What is sore throat?
Sore throat caused by pharyngitis is the result of inflammation of the pharynx and surrounding tissues1 .
It is a common reason for children and adults to seek medical care1.
Types
There are three different causes for infective pharyngitis1:
Viral infection
This is the most common cause and usually clears up on its own.
Bacterial infection
This is more severe than a viral infection and requires treatment. Streptococcus pyogenes infections (strep throat) make up 30 % of sore throats in children and 15 % of sore throats in adults. In rare instances, these group A streptococcal infections can lead to life-threatening complications, such as rheumatic fever, glomerulonephritis (damage to the tiny filters inside the kidneys), and paediatric neuropsychiatric disorders; as well as peritonsillar abscess, septic jugular-vein thrombophlebitis (inflammation with blood clot formation in one of the neck veins), and Vincent angina (also known as trench mouth)1. These complications call for urgent medical treatment and may require surgery1.
Fungal infection
This is caused by Candida albicans and is the rarest type of sore throat.
Clinical presentation
It is difficult to tell the difference between viral, bacterial, and fungal pharyngitis because the symptoms are similar1.
All of them feature sore throat, painful swallowing, and fever.
These symptoms are at their worst after 3 – 5 days and clear up around day 101. However, there are some physical characteristics that are specific to each type1.These are:
- Viral infection: Enlarged tonsils, redness, swelling and “cobble-stoning” of the back of the throat1. Additionally, swollen upper lip, enlarged spleen, swelling of the lymph nodes at the back of the neck, and rash may indicate Epstein-Barr virus specifically1.
- Bacterial infection: Swelling of the lymph nodes in the front of the neck, sandpaper-like rash, fluid secreted from the tonsils and petechiae on the palate1, 2. Petechiae are non-blanching spots (meaning they don’t disappear after being pressed) on the skin or mucous membrane, measuring less than 2 mm3. Other symptoms may include headache, nausea, vomiting, abdominal pain, and muscle aches2.
- Fungal infection: Angular cheilitis (inflammation of the lips) and painful, white plaques or smooth red patches on the upper throat at the back of the mouth1,4.
Non-infective Causes
Apart from infections due to viruses, bacteria, or fungi, sore throat can also be caused by:
- Allergy2
- Injury2
- Toxins2
- Neoplasia – growths, which can be either malignant or benign2
Diagnosis
Viral and bacterial pharyngitis are difficult to differentiate through clinical inspection because they are so similar2. However, it is unlikely to be streptococcal pharyngitis if you do not have a fever or if you have2:
- Red eyes
- Hoarseness
- Runny Nose
- Mouth ulcers
Although time-consuming, a throat swab with laboratory testing is the most reliable way to determine whether the origin of pharyngitis is viral or bacterial1.
Rapid antigen detection testing gives immediate results, although each test is designed to test for a specific infectious agent and cannot generally determine if the infection is viral or bacterial1.
Throat swab cultures do not differentiate between acute infection with streptococcus bacteria and an asymptomatic carrier status7. The percentage of asymptomatic carriers can reach 20 %, but in adults it is less than 5 %7.
Treatment
Viral pharyngitis usually clears up on its own, while bacterial and fungal infections usually call for antimicrobial therapy1. Depending on the diagnosis, healthcare providers may choose to wait or to initiate treatment immediately1. In bacterial pharyngitis, the main reason for prescribing antibiotics is to prevent rheumatic fever2.
Treatment Principles
Patients with a viral infection should receive treatment for symptoms only1. Patients who are at low risk for bacterial infection should receive treatment for symptom relief with follow-up after one week1. Patients with an intermediate risk of bacterial infection, can be given a delayed prescription and be instructed to use it should symptoms not improve within 3 – 5 days1.
Patients who are at increased risk of complications, such those who are immunocompromised and the elderly, should be tested as soon as possible and healthcare providers will act quickly if they suspect complications in these patients1.
Patients who may have Epstein-Barr virus should avoid contact sports to avoid risk of rupturing the spleen1.
Treatment Options
Treatment options for managing symptoms in case of viral infections include1:
- Lozenges
- Mouth rinses containing benzocaine or lidocaine
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen, along with paracetamol to reduce pain and fever
- Oral corticosteroids
For bacterial infections, a 6 – 10-day course of antibiotics is usually prescribed, or a single antibiotic injection if the patient is unlikely to complete their course of antibiotics1.
Fungal pharyngitis is treated with antifungal medication1.
Prevention
Viral pharyngitis can be prevented through6:
- Frequent handwashing
- Using disposable tissues
- Limiting contact with people.
Useful Tools
If you have a throat infection, your doctor may prescribe an oral throat spray for you. Oral throat sprays can be used for the relief of symptoms associated with throat infections. Some oral throat sprays contain antiseptics to kill germs, local anaesthetics for pain relief and anti-inflammatories to reduce inflammation and to provide further pain relief.
More information on the different parts and on how to use your oral throat spray
Once we remove the outer protective cap, we have the following components:
- Nozzle
- Removable spray tube
- Actuator Spindle
- Spray Bottle
Step 1
Remove the outer protective cap.
Step 2
Lift the nozzle.
Step 3
Place the nozzle in an open mouth.
Step 4
Spray 5 – 10 times onto the painful or inflamed area and swallow gently. Repeat every one-and-a-half to three hours as necessary.
Step 5
Rinse the actuator spindle and nozzle after every use. Rinse the spray tube in warm, running water for 30 seconds and allow the water to run through the spray tube. Shake off the excess water and leave the spray tube to dry completely.
