Sore throat

Sore throats are very common and usually nothing to worry about. They normally get better within a week.

Most are caused by minor illnesses such as colds or flu and can be treated at home.

Treatments for a sore throat

The following measures can often help soothe a sore throat:

• take ibuprofen or paracetamol – paracetamol is better for children and for people who can't take ibuprofen (note that children under 16 should never take aspirin)
• drink plenty of cool or warm fluids, and avoid very hot drinks
• eat cool, soft foods
• avoid smoking and smoky places
• gargle with a homemade mouthwash of warm, salty water
• suck lozenges, hard sweets, ice cubes or ice lollies – but don't give young children anything small and hard to suck because of the risk of choking

There are also products such as medicated lozenges and sprays sold in pharmacies that you may want to try. There isn't much scientific evidence to suggest they help, although some people find them worth using.

Antibiotics aren't usually prescribed for a sore throat, even if it's caused by a bacterial infection, as they're unlikely to make you feel better any quicker and they can have unpleasant side effects.

Causes of a sore throat

The cause of a sore throat isn't always obvious. But in most cases it's a symptom of a viral or bacterial infection.

Common causes

A sore throat is often a symptom of:

• colds or flu – you may also have a blocked or runny nose, a cough, a high temperature (fever), a headache and general aches
• laryngitis (inflammation of the voice box) – you may also have a hoarse voice, a dry cough and a constant need to clear your throat
• tonsillitis (inflammation of the tonsils) – you may also have red or spotty tonsils, discomfort when swallowing and a fever
• strep throat (a bacterial throat infection) – you may also have swollen glands in your neck, discomfort when swallowing and tonsillitis
• glandular fever – you may also feel very tired and have a fever and swollen glands in your neck

It may also be caused by something irritating your throat, such as smoke, gastro-oesophageal reflux disease (where acid leaks up from the stomach) and allergies.

Less common causes

Less often, a sore throat can be a sign of:

• quinsy (a painful collection of pus at the back of the throat) – the pain may be severe and you may also have difficulty opening your mouth or difficulty swallowing
• epiglottitis (inflammation of the flap of tissue at the back of the throat) – the pain may be severe and you may have difficulty breathing and difficulty swallowing

These conditions are more serious and should be seen by a doctor as soon as possible (see below).

When to get medical advice

You don't usually need to get medical advice if you have a sore throat.

But it's a good idea to contact your GP or if they're not open, phone the NHS 24 111 service if:

• your symptoms are severe
• you have persistent symptoms that haven't started to improve after a week
• you experience severe sore throats frequently
• you have a weak immune system – for example, you have HIV, are having chemotherapy, or are taking medication that suppresses your immune system

When to get emergency help

Very rarely, a sore throat can be a sign of a serious problem.

Visit your nearest accident and emergency (A&E) department or call 999 for an ambulance immediately if:

• your symptoms are severe or getting worse quickly
• you have difficulty breathing
• you're making a high-pitched sound as you breathe (called stridor)
• you have difficulty swallowing
• you start drooling

A sore throat is often just one symptom of a bacterial or viral infection, such as the common cold.

The most common types of bacteria and viruses that may cause a sore throat include:

• the rhinovirus, coronavirus and parainfluenza viruses, which normally cause the common cold – these are responsible for a quarter of all sore throats
• different types of streptococcal bacteria – group A streptococcal bacteria cause 10% of sore throats in adults and nearly a third of sore throats in children, with groups C and G also thought to be a cause of sore throats

Other bacteria and viruses each tend to be responsible for less than 5% of sore throats. These include:

• types A and B of the flu virus
• adenovirus – which can also cause conjunctivitis, an infection in the eye
• herpes simplex virus type 1 – which normally causes cold sores
• the Epstein-Barr virus (EBV) – which normally causes glandular fever

There are many other, rarer, bacteria and viruses that are each responsible for less than 1% of sore throats.

Catching an infection

The bacterium or virus that causes a sore throat is usually caught from someone else who is already infected. For example, the common cold is spread through tiny droplets of fluid that contain the cold virus, launched into the air when someone coughs, sneezes or speaks.

If you breathe in one of these droplets or touch a surface that has the virus on it, and then touch your face, you may become infected.

Once you have caught an infection, two types of sore throat can develop. These are:

• pharyngitis – when the area at the back of your throat (the oropharynx) becomes inflamed
• tonsillitis – when your tonsils (the two lumps of tissue either side of your throat) become inflamed

Read more about treating a sore throat.

Non-infectious causes

Less commonly, sore throats can have non-infectious causes. These include:

• irritation caused by cigarette smoke or alcohol
• irritation from a nasogastric tube (passed down your nose and into your stomach to provide liquid food if you can't eat solid food)
• gastro-oesophageal reflux disease – a condition that causes acid to leak upwards from the stomach into the gullet
• Stevens-Johnson syndrome – a very severe allergic reaction to medication
• Kawasaki disease – a rare condition that affects children under five years of age
• allergies – such as hay fever (an allergic reaction to pollen or spores) which, in rare cases, may also cause a sore throat
• some blood disorders, such as leukaemia (cancer of the bone marrow) or aplastic anaemia (when the bone marrow does not produce enough blood cells)
• oral mucositis (inflammation of the layer of tissue that lines your mouth), which can be caused by radiotherapy or chemotherapy (cancer treatments)

Sore throats are not usually serious and often pass in three to seven days. There are some treatments you can use at home to relieve your symptoms.

When to see your GP

You should see your GP if you:

• fall into one of the groups of people at risk of developing complications – this includes anyone with a weakened immune system due to medication, or a condition such as HIV
• have persistent symptoms that are not improving or responding to self-care

Visit your nearest accident and emergency department (A&E) or call 999 for an ambulance if you have severe symptoms such as:

• difficulty breathing or swallowing
• severe pain
• drooling
• a muffled voice
• a high-pitched sound as you breathe (stridor)

Read more about when to visit your GP.

Painkillers

For treating sore throats, over-the-counter painkillers, such as paracetamol, are usually recommended. These may also help reduce a high temperature (fever).

You should not take aspirin or ibuprofen if you have:

• asthma
• current or past stomach problems, such as a stomach ulcer
• current or past liver or kidney problems

Children under the age of 16 should never be given aspirin.

Take painkillers as necessary to relieve your pain. Always read the manufacturer’s instructions so you do not exceed the recommended or prescribed dose.

Self-care tips

If you or someone in your family has a sore throat, the tips below may help relieve the symptoms:

• avoid food or drink that is too hot, as this could irritate the throat
• eat cool, soft food and drink cool or warm liquids
• adults and older children can suck lozenges, hard sweets, ice cubes or ice lollies
• avoid smoking and smoky environments
• regularly gargling with a mouthwash of warm, salty water may help reduce swelling or pain
• drink enough fluids, especially if you have a fever

Steam inhalation is not recommended, as it's unlikely to help a sore throat and there is a risk of scalding.

Antibiotics

The use of antibiotics is not usually recommended for treating sore throats. This is because most sore throats are not caused by bacteria.

Even if your sore throat is caused by bacteria, antibiotics have very little effect on the severity of the symptoms and how long they last, and may cause unpleasant side effects.

Overusing antibiotics to treat minor ailments can also make them less effective in the treatment of life-threatening conditions. This is known as antibiotic resistance.

Antibiotics are usually only prescribed if:

• your sore throat is particularly severe
• you are at increased risk of a severe infection – for example because you have a weakened immune system due to HIV or diabetes (a long-term condition caused by too much glucose in the blood)
• you are at risk of having a weakened immune system – there are some medications that can cause this, such as carbimazole (to treat an overactive thyroid gland)
• you have a history of rheumatic fever (a condition that can cause widespread inflammation throughout the body)
• you have valvular heart disease (a disease affecting the valves in your heart, which control blood flow)
• you experience repeated infections caused by the group A streptococcus bacteria

Delayed antibiotics prescription

If your GP thinks you might need antibiotics, they may issue a prescription but ask you to wait up to three days for symptoms to improve.

If your sore throat gets worse, or has not improved after three days, you should have instructions to either:

• take your prescription slip to a pharmacy
• return to the GP surgery after three days to collect your medication

Recent studies show that complications of a sore throat are uncommon and usually not serious. A delayed antibiotic prescription seems to be as effective as an immediate prescription in reducing complications.

Using a delayed prescription provides similar benefits to an immediate prescription. Most importantly, this helps you to avoid taking antibiotics when they're not needed and helps prevent antibiotic resistance.

Tonsillectomy

A tonsillectomy is a surgical procedure to remove the tonsils (the two lumps of tissue on either side of your throat). If your child has repeated infections of the tonsils (tonsillitis), a tonsillectomy may be considered.

Read more about treating tonsillitis.

Persistent sore throat

If you have a persistent sore throat (one that lasts three to four weeks), your GP may refer you for further tests. This is because your sore throat may be a symptom of a more serious condition. Some possibilities are described below.

Glandular fever

If you are 15-25 years of age with a persistent sore throat, you may have glandular fever (also known as infectious mononucleosis, or mono). This is a type of viral infection with symptoms that can last up to six weeks.

Cancer

A persistent sore throat can also be a symptom of some types of cancer, such as throat cancer. This type of cancer is rare and mainly affects people over the age of 50. In the UK every year, 5,300 people are diagnosed with cancer of the oropharynx (the area at the back of your throat) or mouth.

Read more about mouth cancer

Non-infectious causes

In some cases, a sore throat may be caused by substances that irritate the throat. Sources can include:

• alcohol
• cigarette smoke
• an allergy – such as hay fever
• gastro-oesophageal reflux disease (GORD) – when stomach acid leaks out of the stomach and into the gullet

You may find that avoiding these substances, or seeking treatment for an allergy or GORD, can help to reduce symptoms of a sore throat.

Giving up smoking

If you smoke, giving up will reduce irritation to your throat and strengthen your defences against infection.

The Quit Your Way Scotland service can offer you advice and encouragement to help you quit smoking. Phone Quit Your Way Scotland free on 0800 84 84 84 (8.00am to 10.00pm, every day).

Your GP or pharmacist will also be able to give you help and advice about giving up smoking, or you can read more about quitting smoking.

Preventing a sore throat

As sore throats are caused by bacterial or viral infections, they can be difficult to prevent.

If you have a sore throat caused by an infection, you can help prevent the infection spreading by practising good hygiene, such as washing your hands regularly and keeping surfaces clean and free of germs.