Sore Throat: Causes, Symptoms & When to See a Doctor

What Causes a Sore Throat?

Sore throats are most commonly caused by viral infections (70-85% of cases), including the common cold, flu, and COVID-19. Bacterial infections like streptococcus (strep throat) cause 15-30% of cases in children and 5-15% in adults. Other causes include allergies, dry air, acid reflux, and voice strain.

Understanding the underlying cause of your sore throat is essential for determining the most appropriate treatment approach. The throat, or pharynx, can become inflamed due to various infectious and non-infectious factors. The pharynx serves as a gateway between the nasal passages and the larynx, making it vulnerable to pathogens that enter through breathing or ingestion.

When your immune system detects these pathogens, it triggers an inflammatory response that causes the characteristic pain, swelling, and redness associated with sore throat. This inflammation serves a protective purpose, bringing immune cells to the area to fight infection, but it also causes discomfort that can range from mild irritation to severe pain that makes swallowing difficult.

The good news is that most sore throats resolve on their own within a week as your immune system successfully fights off the infection. However, identifying the specific cause can help you manage symptoms more effectively and know when medical intervention might be necessary.

Viral Infections

Viruses are responsible for the vast majority of sore throats. The common cold, caused by rhinoviruses and coronaviruses, is the most frequent culprit. These viral infections typically cause additional symptoms such as runny nose, sneezing, coughing, and mild body aches. The sore throat associated with a cold usually appears within the first few days of infection and gradually improves as other symptoms develop.

Influenza (the flu) can cause more severe sore throat symptoms accompanied by high fever, significant body aches, fatigue, and headache. COVID-19 also frequently presents with sore throat, often alongside loss of taste or smell, fatigue, and respiratory symptoms. Infectious mononucleosis (mono), caused by the Epstein-Barr virus, produces particularly severe and long-lasting sore throat, often with extreme fatigue and swollen lymph nodes that can persist for weeks.

Bacterial Infections

While less common than viral causes, bacterial sore throats often require different treatment approaches. Streptococcal pharyngitis, commonly known as "strep throat," is caused by Group A Streptococcus bacteria. This infection is particularly common in school-age children, accounting for 15-30% of sore throat cases in this age group compared to only 5-15% in adults.

Strep throat has distinctive characteristics that help differentiate it from viral infections. Patients typically experience sudden onset of severe throat pain, high fever (often above 101°F/38.3°C), swollen and tender lymph nodes in the neck, and white patches or pus on the tonsils. Notably, strep throat usually occurs without the runny nose, cough, and sneezing that accompany viral infections.

Non-Infectious Causes

Not all sore throats are caused by infections. Environmental factors and lifestyle habits can also irritate the throat. Allergies to pollen, dust, mold, or pet dander can cause postnasal drip that irritates the throat, particularly during allergy season. Breathing dry air, especially during winter months when indoor heating reduces humidity, can dry out and irritate the throat lining.

Gastroesophageal reflux disease (GERD) can cause chronic sore throat when stomach acid backs up into the esophagus and throat, particularly at night. This type of sore throat is often worse in the morning and may be accompanied by a bitter taste, heartburn, or the sensation of a lump in the throat. Voice strain from shouting, singing, or prolonged talking can also cause throat pain by irritating the vocal cords and surrounding tissues.

What Are the Symptoms of a Sore Throat?

Sore throat symptoms include pain or scratchiness in the throat, difficulty swallowing, swollen glands in the neck, red or swollen tonsils (sometimes with white patches), and hoarse voice. Accompanying symptoms like fever, cough, runny nose, and body aches help determine whether the cause is viral or bacterial.

The symptoms you experience with a sore throat can vary significantly depending on the underlying cause. Recognizing these symptoms and understanding what they might indicate can help you make informed decisions about treatment and when to seek medical care. The severity of symptoms can range from mild discomfort that barely affects daily activities to severe pain that makes eating and drinking extremely difficult.

Most people with a sore throat experience a sensation of pain, scratchiness, or irritation that typically worsens when swallowing. This discomfort occurs because the act of swallowing causes the inflamed throat tissues to move against each other. Some people describe the feeling as having something stuck in their throat or a constant need to clear the throat.

The appearance of the throat often changes during infection. Looking in the mirror with a flashlight, you might notice that the back of your throat appears red and inflamed. The tonsils, if present, may be swollen and may have white or yellow spots or coating in cases of bacterial infection or certain viral infections like mononucleosis.

Symptoms Suggesting Viral Infection

Viral sore throats typically develop gradually and are accompanied by other cold-like symptoms. You might first notice a tickle or slight irritation in the throat that progresses to more noticeable pain over 24-48 hours. Concurrent symptoms usually include nasal congestion or runny nose, sneezing, mild cough, watery eyes, and low-grade fever (under 101°F/38.3°C).

With viral infections, the throat symptoms often improve as other symptoms worsen and then gradually resolve. For example, the sore throat might peak on days 2-3 while nasal symptoms are just beginning, with all symptoms gradually improving by day 5-7. Fatigue and a lingering cough may persist for a week or two after other symptoms resolve.

Symptoms Suggesting Bacterial Infection (Strep Throat)

Bacterial sore throats, particularly strep throat, often present quite differently from viral infections. The onset is typically sudden and severe, with significant throat pain that appears quickly rather than gradually worsening. High fever (101°F/38.3°C or higher) usually accompanies the throat pain, often appearing within the first 24 hours.

Swollen, tender lymph nodes in the front of the neck are a hallmark of strep throat. When you gently press on the sides of your neck below the jaw, you may feel firm, tender lumps. The tonsils often appear very red and swollen with white patches or streaks of pus. Importantly, strep throat usually occurs without the runny nose, sneezing, and cough that characterize viral infections.

• Sudden onset of severe throat pain - appears quickly, often overnight
• High fever - temperature above 101°F (38.3°C)
• Swollen lymph nodes - tender lumps in the front of the neck
• Red, swollen tonsils - often with white patches or pus
• Headache and body aches - without nasal congestion
• Loss of appetite and nausea - particularly in children

When Should You See a Doctor for a Sore Throat?

See a doctor if your sore throat is severe or lasts more than a week, if you have difficulty breathing or swallowing, if you have a fever above 101°F (38.3°C), if you see blood in your saliva, if you have recurring sore throats, or if you notice a lump in your neck. Seek emergency care for severe breathing difficulty or inability to swallow saliva.

While most sore throats resolve without medical intervention, certain symptoms and circumstances warrant professional evaluation. Understanding these warning signs can help you determine when home treatment is appropriate and when medical care is necessary. The decision to see a doctor depends on the severity of your symptoms, how long they have lasted, and whether you have any underlying health conditions.

Medical evaluation is particularly important if you suspect strep throat, as untreated streptococcal infection can lead to serious complications including rheumatic fever (which can damage the heart), kidney inflammation, and spread of infection to other parts of the body. Early antibiotic treatment can prevent these complications and help you recover more quickly.

Your personal health history also matters. People with weakened immune systems, chronic respiratory conditions, or other underlying health problems may need medical attention sooner than otherwise healthy individuals. If you are unsure whether your symptoms warrant a doctor visit, it is always better to err on the side of caution and seek professional advice.

When to Schedule a Doctor's Appointment

Contact your healthcare provider if your sore throat has lasted more than a week without improvement, or if it is accompanied by persistent high fever. A sore throat that keeps coming back, even after treatment, may indicate an underlying condition that needs investigation. Difficulty swallowing food or liquids (beyond just mild discomfort) should also prompt medical evaluation.

Other reasons to see a doctor include joint pain accompanying the sore throat, a rash that develops along with throat symptoms, blood in your saliva or phlegm, a lump in your neck that does not go away, hoarseness lasting more than two weeks, or earache occurring with the sore throat.

How Is a Sore Throat Diagnosed?

Doctors diagnose sore throat through physical examination of the throat and neck, checking for redness, swelling, and white patches. A rapid strep test provides results in 10-15 minutes and detects streptococcal bacteria. If the rapid test is negative but strep is still suspected, a throat culture may be performed, with results taking 24-48 hours.

When you visit a healthcare provider for a sore throat, they will begin with a thorough medical history, asking about your symptoms, when they started, and whether you have been exposed to anyone who is sick. This information helps narrow down the likely causes and guides the physical examination that follows.

During the physical examination, the doctor will look at your throat using a light and possibly a tongue depressor to get a clear view. They will check for redness, swelling, and the presence of white patches or pus on the tonsils or back of the throat. The doctor will also feel your neck to check for swollen or tender lymph nodes, a common sign of infection.

The examination may include checking your ears for infection, listening to your breathing with a stethoscope, and feeling your abdomen if mononucleosis is suspected (as this condition can cause an enlarged spleen). Based on the history and physical findings, the doctor will determine whether diagnostic tests are needed.

Rapid Strep Test

If bacterial infection is suspected, particularly strep throat, a rapid antigen detection test (RADT) is commonly performed. This quick test involves swabbing the back of your throat and tonsils to collect a sample. The swab is then tested for the presence of Group A Streptococcus antigens, with results available in approximately 10-15 minutes.

The rapid strep test is highly specific, meaning a positive result reliably indicates strep throat infection. However, the test can occasionally miss infections (false negative), so if your symptoms strongly suggest strep throat but the rapid test is negative, your doctor may recommend a throat culture for confirmation.

Throat Culture

A throat culture is considered the gold standard for diagnosing strep throat. Like the rapid test, it involves swabbing the throat, but the sample is sent to a laboratory where bacteria are grown and identified over 24-48 hours. While this takes longer than the rapid test, it is more sensitive and can detect infections that the rapid test might miss.

Throat cultures may also identify other bacterial pathogens that can cause sore throat. In some cases, additional blood tests might be ordered to check for mononucleosis or other conditions if the presentation is atypical or symptoms are prolonged.

How Is a Sore Throat Treated?

Viral sore throats are treated with rest, fluids, and symptom relief using pain relievers like acetaminophen or ibuprofen, throat lozenges, salt water gargles, and humidified air. Bacterial sore throats (strep throat) require antibiotics, typically penicillin or amoxicillin, taken for the full prescribed course even when symptoms improve.

Treatment for sore throat depends primarily on the underlying cause. Since the majority of sore throats are viral in origin, treatment focuses on managing symptoms while your immune system fights the infection. Understanding appropriate treatment options helps ensure you recover as comfortably as possible while avoiding unnecessary medications.

It is crucial to understand that antibiotics are ineffective against viral infections and should not be taken for viral sore throats. Taking antibiotics when they are not needed contributes to the growing problem of antibiotic resistance, making these medications less effective when they are truly needed. Antibiotics can also cause side effects including digestive upset, allergic reactions, and disruption of beneficial gut bacteria.

Home Remedies and Self-Care

For most sore throats, home treatment effectively manages symptoms and supports recovery. Staying well-hydrated is essential, as fluids help keep the throat moist and make swallowing easier. Warm beverages like tea, broth, or warm water with honey are particularly soothing. Honey has natural antibacterial properties and can coat and soothe an irritated throat; however, honey should not be given to children under one year of age due to the risk of botulism.

Gargling with warm salt water is a time-tested remedy that helps reduce swelling and discomfort. Mix approximately half a teaspoon of table salt in eight ounces of warm water and gargle for 30 seconds before spitting out. This can be repeated several times throughout the day. The salt helps draw excess fluid from inflamed tissues and creates an environment less hospitable to bacteria.

Throat lozenges and hard candies stimulate saliva production, which keeps the throat moist and can provide temporary relief. Some lozenges contain numbing agents like benzocaine that provide additional pain relief. Using a cool-mist humidifier adds moisture to the air, which can be particularly helpful if dry air is contributing to throat irritation.

Over-the-Counter Medications

Pain relievers such as acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can effectively reduce throat pain and fever. These medications can be taken as directed on the package, and alternating between acetaminophen and ibuprofen every few hours can provide more consistent relief for some people.

Throat sprays containing numbing agents like phenol or benzocaine can provide temporary relief by numbing the throat surface. Antihistamines may help if allergies are contributing to throat irritation and postnasal drip. Decongestants can reduce nasal congestion that leads to mouth breathing and throat dryness.

Antibiotic Treatment for Strep Throat

When strep throat is confirmed through testing, antibiotic treatment is necessary to prevent complications and speed recovery. Penicillin or amoxicillin are typically the first-choice antibiotics due to their effectiveness against Group A Streptococcus, their safety profile, and their narrow spectrum of activity. For patients allergic to penicillin, alternatives include cephalosporins, macrolides (like azithromycin), or clindamycin.

It is essential to complete the entire course of antibiotics as prescribed, even if you feel better before finishing the medication. Stopping antibiotics early can allow bacteria to survive and potentially become resistant to treatment. With appropriate antibiotic treatment, most people with strep throat feel significantly better within 24-48 hours and are no longer contagious after 24 hours of treatment.

How Can You Prevent a Sore Throat?

Prevent sore throat by washing hands frequently with soap and water, avoiding close contact with sick people, not sharing food or drinks, keeping hands away from your face, maintaining good indoor air humidity, staying hydrated, and getting adequate sleep. During cold and flu season, these measures are especially important.

While it is impossible to prevent all sore throats, certain practices can significantly reduce your risk of developing throat infections. Since most sore throats are caused by viruses and bacteria that spread from person to person, measures that reduce transmission are most effective. These preventive strategies are particularly important during fall and winter months when respiratory infections are most common.

Hand hygiene is the single most effective way to prevent the spread of infectious diseases. Washing hands thoroughly with soap and water for at least 20 seconds helps remove viruses and bacteria that you may have picked up from contaminated surfaces. When soap and water are not available, alcohol-based hand sanitizers with at least 60% alcohol content are an effective alternative.

The respiratory viruses and bacteria that cause sore throat spread through droplets when an infected person coughs, sneezes, or talks, and through contact with contaminated surfaces. Being mindful of these transmission routes and taking appropriate precautions can help protect you and those around you from infection.

Practical Prevention Tips

Avoid close contact with people who are visibly sick, especially those with respiratory symptoms. While this is not always possible in work or school settings, maintaining distance when feasible can reduce your exposure. Do not share food, drinks, or eating utensils with others, as these items can harbor infectious agents that spread through saliva.

Keep your hands away from your face, particularly your eyes, nose, and mouth, which are entry points for viruses and bacteria. Replace your toothbrush after recovering from a throat infection to avoid reinfecting yourself. If you smoke, consider quitting; smoking irritates the throat and weakens the immune system, making you more susceptible to infections.

Maintaining good overall health supports your immune system's ability to fight off infections. This includes getting adequate sleep (7-9 hours for adults), eating a balanced diet rich in fruits and vegetables, exercising regularly, managing stress, and staying well-hydrated. Using a humidifier to maintain indoor humidity between 30-50% can prevent throat dryness that makes you more vulnerable to infection.

What Are the Potential Complications of Sore Throat?

Most sore throats resolve without complications. However, untreated strep throat can lead to rheumatic fever (which can damage the heart), kidney inflammation (post-streptococcal glomerulonephritis), peritonsillar abscess, and scarlet fever. Recurring tonsillitis may require surgical removal of the tonsils (tonsillectomy).

While the vast majority of sore throats heal without problems, certain conditions can develop complications that require medical attention. Understanding these potential complications helps emphasize the importance of appropriate treatment, particularly for bacterial infections like strep throat that require antibiotic therapy.

Complications are most likely to occur when bacterial infections go untreated or when treatment is incomplete. This is why it is important to complete the full course of antibiotics if prescribed and to follow up with your healthcare provider if symptoms do not improve as expected or if new symptoms develop during or after treatment.

Complications of Strep Throat

Rheumatic fever is a rare but serious inflammatory condition that can develop 2-4 weeks after untreated strep throat. It affects the heart, joints, nervous system, and skin. While rheumatic fever has become uncommon in developed countries due to widespread antibiotic use, it remains a concern in areas with limited healthcare access and can cause permanent heart valve damage.

Post-streptococcal glomerulonephritis is kidney inflammation that can occur 1-3 weeks after strep throat. Symptoms include decreased urination, blood in the urine, swelling (particularly around the eyes and legs), and high blood pressure. Most cases resolve completely with supportive care, but severe cases may require hospitalization.

Peritonsillar Abscess

A peritonsillar abscess occurs when infection spreads beyond the tonsil to create a collection of pus between the tonsil and the throat wall. Symptoms include severe, often one-sided throat pain, difficulty opening the mouth, changes in voice quality ("hot potato voice"), drooling, and fever. This condition requires prompt medical treatment, typically drainage of the abscess and antibiotics.

People who experience recurrent tonsillitis (multiple episodes per year over several years) may be candidates for tonsillectomy, surgical removal of the tonsils. While this surgery was once performed routinely, it is now generally reserved for cases where recurrent infections significantly impact quality of life or cause other complications.