Sore Throat (Acute)

 

Sore throat is a common cause for an office visit. The diagnosis and treatment remains controversial and is still actively discussed in the medical literature. The problem is that symptoms overlap and limit the accuracy for even this simple diagnosis.

Viral infections are the most common and are frequently preceded by nasal congestion. Throat pain is usually mild and improves with liquids; however herpangina, an enterovirus infection, can cause severe pain and blisters on the roof of the mouth. Viral infections take 7 days to resolve. Treatment is symptomatic with salt water gargling, ibuprofen and decongestants like Sudafed.

Strep infections tend to be more severe and start directly in the throat without nasal congestion. High fever, swollen lymph nodes in the front of the neck, and severe swelling of the throat suggest a strep infection. Body aches and headaches are also possible. White exudates on the tonsils are not specific for strep throat, but difficulty swallowing associated with enlarged tonsils or asymetric tonsils requires treatment to avoid tonsil abscess formation. The office rapid strep test can confirm a strep infection, but a negative test is not as accurate in excluding an infection. Antibiotic treatment protects the heart from Rheumatic fever, and I believe shortens the duration of throat pain.

Mononucleosis causes a severe sore throat and fever that does not respond to antibiotics. Fifty percent of patients with Mono also have a strep infection. Other symptoms include fatigue, body aches and and a stiff neck. Occasional the spleen enlarges and causes pain. The diagnosis is confirmed with a blood test. Prednisone rapidly decreases the swelling and throat pain.

Influenza and strep infections can both start with abrupt body aches, fever headache, and a sore throat. Influenza settles into the chest and causes a cough.

Bacterial and atypical infections that cause bronchitis, pneumonia, sinus and ear infections can irritate the throat.

Gonorrhea can cause throat infections.