What Causes a Sore Throat?
Sore throat is a symptom of many medical disorders. Infections cause the majority
of sore throats and are contagious. Infections are caused either by viruses such
as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma,
While bacteria respond to antibiotic treatment, viruses do not.
Viruses: Most viral sore throats accompany flu or colds along with a stuffy,
runny nose, sneezing, and generalized aches and pains. These viruses are highly
contagious and spread quickly, especially in winter. The body builds antibodies
that destroy the virus, a process that takes about a week.
Sore throats accompany other viral infections such as measles, chicken pox,
whooping cough, and croup. Canker sores and fever blisters in the throat also
can be very painful.
One viral infection takes much longer than a week to be cured: infectious
mononucleosis, or "mono." This virus lodges in the lymph system,
causing massive enlargement of the tonsils, with white patches on their surface
and swollen glands in the neck, armpits, and groin. It creates a severely sore
throat and, sometimes, serious breathing difficulties. It can affect the liver,
leading to jaundice— yellow skin and eyes. It also causes extreme fatigue
that can last six weeks or more.
"Mono," a severe illness in teenagers but less severe in children,
can he transmitted by saliva. So it has been nicknamed the "kissing disease," but
it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing
of towels and eating utensils.
Bacteria: Strep throat is an infection caused by a particular strain of streptococcus
bacteria. This infection can also damage the heart valves (rheumatic fever)
and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis,
and ear infections.
Because of these possible complications, a strep throat should be treated
with an antibiotic. Strep is not always easy to detect by examination, and
a throat culture may be needed. These tests, when positive, persuade the physician
to prescribe antibiotics. However, strep tests might not detect other bacteria
that also can cause severe sore throats that deserve antibiotic treatment.
For example, severe and chronic cases of tonsillitis or tonsillar abscess may
be culture negative. Similarly, negative cultures are seen with diphtheria,
and infections from oral sexual contacts will escape detection by strep culture
Tonsillitis is an infection of the lumpy tissues on each side of the back
of the throat. In the first two to three years of childhood, these tissues "catch" infections,
sampling the child's environment to help develop his immunities (antibodies).
Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis
suggest the infection is not fully eliminated between episodes. A medical study
has shown that children who suffer from frequent episodes of tonsillitis (such
as three- to four- times each year for several years) were healthier after
their tonsils were surgically removed.
Infections in the nose and sinuses also can cause sore throats, because mucus
from the nose drains down into the throat and carries the infection with it.
The most dangerous throat infection is epiglottitis, caused by bacteria that
infect a portion of the larynx (voice box) and cause swelling that closes the
airway. This infection is an emergency condition that requires prompt medical
attention. Suspect it when swallowing is extremely painful (causing drooling),
when speech is muffled, and when breathing becomes difficult. A strep test
may miss this infection.
Allergy: The same pollens and molds that irritate the nose when they are inhaled
also may irritate the throat. Cat and dog danders and house dust are common
causes of sore throats for people with allergies to them.
Irritation: During the cold winter months, dry heat may create a recurring,
mild sore throat with a parched feeling, especially in the mornings. This often
responds to humidification of bedroom air and increased liquid intake. Patients
with a chronic stuffy nose, causing mouth breathing, also suffer with a dry
throat. They need examination and treatment of the nose.
Pollutants and chemicals in the air can irritate the nose and throat, but
the most common air pollutant is tobacco smoke. Other irritants include smokeless
tobacco, alcoholic beverages, and spicy foods.
A person who strains his or her voice (yelling at a sports event, for example)
gets a sore throat not only from muscle strain but also from the rough treatment
of his or her throat membranes.
Reflux: An occasional cause of morning sore throat is regurgitation of stomach
acids up into the back of the throat. To avoid reflux, tilt your bedframe so
that the head is elevated four- to six- inches higher than the foot of the
bed. You might find antacids helpful. You should also avoid eating within three
hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see
Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but
not always) associated with long-time use of tobacco and alcohol. Sore throat
and difficulty swallowing—sometimes with pain radiating to the ear—may
be symptoms of such a tumor. More often the sore throat is so mild or so chronic
that it is hardly noticed. Other important symptoms include hoarseness, a lump
in the neck, unexplained weight loss, and/or spitting up blood in the saliva
When Should I See a Doctor?
Whenever a sore throat is severe, persists longer than the usual five- to seven-
day duration of a cold or flu, and is not associated with an avoidable allergy
or irritation, you should seek medical attention. The following signs and symptoms
should alert you to see your physician:
- Severe and prolonged sore throat
- Difficulty breathing
- Difficulty swallowing
- Difficulty opening the mouth
- Joint pain
- Fever (over 101°)
- Blood in saliva or phlegm
- Frequently recurring sore throat
- Lump in neck
- Hoarseness lasting over two weeks
When should I take antibiotics?
Antibiotics are drugs that kill or impair bacteria. Penicillin or erythromycin
(well-known antibiotics) are prescribed when the physician suspects streptococcal
or another bacterial infection that responds to them. However, a number of
bacterial throat infections require other antibiotics instead. Antibiotics
do not cure viral infections, but viruses do lower the patient's resistance
to bacterial infections. When such a combined infection occurs, antibiotics
may be recommended. When an antibiotic is prescribed, it should be taken as
the physician directs for the full course (usually 10 days). Otherwise the
infection will probably be suppressed rather than eliminated, and it can return.
Some children will experience recurrent infection despite antibiotic treatment.
When some of these are strep infections or are severe, your child may require
Should other family members be treated or cultured?
When a strep test is positive, many experts recommend treatment or culturing
of other family members. Practice good sanitary habits; avoid close physical
contact; and sharing of napkins, towels, and utensils with the infected person.
Handwashing makes good sense.
What if my throat culture is negative?
A strep culture tests only for the presence of streptococcal infections. Many
other infections, both bacterial and viral, will yield negative cultures and
sometimes so does a streptococcal infection. Therefore, when your culture is
negative, your physician will base his/her decision for treatment on the severity
of your symptoms and the appearance of your throat on examination.
How Can I Treat My Sore Throat?
A mild sore throat associated with cold or flu symptoms can be made more comfortable
with the following remedies:
- Increase your liquid intake.
- Warm tea with honey is a favorite home remedy.
- Use a steamer or humidifier in your bedroom.
- Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup
- Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore
- - - Tempra®) or ibuprofen (Motrin IB®, Advil®).
If you have further questions about Sore Throat, please feel free to contact
Tonsiles and Adenoids