococcal glomerulonephritis) and rheumatic fever.
  • Patients with severe throat pain may require the short-term use of opiate analgesics such as codeine, tramadol, Vicodin (hydrocodone – acetaminophen), or Percocet (oxycodone – acetaminophen).

References:

  1. Choby B. Diagnosis and Treatment of Streptococcal Pharyngitis. Am Fam Physician. 2009 Mar 1;79(5):383-390.
  2. IDSA Updates Guideline for Managing Group A Streptococcal Pharyngitis. Am Fam Physician. 2013 Sep 1;88(5):338-340.

Wessels MR.Clinical practice. Streptococcal pharyngitis. N Engl J Med. 2011 Feb 17;364(7):648-55.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.