Condition

Sore Throat

We’ve all had it at one time or another – a sore throat. It’s painful, it’s uncomfortable; your throat feels scratchy and raw and even drinking water can be difficult. Having a sore throat is one of the most common reasons for a doctor’s visit.

A sore throat is a symptom, rather than a condition, and can therefore be caused by a myriad of reasons: viral or bacterial infections mainly, as well as other factors such as dry air, allergies, acid reflux, tonsillitis or even sleeping with your mouth open. Sore throats caused by viral infections, such as the common cold or the flu, usually go away on their own within a few days, and can be treated with over-the-counter pain relievers and home remedies such as getting plenty of rest. Bacterial infections such as strep throat (also a common cause of sore throat) often require antibiotic treatment.

What is a sore throat?

A sore throat is that painful scratchy feeling at the back of the throat. Sore throats are divided into three types:

Pharyngitis:

Swelling and redness (inflammation) of the pharynx

Tonsillitis:

Swelling and redness of the tonsils (the soft tissue in the back of the mouth)

Laryngitis:

Swelling and redness of the voice box, or larynx.

Symptoms

The symptoms of your sore throat depend on the cause. Symptoms may include:

A painful throat
A scratchy sensation in the throat
Pain that worsens with talking
Difficulty swallowing
Sore, swollen glands in your neck or jaw
Swollen, red (inflamed) tonsils
White patches or pus on your tonsils
A hoarse or muffled voice

More symptoms

If your sore throat is due to an infection, the sore throat may be accompanied by these symptoms:

See your doctor if:

Your sore throat lasts for more than two weeks, and you have additional symptoms such as blood in your saliva, a swollen face and neck.
You have persistent or recurrent symptoms that warrant further investigation, including the possibility of antimicrobial resistance or debilitating chronic conditions.
Your child has severe symptoms, including difficulty breathing, swallowing and unusual drooling.

Causes

Sore throats have various causes, though viral and bacterial infections are the most common.

Viral infections include:

• the common cold
• flu (influenza)
• mono (mononucleosis), an infectious disease that’s transmitted through saliva
• measles, an illness that causes a rash and fever
• chickenpox, an infection that causes a fever and an itchy bumpy rash
• COVID-19 (Coronavirus disease 2019)
• croup (a childhood illness)
• mumps, an infection that causes swelling of the salivary glands in the neck

Bacterial infections, include:

• Strep throat caused by Group A Streptococcus (streptococcus pyogenes)
• bacterial sinus infections
• sexually transmitted infections like gonorrhoea and chlamydia

Other causes include:

• allergies – pet dander, mold, dust, pollen, grass
• tonsillitis – this occurs when bacteria and viruses cause the tonsils (the two small lumps of soft tissue
at the back of your throat) to become infected and inflamed.
• dryness – dry indoor air, mouth breathing (often because of nasal congestion)
• irritants – air pollution, tobacco smoke, aerosols, cleaning products, alcohol and spicy foods
• muscle strain – from excessive shouting, talking loudly or talking for long periods without rest
• gastroesophageal reflux disease (GERD) – when the stomach acid goes back up the food pipe it causes
heartburn and acid reflux which can affect the throat
• HIV infection – HIV-positive people could have recurring sore throats because of oral thrush or due to
a viral infection called cytomegalovirus (CMV)
• cancerous tumours of the throat, tongue or voice box (larynx)
• abscess in the throat or swelling of the epiglottitis that covers the windpipe
• epiglottitis – a rare, but potentially dangerous throat infection where swelling of the epiglottis can
close the airway, making it difficult to breathe. [This is a medical emergency.]

Risk factors

Sore throats can affect anyone at any time, though the following factors make you more susceptible:

Age.

Children and teens tend to get sore throats often. They are also more likely to have strep throat, the most common bacterial infection associated with a sore throat.

Time of year.

Some types of infection are more common during certain seasons, like winter.

Allergies.

Seasonal allergies or ongoing allergic reactions to dust, mold or pet dander make developing a sore throat more likely.

Exposure to irritants.

Tobacco smoke, air pollution and certain household chemicals can cause throat irritation.

Frequent sinus infections.

Drainage from your nose can irritate your throat or spread infection.

Vocal strain.

People who regularly talk loudly, yell, or sing for long periods can strain their vocal cords more easily.

A weakened immune system.

When you’re immunocompromised you’re more likely to pick up infections. Low immunity may be caused by HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet.

Diagnosis

A diagnosis is given pending a review of the symptoms, a medical history and a physical exam. Your doctor may do a throat culture swab to diagnose strep throat bacteria or other types of bacterial infections, such as chlamydia or gonorrhoea.

Treatment

Treatment includes treating the symptoms, or based on the diagnosis, the cause.

These work directly on the pain of a sore throat:
• a sore throat spray, such as that contains benzydamine hydrochloride and chlorhexidine gluconate or
a cooling ingredient like menthol or eucalyptus
• throat lozenges
• cough syrup
• low doses of corticosteroids (on a short course)

Viral infections usually last up to a week and they usually don’t require any medical treatment. You can use paracetamol or other mild pain relievers to relieve pain and fever. Over-the-counter pain medication or topical analgesics, like an oral spray, can also be given to children with viral infections.

Bacterial infections are treated with antibiotics. Antibiotics are needed when you have a strep throat, as to prevent more serious conditions such as pneumonia, bronchitis and rheumatic fever. In South Africa, the following antibiotics are recommended: penicillin, amoxicillin (or amoxicillin-clavulanate), azithromycin (for those with a penicillin allergy) and clindamycin (in patients with resistance towards the macrolide antibiotics).

If your doctor prescribes antibiotics for you or your child, you or your child must take the complete course of antibiotics or risk the infection getting worse. Stopping the antibiotic too early can also lead to antibiotic resistance, which makes it more difficult to treat infections in the future.

Allergies are treated with over-the-counter antihistamine medication. Postnasal drip coming from an allergic reaction may cause sore throats, and antihistamines treat the postnasal drip.

Heartburn can be treated with over-the-counter antacids, which help with acid reflux that causes heartburn and sore throats.

Taking care of your sore throat at home

If you or your child has a sore throat, these strategies can help ease the symptoms:

• Rest. Ensure that you get enough of sleep. You should also stay at home to prevent the cold or flu from spreading.
• Rest your voice. Try not to raise your voice or shout.
• Gargle with saltwater. A saltwater gargle of 1⁄4 to 1⁄2 teaspoon of table salt to a half a glass of lukewarm water can help soothe a sore throat. Gargle and then spit out. This is suitable for children over the age of 6.
• Stay hydrated. Drinking fluids prevents dehydration and keeps the throat moist. Stay away from caffeine and alcohol, which can dehydrate you.
• Drink warm liquids. Warm water with honey or caffeine-free tea can soothe a sore throat. Honey is
not suitable for children under the age of 1.
• Humidify the air. Sitting for several minutes in a steamy bathroom or by using a humidifier, keeps the throat moist, which lessens irritation.
• Suck on throat lozenges or hard sweets. These can soothe a sore throat. (Any type of hard sweets
should not be given to children under the age of 5 because it can be a choking risk.)
• Avoid irritants. Stay away from cigarette smoke and cleaning products that can irritate the throat.
• Avoid dry foods, spicy foods or acidic fruits. Dry foods such as crackers and raw vegetables, spicy
foods, and acidic fruits, such as lemons, can irritate your throat.

Prevention

To prevent sore throats, it’s important for you and your family to practice good hygiene. Here are a few ways:
• Wash your hands with soap (at least 20 seconds), especially after using the toilet, before and after
eating, and after sneezing or coughing.
• Cough or sneeze into a tissue and throw it away, and then wash your hands.
• Avoid touching your face, eyes, nose or mouth.
• Avoid close contact with people who are sick or have symptoms.
• Avoid smoking and exposure to second-hand smoke.
• Keep your throat moist by drinking plenty of water.

References

1. Best, S. (n.d.). Pharyngitis. Johns Hopkins Medicine [Online]. Accessed on 12 January 2023. Available from https://www.hopkinsmedicine.org/health/conditions-and-diseases/pharyngitis

2. Cingi, C., Songu, M., Ural, A., Erdogmus, N., Yildirim, M., Cakli, H., & Bal, C. (2011). Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: multicentre, prospective, randomised, double blinded, placebo-controlled study. The Journal of Laryngology and Otology, 125(6), 620–625. https://doi.org/10.1017/S0022215111000065

3. Cleveland Clinic. (2022). Sore Throat (Pharyngitis). Cleveland Clinic [Online]. Accessed on 6 January 2023. Available from https://my.clevelandclinic.org/health/symptoms/8274-sore-throat-pharyngitis

4. Higuera, V. (2022). How to deal with a sore throat. Medical News Today [Online]. Accessed on 6 January 2023. Available from https://www.medicalnewstoday.com/articles/311449

5. Marais, A. & Leuschner, M. (2019). The sore throat: a clinical approach to tonsillopharyngitis. South African Family Practice. 61(4):22-24. Retrieved from https://safpj.co.za/index.php/safpj/article/view/4957/5854

6. Mayo Clinic. (2022). Sore Throat Symptoms & Causes. Mayo Clinic [Online]. Accessed on 6 January 2023. Available from https://www.mayoclinic.org/diseases-conditions/sore-throat/symptomscauses/syc-20351635

7. Mayo Clinic. (2022). Sore Throat Diagnosis & Treatment. Mayo Clinic [Online]. Accessed on 6 January 2023. Available from https://www.mayoclinic.org/diseases-conditions/sore-throat/diagnosistreatment/drc-20351640

8. Watson, F. (2022). Sore Throat 101: Symptoms, Causes, and Treatment. Healthline. [Online]. Accessed on 12 January 2023. Available from https://www.healthline.com/health/sore-throat