Everybody gets a sore throat now and then. When you have a sore throat, this can affect speaking, swallowing, or breathing. Infections from viruses or bacteria are the main cause of sore throats, but allergies and sinus infections can also contribute. Some sore throats are worse than others. If you have a sore throat that lasts for more than five to ten days, you should see your doctor.
Whenever a sore throat is severe, lasts longer than the usual five- to ten-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:
Infections by contagious viruses or bacteria are the source of most sore throats. Other potential causes include:
Viruses—Sore throats often accompany viral infections, including the flu, colds, measles, chickenpox, croup, or mononucleosis (mono). Mono has the longest duration of symptoms, such as sore throat and extreme fatigue, and can last several weeks. Other symptoms include swollen glands in the neck, armpits, and groin; fever, chills, headache, or sometimes, serious breathing difficulties.
Bacterial infections—Strep throat is an infection caused by Streptococcus bacteria. This infection can also cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Symptoms of strep throat often include fever (greater than 101°F), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have a headache and stomach pain.
Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by Bordetella pertussis bacteria. This infection can bring about violent, uncontrollable coughing, making it hard to breathe and causing you to make a “whooping” sound. Whooping cough can affect people of all ages, but can be especially serious, even deadly, for babies less than one-year-old.
Epiglottitis—Epiglottitis is the most dangerous throat infection because it causes swelling that closes the airway and requires prompt emergency medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. Epiglottitis is often not seen just by looking in the mouth.
Allergies—You may also be allergic to pollens, molds, animal dander, and/or house dust, for example, which can lead to a sore throat.
Irritation—Dry heat, dehydration, chronic stuffy nose, pollutants, car exhaust, chemical exposure, or straining your voice are examples of irritations that can lead to a sore throat.
Reflux—Reflux occurs when you regurgitate stomach contents up into the throat. You may notice this often in the morning when you first wake up. Reflux that goes into the throat is called laryngopharyngeal reflux (LPR).
Tumors—Tumors of the throat, tongue, and larynx (voice box) can cause a sore throat with pain going up to the ear. Other important symptoms can include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.
A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:
For a more severe sore throat, your doctor may want to do a throat culture—swabbing the inside of your throat to see if there is a bacterial infection. If it is negative, your physician will base their treatment recommendation on the severity of your symptoms and the appearance of your throat on examination.
If you have a bacterial infection your doctor will likely recommend an antibiotic (such as penicillin or erythromycin) that kills or impairs bacteria. Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. When a combined infection like this happens, antibiotics may be recommended.
It is important to take an antibiotic as your physician directs and to finish all doses, even if your symptoms improve, otherwise the infection may not be gone and could return. Some patients will experience returning infections despite antibiotic treatment. If you experience this, it is important to discuss this situation with your physician.
You may also want to review these Sore Throat Prevention Tips.
Copyright 2021. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed April 2020.