What is causing my sore throat?

Sore throat is a condition that we see very often in general practice. It is most commonly caused by a viral infection and typically will settle by itself without the need for any medical treatment, however there are other causes of sore throat, and this blog article will discuss the important things to be aware of when you are experiencing a sore throat.

Symptoms: Pain when swallowing, difficulty with eating and drinking. Can be associated with fever and feeling generally unwell. Sometimes there will be associated hoarseness of the voice. Due to the nerve supply of the throat and ears, a sore throat often causes pain that you feel in your ears when swallowing, pain in the ears when you have a sore throat does not necessarily mean that there is any problem in the ears themselves.

Causes

1. Viral infection. Many different viruses can cause a sore throat, often in combination with other symptoms such as runny nose and cough.
2. Glandular fever is caused by the Epstein Barr virus (EBV) and typically causes a bad sore throat in association with other symptoms such as fatigue.
3. Bacterial tonsillitis.
4. Quinsy. This is a possible complication of bacterial tonsillitis and is an abscess that develops alongside a tonsil. It causes severe pain on one side of the throat and difficulty swallowing.
5. Oral thrush. This is uncommon in people who are healthy, and we see it mostly in people who have a weakened immune system. A sore throat due to oral thrush is often accompanied by a sore, white coated tongue.
6. Acid reflux. This can cause irritation in the throat which tends to be worst first thing in the morning after lying flat in bed at night. It may be associated with heartburn or indigestion symptoms but can be so-called “silent reflux” which is not associated with these symptoms.
7. Throat cancer. This is rare and mostly affects older people who have a history of smoking but should be ruled out in any new onset sore throat that is not settling within 2-3 weeks.

As GPs we use a scoring system called the CENTOR score to help us decide how likely it is that a sore throat is due to a virus or a bacterial infection. If you score 0 points then it is most likely that your sore throat is due to a virus. If you score 4 points then it is very likely that you have a bacterial sore throat and will benefit from antibiotics.

You get one point for each of the following:

• Fever above 38 degrees
• Pus seen on the tonsils
• Swollen lymph nodes can be felt in the neck
• No cough

So, from this you can see that if you have a high temperature, can see pus on your tonsils, can feel swollen glands in your neck and do not have a cough then it is very likely that you have a bacterial sore throat and may need antibiotics.

On the other hand, if you do not have a fever, cannot see any white spots/pus in your throat, do not have swollen glands in your neck and do have a cough and runny nose alongside the sore throat then it is very likely that your sore throat is due to a virus, and you will not benefit from antibiotics.

Treatment

The treatment for a sore throat depends upon the likely underlying cause.

• If you have a viral sore throat then the best treatment is rest, drinking plenty of fluids (some people find warm drinks with honey soothing, other people find drinking cold drinks is actually more helpful for the pain) and taking over the counter painkillers +/- numbing throat sprays. If there is a suspicion of glandular fever, then blood tests and a throat swab may be necessary to confirm this. Glandular fever tends to cause symptoms that go on for several weeks, longer than other viral sore throats.
• If you have features consistent with a bacterial throat infection, then you may need antibiotics.
• A quinsy will require antibiotics but may also require a small operation to drain out the infection.
• Oral thrush requires treatment with anti-fungal medication.
• Acid reflux can be treated with proton pump inhibitors (PPIs) which reduce the amount of acid in the stomach.
• If there is any concern about possible throat cancer and a sore throat is not settling within 2-3 weeks with appropriate treatment then further investigation should be arranged via an Ear, Nose and Throat (ENT) specialist who could look into the throat with a special camera.

Conclusion

If you have a sore throat in the context of other viral symptoms, then the best thing is to rest at home and your symptoms should settle over the course of approximately 1 week.

If you have the features described above that are suggestive of a bacterial sore throat, then you should speak with a doctor because antibiotics may be necessary. It is especially important that you should seek urgent medical advice if you have difficulty swallowing fluids, feel very unwell in yourself or have any breathing difficulties.

If you have a sore throat that is not settling over 2-3 weeks, then it is important that the underlying cause is identified to rule out cancer. This is done by a referral to an ENT specialist who can look in the throat with a special camera.

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