A sore throat is a symptom, not a diagnosis. Most come from infection. Some come from allergy, dry air, or acid.
Infection
Viruses cause most sore throats, including colds, flu, and mononucleosis. Bacteria, including streptococcus, cause others. That split matters: antibiotics can treat bacteria. They do not treat viruses.
A viral sore throat often arrives with a runny or stuffy nose, sneezing, and body aches. These infections spread easily, especially in winter. The body clears a typical virus in about a week.
Mono takes longer. The virus settles in lymph tissue, so the tonsils swell, often with white patches, and glands enlarge in the neck, armpits, and groin. The throat can be severe enough to make breathing hard. The liver can be involved, which shows up as yellow skin or eyes. Fatigue can last six weeks or more. It is harder on teens and young adults than on young children, and it spreads through saliva, shared utensils, and towels.
Strep can also injure heart valves (rheumatic fever) and kidneys, which is why a true strep throat is treated. It often lasts longer than a cold, but an exam alone can miss it. A rapid test gives an answer in minutes. A culture takes a day or more. A negative strep test does not rule out every bacterial infection. Tonsil abscesses and some other throat infections will not show up on a strep swab.
Tonsils sample germs in early childhood and help build immunity. They should not stay infected. Children with several bouts a year for more than one year are sometimes healthier after the tonsils are removed. That decision is individual.
Mucus from a sinus or nose infection drips into the throat and can infect it too. The most dangerous throat infection is epiglottitis: bacteria swell the voice box and can close the airway. Go to emergency care if swallowing is so painful that saliva pours out, the voice is muffled, or breathing is difficult. A strep test can be negative.
Allergy, dry air, and acid
Hay fever irritates the throat the same way it irritates the nose. Pollen, mold, animal dander, and house dust are common triggers. Winter heating blows dust and dries the air, so some people wake with a parched throat. A humidifier and more fluids help. Mouth breathing from a blocked nose does the same thing, and the nose should be treated, not only the throat.
Stomach acid that reaches the throat overnight is another morning sore throat. Raising the head of the bed a few inches, and skipping food and drink for an hour or two before sleep, often helps. If that fails, we should see you. Tobacco smoke is the irritant we see most. Alcohol and spicy food bother some people as well. Voice strain from yelling can leave the throat raw. See hoarseness if the voice changed with it.
Antibiotics and family
We prescribe an antibiotic when the exam or a test points to bacteria that drug can treat. Not every bacterium responds to penicillin. If one is prescribed, take the full course, often about 10 days. Stopping early can suppress the infection and let it return.
A negative culture does not mean you should stop medicine on your own. Tell us how the throat looks and feels, and follow the plan from the visit.
Strep spreads easily in a household. Tell us if anyone else is sick. Some families are treated. Others are cultured. Wash hands, and do not share napkins, towels, or utensils with the person who is ill.
Sore throats are part of our ear, nose, and throat care. Allergy-driven throat irritation can also be sorted out with allergy care.
