Painful and irritated sore throat?

Sore throat and coronavirus:

The main symptoms of coronavirus areⁱ:

• a new, continuous cough – in other words, three or more episodes of coughing in 24 hours or repeated coughing for more than an hour. Some people who have a long-term cough might find that they are coughing more than usual.
• A fever (raised temperature when you check it or feeling hot to touch on your back or chest). Symptoms associated with coronavirus, such as fever can also cause sore throats.
• A loss of, or change to, your sense of smell or taste. Some people lose their sense of smell entirely, while others find things smell or taste different compared to how they usually do.

How common is sore throat?ⁱⁱ

Sore throat is very common, with almost 2 in 5 people saying they have a severe sore throat over the course of a yearⁱⁱⁱ. Of these, about 1 in 3 visit their doctorⁱⁱⁱ. That means the average GP will see about 120 people a year with acute sore throatⁱⁱⁱ. About 1 in 10 people in the UK has recurrent sore throat^iv. * * attempted to obtain UK Wide data, but unavailable to provide.

Sore throat most often affects in children and young adults – in fact, half of cases affect people aged 5-24 years^iv.

What causes sore throat?

In winter and early spring, bacterial infections are more common, while viral infections are more common in summer and autumn^iv.

Your tonsils sit at the back of your throat and the medical name for the back of your throat is your pharynx. '-itis' is the medical term for any kind of inflammation, so pharyngitis means inflammation of the throat and tonsillitis means swollen tonsils. Either can lead to a painful throat or a feeling of swollen throat. Because food has to go past this inflamed area, it often hurts to swallow.

The most common cause of an 'acute' sore throat is a throat infection^iv. Most sore throats are caused by a viral infection – between 1 in 7 and 1 in 20 are due to a bacterial infection^v. Even if you have a bacterial infection, it is likely that your symptoms will settle down within a week without taking antibioticsⁱ.

The viruses and bacteria that cause sore throat are spread from other infected people, often from their saliva or nostrils^vi – droplets can be spread when someone coughs or sneezes. If you're in regular close contact with someone who has an infection, they're more likely to pass the infection on – that's why sore throats often spread round members of a family or children in the same class^vi.

The most common viruses to cause sore throat include the various viruses that cause the common cold and flu viruses^v. The most common bacterial cause of sore throat is a germ called Group A beta-haemolytic streptococcus^v, which causes what is sometimes known as 'strep throat'. This bacterial infection can lead to inflammation of your throat – pharyngitis – or tonsillitis^v.

Glandular fever can also give rise to sore throat, which may be severe. Glandular fever mostly affects teenagers and young adults, and other symptoms include a high temperature, swollen glands on either side of your neck and extreme tiredness^vi.

Less common are non-infectious causes of sore throat. These include hay fever and 'reflux', officially called gastro-oesophageal reflux disease, where acid from your tummy refluxes up your gullet into the back of your throat, especially when you lie down^v.

Serious causes of sore throat, such as leukaemia or other blood problems are less common^v. However, if you have a sore throat that doesn't settle on its own, or you have other symptoms of feel very unwell, do contact your doctor.

When do I need to see a doctor?

People often assume that tonsillitis treatment always involves antibiotics. In fact, even if your sore throat is caused by a bacterial infection, antibiotics often don't speed recoveryⁱ.

There are some combinations of symptoms which suggest you may need to see a doctor. That's because they tell your doctor how likely it is that you have a bacterial infection which needs antibiotic treatment. National guidance from the National Institute of Health and Care Excellence (NICE)ⁱ recommends that healthcare professionals use these scores to decide whether antibiotics might be needed.

One of these tools is called the Centor criteriaⁱ. If you have 3 or 4 of the symptoms below, you may need antibiotics. If you have fewer than three, and you don't have any of the 'red flags' below, your healthcare professional is advised not to prescribe antibioticsⁱ. However, your pharmacist can provide treatment to relieve your symptoms. The symptoms in the Centor criteria are:

• Sore throat without a cough or cold.
• Pus on your tonsils (open your mouth wide and shine a torch into the back of your throat – white spots on your tonsils are due to pus).
• Fever over 38 °C.
• Tender swollen glands on the front of your neck.

Some doctors use the FeverPAIN score insteadⁱ. Here the recommendation is that if you have 4 or 5 of these features, you're likely to benefit from antibiotics, and if you have 2 or 3 you might. If you don't have any (or only have one) of these features, your healthcare professional is advised not to prescribe antibioticsⁱ

The features of the FeverPAIN scoring system are:

• Fever over 38 °C.
• Purulence (open your mouth wide and shine a torch into the back of your throat – white spots on your tonsils or the back of your throat are due to pus).
• Attend rapidly (your symptoms were bad enough that you needed to see a doctor within 3 days).
• Severely Inflamed tonsils (again, shine a torch on the back of your throat).
• No cough or cold symptoms apart from sore throat.

What are the red flags that need urgent medical attention^vii?

If you have any of these 'red flags', you should always seek medical attention quickly:

• Feeling extremely unwell
• A fever or sore throat that lasts for more than 2 weeks
• Problems breathing because of your sore throat.
• Severe pain that doesn't improve.
• Severe pain on one side of your throat only (or swollen neck glands on one side only).
• Bleeding from your throat.
• Medical Term Trismus (Being unable to open your mouth wide because of the pain)
• Drooling saliva – in other words, the pain is so bad that you can't swallow your own saliva.
• Sore throat accompanied by weight loss.
• Ulcers in your throat^vii.
• Taking medication that might damp down your immune system, such as cytotoxic drugs, carbimazole, clozapine or sulfasalazine^ix.

How can I help myself?

Sore throats usually last for about a week, and most people will recover without any long-term consequences. In the meantime, however, your pharmacist can help with advice and sore throat remedies to relieve your symptoms. Top tips to consider include:

• Plenty of (non-alcoholic) fluidsⁱ.
• Paracetamol or ibuprofen for pain or feverⁱ.
• Medicated lozenges containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antisepticⁱ.

 

ⁱ NHS UK. Check if you or your child has coronavirus symptoms. Available at https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/ last accessed 18/6/2020.

ⁱⁱ Kinneally T. Sore throat. BMJ. Clinical Evidence 2007;11:1509. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943825/pdf/2007-1509.pdf .

ⁱⁱⁱ NICE Clinical Knowledge Summaries. Sore throat. How common is is? Available from https://cks.nice.org.uk/sore-throat-acute#!backgroundSub:2 last accessed 23/7/2020 .

^iv NICE Clinical Knowledge Summaries. Sore throat - acute. What causes it? Available from https://cks.nice.org.uk/sore-throat-acute#!backgroundSub:1 last accessed 23/7/2020.

^v Wilson A. Pharyngitis. Essential Infectious Disease Topics for Primary Care. 2008 : 15–24.

^vi NHS UK. Glandular fever. Available from https://www.nhs.uk/conditions/glandular-fever/ last accessed 23/7/2020.

^vii Tanz R. Sore throat. Nelson Pediatric Symptom-Based Diagnosis. 2018 : 1–14.e2. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152117/ last accessed 24/7/2020.

^viii NICE Clinical Knowledge Summaries. Sore throat – acute. How do I diagnose the cause of a sore throat? Available from https://cks.nice.org.uk/sore-throat-acute#!diagnosisSub last accessed 23/7/2020.