Continuing our popular medical column, Medical Matters, Dr Ciaran Roarty addresses the issue of a sore throat and what to do about it.
A sore throat (or pharyngitis) is very common.
The cause is usually an infection in the throat and while a sore throat may be the only symptom, you may also notice a hoarse voice, mild cough, a high temperature, headache nausea or tiredness.
You may also notice swollen glands in your neck or pain when you swallow. The pain peaks over two or three days and then generally settles over a week or so. If you have a cold or flulike illness you may also develop a sore throat.
Tonsillitis is an infection in the actual tonsils at the back of the mouth. It can feel like a sore throat but tends to be more severe. You may feel quite feverish and generally unwell. Sometimes you may be able to see pus or white spots on the enlarged red tonsils.
Many sore throats are mild and get better without any treatment.
Fluids are important as we are more prone to dehydration if it is difficult to drink or if we have a fever. Dehydration worsens a headache and makes us feel tired.
Paracetamol or ibuprofen helps ease the pain, headache and fever. They work best if taken at regular intervals as recommended rather than just now and again. If necessary you can alternate and take both. Some people should not take ibuprofen (eg patients with asthma, or patients with tummy ulcers) so read the packet label carefully. Some people find throat lozenges helpful along with gargles and sprays which can be bought in pharmacies.
Are any tests required?
Usually not, unless you are slow to improve or your infection keeps returning. Blood tests are not routinely needed though some people on medication which may affect the immune system may require tests, or if glandular fever is suspected by your doctor
So what about an antibiotic Doctor?
Most throat and tonsil infections are caused by viruses, which hopefully by now, everyone knows are not susceptible to antibiotics. Sometimes bacteria causes sore throats, but even if they are the culprit, an antibiotic will make very little difference in most cases. Your immune system clears the infection within a few days whether caused by a virus or bacteria .
Also antibiotics are not without their own potential side effects, such as diarrhoea, nausea and rashes.
Most doctors use a scoring system called the Centor Score to decide if antibiotics are needed or not for a sore throat. They may look for:
• tender lymph glands in the neck.
• pus on the tonsils.
• absence of a cough.
Any three out of four of these make it more likely that your sore throat is caused by a bacteria and the doctor may give you a “delayed prescription”. This is a prescription for an antibiotic with the instructions to delay taking the antibiotic for 2-3 days and only start if your symptoms get worse or have not started to improve. An antibiotic may be prescribed to start immediately for severe infection or if your immune system is not functioning properly (eg if you’ve had your spleen removed or are on chemotherapy) or have heart valve problems.
Thankfully nearly all cases of sore throat or tonsillitis clear without any problems. Occasionally a very typical sore throat may progress to cause complications such as spread of infection to the ears, sinuses or chest.
Other things that your doctor may be on the lookout for include:
Glandular Fever (Infectious mononucleosis). This is caused by a virus but typically produces a severe bout of tonsillitis as well as other symptoms.
Quincy . This is an uncommon condition where an abscess (a collection of pus) develops next to a tonsil on one side and pushes the tonsil towards the midline. You will feel very unwell and it is very painful. It can develop after tonsillitis or even without you ever having had tonsillitis.
Other uncommon causes of a sore throat or tonsillitis include thrush, certain sexually transmitted infections and even hayfever. Very rarely it can be associated with throat cancer but this tends to be in older adults who smoke.
So what we need to remember is that you should see a doctor if your symptoms of a sore throat are severe, unusual or do not improve within a week. Be alert for any difficulty breathing, swallowing saliva, opening your mouth or severe pain and seek medical help immediately. If your temperature is persistently high or you have a severe illness with mainly one-sided symptoms see a doctor as soon as possible
The above information is intended as advice only and should you have any concerns contact your own Doctor.
Dr Ciaran Roarty MB BCh BAO MICGP DRCOG is a full-time GP at Scally McDaid Medical Practice, Scally Place, Letterkenny, Tel 0749164111