Sore Throat

The dry scratchiness and painful swallowing that are the hallmarks of a sore throat can be miserable. Yet a sore throat isn't a disease. Most often, it's a symptom of another illness, such as the common cold or the flu. In many cases, a sore throat is the first indication that you're getting sick.

Sore throats are a common reason that people visit their doctors, but many of those visits aren't necessary. Most sore throats go away on their own in about a week. Only a small percentage may require medical care.

Bacterial infections that cause sore throats are sometimes treated with antibiotics. But antibiotics aren't effective against viruses, the cause of most illnesses that result in a sore throat. In that case, your best response is self-care measures including rest and plenty of liquids.

A sore throat, known medically as pharyngitis, usually occurs along with other signs and symptoms. These can vary considerably, depending on the type of infection you have. Most often, a sore throat accompanies a viral infection, such as a common cold or the flu. You can usually distinguish between the two based on your sore throat symptoms.

Sore throat with common cold
For example, in addition to a sore throat, a common cold is likely to cause:

• Sneezing
• Watery eyes
• Cough
• A low fever, less than 102' F
• Slight body aches or mild headache

Sore throat with influenza
Influenza, on the other hand, is usually marked by:

• Fatigue
• Body aches
• Chills
• Sweats
• A fever higher than 102' F

Sore throat with mononucleosis
Mononucleosis (mono) is another viral illness associated with a severe sore throat. Although signs and symptoms of the disease typically last about 10 days, it can take weeks to recover your strength after a bout of mono. In addition to a sore throat, mononucleosis may cause:

• Swollen lymph nodes in your neck and armpits
• Swollen tonsils
• Headache
• Skin rash
• Loss of appetite
• Soft, swollen spleen
• Liver inflammation

A sore throat can occur with a number of other viral and bacterial illnesses as well.

Most sore throats are caused by viruses, the same germs that cause colds and flu. A much smaller number are due to bacterial infections.

Viruses and bacteria both enter your body through your mouth or nose ý either because you breathe in particles that are released into the air when someone coughs or sneezes, or because you have hand-to-hand contact with an infected person or use shared objects such as utensils, towels, toys, doorknobs or a telephone. Touch your eyes or nose after such contact and you're likely to become sick yourself.

Viral causes
Viruses that can cause a sore throat include:

• Common cold viruses
• Influenza
• Mononucleosis
• Measles
• Chickenpox
• Croup

Bacterial causes
Bacteria that can cause a sore throat include:

• Strep throat
• Tonsillitis
• Diphtheria
• Mycoplasma
• Chlamydophila
• Gonorrhea

Other causes
Because the germs that cause sore throats are contagious, they can spread easily wherever large numbers of people congregate: schools, child care centers and offices. Even so, not all sore throats result from viral or bacterial infections. Other common causes of sore throat include:

• Allergies. The same pet dander, molds and pollens that trigger allergic reactions such as red, swollen eyes and a runny nose can also cause a sore throat.
• Dryness. Dry indoor air, especially in winter when rooms tend to be overheated, can make your throat feel rough and scratchy, particularly in the morning when you first wake up. Breathing through your mouth ý often because of chronic nasal congestion, can also cause a dry, sore throat.
• Pollution and other irritants. Outdoor air pollution can cause ongoing throat irritation. But indoor pollution ý especially tobacco smoke, is an even greater cause of chronic sore throat. What's more, inhaling secondhand smoke is often just as damaging as smoking itself. Smokeless tobacco, alcohol and spicy foods can also inflame your throat.
• Muscle strain. You can strain muscles in your throat just as you can strain them in your arms or legs. If you've ever gotten a sore throat after yelling at a concert or sporting event, you've likely strained your throat muscles.
• Gastroesophageal reflux disease (GERD). This occurs when stomach acid backs up into your food pipe (esophagus). Normally, a circular band of muscle (lower esophageal sphincter) acts as a one-way valve, allowing food and fluid to pass into the stomach while blocking acid from coming up into the esophagus. But if the sphincter relaxes abnormally or weakens, stomach acid can back up, irritating your throat as well as your esophagus. Throat irritation caused by GERD doesn't occur with other symptoms of a viral illness, and it tends to be persistent, rather than lasting just a few days.
• HIV infection. HIV-positive people sometimes develop a chronic sore throat. This isn't due to HIV itself but to a secondary infection such as oral thrush or cytomegalovirus, a common viral infection that can be extremely serious in people with compromised immune systems.
• Tumors. If you smoke or abuse alcohol, you're at high risk of tumors of the throat, tongue and voice box. In some people these tumors cause few, if any, signs and symptoms. In others, they can lead to hoarseness, difficulty swallowing and sore throat.

Although uncomfortable, most sore throats aren't harmful and go away on their own in five to seven days. But sometimes they can signal a more serious condition. See your doctor if you or your child has any of the following:

• A sore throat that is severe or lasts longer than a week
• Severe difficulty swallowing or breathing
• Excessive drooling in a young child
• A temperature higher than 101' F in babies under age 6 months and 103' F in older children
• Tender or swollen lymph glands in the neck
• Pus at the back of the throat
• Rash
• Hoarseness that lasts longer than two weeks
• Blood in saliva or phlegm
• Symptoms of dehydration, such as sunken eyes, severe weakness and decreased urine output
• Contact with someone who has been diagnosed with strep throat
• Recurring sore throats

Most often, your doctor or your child's pediatrician will diagnose the cause of a sore throat on the basis of a physical exam and a throat culture. During the exam, your doctor is likely to check your throat for redness and swelling and for white streaks or pus on your tonsils. Although these signs indicate an infection, there's no accurate way to tell by looking if it's viral or bacterial.

For that reason, your doctor is likely to take a throat culture or perform a rapid strep test to check for the presence of bacteria that cause strep throat. In either case, your doctor will rub a sterile swab over the back of your throat and tonsils to get a sample of the secretions.

In the past, the only way to accurately diagnose strep throat was to have these secretions cultured in a laboratory, a procedure could take up to two days. Now, your doctor may use a rapid test that checks for bacterial infections within hours, but because rapid tests may miss a fair number of infections, your doctor may choose to have additional laboratory testing done as well.

Although most bacterial throat infections aren't dangerous, they can lead to serious complications. Strep throat, in particular, can cause other infections, such as tonsillitis, sinusitis, ear infections and scarlet fever, an illness marked by fever, severe sore throat and rash.

For reasons that aren't clear, two of the most serious strep throat complications, kidney damage (glomerulonephritis) and rheumatic fever, are less common than they once were, but they can cause real problems when they do occur. Rheumatic fever, for instance, causes inflammatory spots (nodes) to form in various tissues, including your joints, skin and muscles. These nodes also may form on the heart muscle, the lining of the heart and especially the heart valves, causing scarring that can interfere with the flow of blood inside the heart. Sometimes surgical valve repair or replacement is necessary to correct the scarred valves.

Complications of viral infections
Although bacterial infections that cause sore throats are generally more serious than viral infections are, even viral infections aren't without risk. Infectious mononucleosis, for instance, can lead to an enlarged spleen with the chance of rupture. Other complications of mononucleosis include:

• Liver inflammation (hepatitis)
• Low levels of blood cells involved in clotting (platelets)
• Anemia
• Inflammation of the heart
• Nerve damage, possibly leading to paralysis
• Swollen tonsils, leading to obstructed breathing
• Potential for spleen rupture, with trauma

Most sore throats go away without treatment, often within a week or so. That's a good thing, because no medical therapy exists for sore throats caused by viral infections. But increasing your fluid intake and getting extra sleep can help speed your recovery.

When you're sick, choose fluids such as water, soups and broths - not sodas or drinks that contain caffeine, which can dehydrate you further. If you find it extremely painful to swallow, try sipping warm broth through a straw or sucking on ice chips. You may also find that Jello slides down easily.

Treating bacterial infections
At one time, doctors automatically treated all sore throats with antibiotics, both to cure the infection and to prevent dangerous complications such as rheumatic fever. Now, doctors are much less likely to prescribe medication because the overuse of antibiotics has led to an increase in antibiotic-resistant strains of bacteria. What's more, antibiotics such as penicillin do little to hasten recovery from strep throat or to reduce signs and symptoms, and they don't prevent infections from recurring. Be sure your doctor performs a rapid strep test before prescribing any antibiotic for a sore throat.

If your doctor does recommend antibiotics for you or your child, take the entire course of medication, even if you feel better. This helps prevent a partially treated strep infection from coming back, and helps prevent the most serious strep throat complications, kidney damage (glomerulonephritis) and rheumatic fever. Taking the entire course also prevents bacteria from becoming resistant to the medication.

If children on antibiotic therapy feel well and don't have a fever, they often can return to school or child care when they're no longer contagious, usually 24 hours after beginning sore throat treatment. 

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.