Sore throat

Definition

Sore throat, also called pharyngitis, is a painful inflammation of the back of the throat. It is a symptom of many conditions, but most often is associated with colds or influenza . Sore throat may be caused by either viral or bacterial infections or by environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) and influenza are more frequent.

Sore throats can be either acute or chronic. Acute sore throats are the more common. They may appear suddenly and last approximately three to about seven days. A chronic sore throat that is still present after three weeks may be a symptom of an unresolved underlying condition or disease, such as a sinus infection or mononucleosis .

Causes & symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever , or swollen lymph glands. Proper treatment depends on identifying the cause.

Viral sore throat

Viruses cause 90–95% of all sore throats. Cold and flu viruses are the main culprits. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis ). Cold symptoms usually accompany a viral sore throat. These can include a runny nose, cough , congestion, hoarseness, conjunctivitis , fever, and swollen lymph nodes in the neck. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection may include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea, vomiting , and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age 10 and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the virus, an infected person develops a sudden sore throat that is usually accompanied by a fever usually between 102–104°F (38.9–40°C). Tiny grayish-white blisters form on the throat and in the mouth. These fester and become small ulcers. Throat pain is often severe, interfering with swallowing. Children may easily become dehydrated if they are reluctant to eat or drink because of the pain. In addition, people with herpangina may vomit, have abdominal pain, and generally feel ill and miserable.

Another common cause of a viral sore throat is mononucleosis. Mononucleosis occurs when the Epstein-Barr virus infects one specific type of lymphocyte. The infection may spread to the lymphatic system, respiratory system, liver, spleen, and throat. Symptoms appear 30–50 days after exposure.

Mononucleosis, sometimes called the kissing disease, is extremely common in young adults. It is estimated that by the age of 35–40, 80–95% of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as mononucleosis in this age group. One of the main symptoms of mononucleosis is a severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test. Viral sore throats are contagious and are passed directly from person to person by coughing and sneezing .

Bacterial sore throat

From 5–10% of sore throats are caused by bacteria. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat , or GABHS pharyngitis. The acronym stands for "Group A beta-hemolytic streptococci." Anyone can get strep throat, but it is most common in school age children. Since three is a low risk of strep throat invading and damaging heart valves (rheumatic fever ), it is important to see a doctor who may prescribe antibiotics to eliminate the risk.

Pharyngeal gonorrhea , a sexually transmitted bacterial disease, causes a severe sore throat. Gonorrhea in the throat is transmitted by having oral sex with an infected person.

Noninfectious sore throat

Not all sore throats are caused by infection. Post-nasal drip from allergies and airborne irritants can cause sore throat. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to diagnose its cause without seeing a doctor and having laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats develop into serious diseases. It is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea , or abdominal pain.

Diagnosis of a sore throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis . Since both bacterial and viral sore throats are contagious and pass easily from person to person, the doctor will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

One test that doctors are using more often in diagnosing a sore throat is the rapid antigen test. While a throat culture may require 2 days for the laboratory to identify the causative organism, a rapid antigen test gives results in a few hours.

If mononucleosis is suspected, the doctor may do a Monospot test to look for antibodies indicating the presence of the Epstein-Barr virus. The test in inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine the presence of antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. As frustrating as it may be to the patient,

viral sore throat is best left to run its course without drug treatment. Antibiotics have no effect on a viral sore throat. They do not shorten the length of the illness, nor do they lessen the symptoms.

Treatment uses antiviral plants and herbs and vitamins to boost immunity and speed recovery.

• Aromatherapists recommend inhaling the fragrances of essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris ), eucalyptus (Eycalyptus globulus ), sage (Salvia officinalis ), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and turmeric (Curcuma longa ) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri ) internally for infection, or drinking ginger (Zingiber officinale ) or slippery elm (Ulmus fulva ) tea for pain.
• Homeopaths may treat sore throats with superdilute solutions of Lachesis, Belladonna, or Phytolacca, yellow jasmine (Gelsemium ), or mercury (Mercurius).
• Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A , and beta-carotene supplements.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If a sore throat is caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment. In the case of chronic sore throat in a child, the doctor may recommend a tonsillectomy (surgical removal of the tonsils).

Home care for sore throat

Regardless of the cause of a sore throat, there are some home care steps that people can take to ease their discomfort. These include:

• Gargling with warm double strength tea or warm salt water made by adding one teaspoon of salt to 8 oz of water.
• Drinking plenty of fluids, but avoiding acid juices like orange juice, which can irritate the throat. Sucking on popsicles is a good way to get fluids into children.
• Eating soft, nutritious foods like noodle soup and avoiding spicy foods.
• Refraining from smoking.
• Resting until the fever is gone, then resuming strenuous activities gradually.
• A room humidifier may make sore throat sufferers more comfortable.
• Antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Allopathic treatment

Sore throat caused by a streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed, even after symptoms of the sore throat improve. Stopping the antibiotic early can lead to a return of the sore throat. Sometimes a single injection of long-acting penicillin G is given instead of 10 days of oral treatment. These medications generally cost under $15.

Because mononucleosis is caused by a virus, there is no specific drug treatment available. Rest, a healthy diet, plenty of fluids, limiting heavy exercise and competitive sports, and treatment of aches with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren) are the prescribed treatments. Nearly 90% of mononucleosis infections are mild. The infected person does not normally get the disease again.

Aspirin should not be given to children because of its association with increased risk for Reye's Syndrome, a serious disease.

Expected results

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children the symptoms may last only a week, but in adolescents the symptoms last longer. Adults over age 30 have the most severe and long lasting symptoms. Adults may take up to six months to recover. In all age groups fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the patient should immediately seek emergency medical care.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. Untreated strep throat has the potential to cause scarlet fever , kidney damage, or rheumatic fever. Scarlet fever causes a rash, and can cause high fever and convulsions. Rheumatic fever causes inflammation of the heart and damage to the heart valves. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until after they have been taking antibiotics for 24 hours.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• Washing hands with warm water and soap frequently.
• Maintaining a balanced life with adequate sleep, nutrition , and personal fulfillment.
• Avoiding close contact with someone who has a sore throat.
• Not sharing food and eating utensils with anyone.
• Not smoking.
• Optimizing the functioning of the immune system by exercising and eating such immune-boosting foods as carrots, yams, shiitake mushrooms, etc.
• Avoiding sources of air pollution.

Resources

BOOK

Berkow, Robert. The Merck Manual of Diagnosis and Therapy Rahway, NJ: Merck Research Laboratories, 1992.

PERIODICALS

Larkin, Marilynn. "A Single, Rapid Test Suffices for Pharyngitis Diagnosis in High-Risk Patients." Lancet 358 (December 8, 2001): 1969.

National Institute of Allergy and Infectious Diseases. Infectious Mononucleosis Fact Sheet http://www.niaid.nih.gov/factsheets/infmono.htm (September 1997).

Kathleen Wright

Rebecca J. Frey, PhD

Sore throat

Definition

Sore throat is an upper respiratory infection that may be caused by inflammation of the pharynx, larynx, or tonsils. Thus, it is a symptom of many conditions, but most often is associated with common cold or influenza . Sore throat may be caused by either a virus or bacteria in addition to certain environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another. Sore throat and cold are more prevalent among children in daycare centers or schools and seem to be related to their lack of resistance as compared to the adolescents and adults. It is interesting to note that women in the age of 20–30 are affected by more cold attacks than men, which may be attributed to their contact with children. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent. The National Center for Health Statistics has estimated that common cold symptoms (which include sore throat) amounted to 62 million cases, in 1996, that needed medical attention.

Sore throats can be either acute or chronic. Acute sore throats are more common. They last from three to seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

Causes and symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever , or swollen lymph glands. Proper treatment depends on understanding the cause of the sore throat.

Viral sore throat

Viruses cause 90-95% of all sore throats. Cold and flu viruses are the main culprits although about 200 different viruses are known to cause the symptoms of sore throat. Rhinoviruses cause 30-35% of all adult colds in fall, spring, and summer. Coronaviruses cause the infections in winter and spring. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis). The causative agents of viral tonsillitis are Epstein-Barr virus, influenza virus, enterovirus, or adenoviruses. Cold symptoms almost always accompany a viral sore throat. These can include a runny nose, cough, congestion, hoarseness, conjunctivitis, and fever. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea , vomiting, and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age ten and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the virus, an infected person develops a sudden sore throat that is accompanied by a substantial fever usually between 102-104°F (38.9-40°C). Tiny grayish-white blisters form on the throat that turn into ulcerative lesions. Throat pain is often severe, interfering with swallowing. Children may become dehydrated if they are reluctant to eat or drink because of the pain. In addition, people with herpangina may vomit, have abdominal pain, and generally feel ill and miserable.

One other common cause of a viral sore throat is mononucleosis. An estimated 90% of mononucleosis cases are caused by the Epstein-Barr virus (EBV), while the remaining cases may be attributed to the cytomegalovirus. EBV is known to infect B lymphocytes (a subset of white blood cells). The infection spreads to the lymphatic system , respiratory system , liver , spleen, throat and salivary glands. Symptoms appear 30-50 days after exposure.

Mononucleosis, sometimes called the "kissing disease," is extremely common. It is estimated that by the age of 35-40, 80-95% of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as mononucleosis in this age group. One of the main symptoms of mononucleosis is severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test. Viral sore throats are contagious and are passed directly from person to person by coughing and sneezing.

Bacterial sore throat

About 5-10% of sore throats are caused by bacteria. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat . Anyone can get strep throat, This organism may also cause laryngitis, which is predominantly marked by hoarseness of voice, sore throat, dry and persistent cough, and fever. Yet another ailment caused by Streptococcus is pharyngitis, which is inflammation of pharynx leading to fever, tenderness in the neck glands, sore throat, abdominal pain, headache, cough, hoarseness, and skin rash. Other bacteria that are known to cause pharyngitis are groups C and G Streptococcus, Yersinia enterocolitica, and rarely Corynebacterium diphtheriae. Untreated streptococcal pharyngitis may lead to peritonsillar abscess that is accompanied by severe sore throat and hoarseness of voice. In these cases, immediate intervention by otolaryngologists is required to aspirate the abscess.

Pharyngeal gonorrhea, a sexually transmitted bacterial disease, causes severe sore throat. Gonorrhea in the throat is transmitted by having oral sex with an infected person.

Noninfectious sore throat

Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that are irritating to the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, heavy alcohol consumption, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to know what has caused it without laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats do develop into serious diseases. Because of this, it is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea, or abdominal pain.

Diagnosis of a sore throat begins with a physical examination of the throat and chest. The examiner will also look for signs of other illness, such as a sinus infection or bronchitis. Since both bacterial and viral sore throat are contagious and pass easily from person to person, the health care provider will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, laboratory Tests will be performed.

If mononucleosis is suspected, the doctor may do a mono spot test to look for antibodies indicating the presence of the Epstein-Barr virus. The test in inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine increased lymphocytes and the presence of specific antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. As frustrating as it may be to the patient, viral sore throat is best left to run its course without drug treatment. Antibiotics are ineffective against viruses. They do not shorten the length of the illness, nor do they lessen the symptoms.

Sore throat caused by a streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for ten days. Patients need to take the entire course of antibiotic prescribed, even after symptoms of the sore throat improve. Incomplete treatment may lead to the relapse of the symptoms. Occasionally a single intramuscular injection of long-acting penicillin G is administered instead of ten days of oral treatment. In cases of penicillin allergy, cephalexin, cefuroxime, or cefprozil are the preferred alternative antibiotics that are recommended. These medications generally cost under fifteen dollars.

Mononucleosis, being a viral infection, is self-limiting with no means of therapeutic control. Rest, a healthy diet, plenty of fluids, avoiding strenuous exercises and competitive sports are recommended. The acute phase of infection is treated with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren). Nearly 90% of mononucleosis infections are mild. The infected person does not normally get the disease again.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If sore throat is caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment.

Home care for sore throat

Regardless of the cause of a sore throat, there are some home care steps that can be taken to ease discomfort. These include:

• Taking acetaminophen or ibuprofen for pain. Aspirin should not be given to children because of its association with increased risk for Reye's syndrome, a serious disease.
• Gargling with warm double strength tea or warm salt water made by adding one teaspoon of salt to eight ounces of water.
• Drinking plenty of fluids, but avoiding acid juices like orange juice, which can irritate the throat. Sucking on popsicles is a good way to get fluids into children.
• Eating soft, nutritious foods like noodle soup and avoiding spicy foods.
• Refraining from smoking.
• Resting until the fever is gone, then resuming strenuous activities gradually.
• Often minimizing the dryness by using room humidifier may improve the symptoms of sore throat, especially in pediatric population.
• Antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Alternative treatment

Alternative treatment focuses on easing the symptoms of sore throat using herbs and botanical medicines.

• Aromatherapists recommend inhaling the fragrances of essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris), eucalyptus (Eycalyptus globulus), sage (Salvia officinalis), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and turmeric (Curcuma longa) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri) internally for infection or drinking ginger (Zingiber officinale), slippery elm (Ulmus fulva), sage or marshmallow tea for pain. Also fresh juice of Echinacea along with the root of goldenseal may have a soothing effect on the throat. The tannins found in blueberries, blackberries and red raspberries have also been shown to be effective for sore throats
• Homeopaths may treat sore throats with superdilute solutions of Lachesis, Belladonna, Phytolacca, or yellow jasmine (Gelsemium).
• Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A , and beta-carotene supplements.

KEY TERMS

Antigen —A foreign protein to which the body reacts by making antibodies.

Conjunctivitis —An inflammation of the membrane surrounding the eye; also known as pink-eye.

Lymphocyte —A type of white blood cell. Lymphocytes play an important role in fighting disease.

Pharynx —The pharynx is the part of the throat that lies between the mouth and the larynx or voice box.

Tonsils —Fleshy tissues located on either side of the back of the throat.

Toxin —A poison. In the case of scarlet fever, the toxin is secreted as a byproduct of the growth of the streptococcus bacteria and causes a rash.

Prognosis

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children the symptoms may last only a week, but in adolescents the symptoms last longer. Adults over age 30 have the most severe and long lasting symptoms. Adults may take up to six months to recover. In all age groups fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the patient should immediately seek emergency medical care.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. If left untreated strep throat may lead to scarlet fever, rheumatic fever resulting in rheumatic heart disease or glomerulonephritis. Scarlet fever is a combination of sore throat with rash of sand paper consistency that may appear in the lower abdomen and gradually spread to the trunk. Rheumatic fever is marked by inflammation and pain in the joints. In severe cases, inflammation of the heart valves can lead to heart failure . Glomerulonephritis is inflammation of glomeruli that serve as filters in the kidney. The damaged filters result in red urine due to the release of red blood cells. The treatment for this disorder is aimed at controlling the symptoms. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until after they have been taking antibiotics for 24 hours.

Health care team roles

Sore throat may not always need medical intervention, but persistent sore throats and accompanying symptoms should not be ignored. A general physician helps in determining whether the sore throat is a result of a viral or bacterial infection. A thorough physical examination followed by laboratory tests in cases of a doubtful bacterial infection is performed. If a bacterial sore throat is diagnosed by the physician, antibiotics are prescribed. Health care professionals, including the pharmacists, play a key role in cautioning the patient regarding the potential allergic reactions associated with the intake of antibiotics. Some of these reactions may be serious and need immediate medical intervention.

There may be lingering symptoms or changes in the symptoms after visiting the doctor. Some of the concerns will be:

• persistent fever
• continuing and severe sore throat
• discomfort in opening the mouth wide
• dizziness

In such cases, a doctor's advice is highly recommended. In addition, health care professionals will provide the best resources for nutrition , suggestions for pain relievers and effective home remedies for viral sore throats.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• Washing hands well and frequently.
• Avoiding close contact with someone who has a sore throat.
• Not sharing food and eating utensils with anyone.
• Cleaning the environmental surfaces with a disinfectant.
• Not smoking.
• Avoiding polluted air.
• Using a room humidifier at home during the winter months when the dryness is maximum.
• Avoiding exposures to sudden and frequent changes in temperatures (in winter, being exposed to severe cold outside and heated room within the home).

Resources

BOOKS

Cummings, Stephen and Dana Ullman. "Sore Throats." Everybody's Guide to Homeopathic Medicine. Health World Online, <http://www.healthy.net>.

Harrison's Principles of Internal Medicine, Vol. 1. 14th ed. New York: McGraw-Hill, 1998.

PERIODICALS

National Institute of Allergy and Infectious Diseases. The Common Cold Fact Sheet.<http://www.niaid.nih.gov/factsheets/cold.htm>.March 26, 2001).

OTHER

"Laryngitis." Virtual health fair. March 2000, <http://www.vfair.com/conditions/laryngitis.htm>.

"Mononucleosis." Virtual health fair. <http://www.vfair.com/conditions/mononucleosis.htm>.(March 19, 2001).

"When you have a sore throat." American Family Physician <http://www.aafp.org/afp/970100ap/970100a.htm>.

Tish Davidson

Kausalya Santhanam

Sore Throat

Definition

Sore throat is an upper respiratory infection that may be caused by inflammation of the pharynx, larynx, or tonsils. Thus, it is a symptom of many conditions, but most often is associated with common cold or influenza. Sore throat may be caused by either a virus or bacteria in addition to certain environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another. Sore throat and cold are more prevalent among children in daycare centers or schools and seem to be related to their lack of resistance as compared to the adolescents and adults. It is interesting to note that women in the age of 20 to 30 are affected by more cold attacks than men, which may be attributed to their more frequent contacts with children. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent. The National Center for Health Statistics has estimated that common cold symptoms (which include sore throat) amounted to 62 million cases, in 1996, that needed medical attention.

Sore throats can be either acute or chronic. Acute sore throats are more common. They last from three to seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

Causes and symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever, or swollen lymph glands. Proper treatment depends on understanding the cause of the sore throat.

Viral sore throat

Viruses cause 90-95% of all sore throats. Cold and flu viruses are the main culprits although about 200 different viruses are known to cause the symptoms of sore throat. Rhinoviruses cause 30-35% of all adult colds in fall, spring, and summer. Coronaviruses cause the infections in winter and spring. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis). The causative agents of viral tonsillitis are Epstein-Barr virus, influenza virus, enterovirus, or adenoviruses. Cold symptoms almost always accompany a viral sore throat. These can include a runny nose, cough, congestion, hoarseness, conjunctivitis, and fever. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea, vomiting, and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age ten and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the virus, an infected person develops a sudden sore throat that is accompanied by a substantial fever usually between 102-104°F (38.9-40°C). Tiny grayish-white blisters form on the throat that turn into ulcerative lesions. Throat pain is often severe, interfering with swallowing. Children may become dehydrated if they are reluctant to eat or drink because of the pain. In addition, people with herpangina may vomit, have abdominal pain, and generally feel ill and miserable.

One other common cause of a viral sore throat is mononucleosis. An estimated 90% of mononucleosis cases are caused by the Epstein-Barr virus (EBV), while the remaining cases may be attributed to the cytomegalovirus. EBV is known to infect B lymphocytes (a subset of white blood cells). The infection spreads to the lymphatic system, respiratory system, liver, spleen, throat and salivary glands. Symptoms appear 30-50 days after exposure.

Mononucleosis, sometimes called the "kissing disease," is extremely common. It is estimated that by the age of 35-40, 80-95% of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as mononucleosis in this age group. One of the main symptoms of mononucleosis is severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test. Viral sore throats are contagious and are passed directly from person to person by coughing and sneezing.

Bacterial sore throat

About 5-10% of sore throats are caused by bacteria. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat. Anyone can get strep throat, This organism may also cause laryngitis, which is predominantly marked by hoarseness of voice, sore throat, dry and persistent cough, and fever. Yet another ailment caused by Streptococcus is pharyngitis, which is inflammation of pharynx leading to fever, tenderness in the neck glands, sore throat, abdominal pain, headache, cough, hoarseness, and skin rash. Other bacteria that are known to cause pharyngitis are groups C and G Streptococcus, Yersinia enterocolitica, and rarely Corynebacterium diphtheriae. Untreated streptococcal pharyngitis may lead to peritonsillar abscess that is accompanied by severe sore throat and hoarseness of voice. In these cases, immediate intervention by otolaryngologists is required to aspirate the abscess.

Pharyngeal gonorrhea, a sexually transmitted bacterial disease, causes severe sore throat. Gonorrhea in the throat is transmitted by having oral sex with an infected person.

Noninfectious sore throat

Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that are irritating to the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, heavy alcohol consumption, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to know what has caused it without laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats do develop into serious diseases. Because of this, it is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea, or abdominal pain.

Diagnosis of a sore throat begins with a physical examination of the throat and chest. The examiner will also look for signs of other illness, such as a sinus infection or bronchitis. Since both bacterial and viral sore throat are contagious and pass easily from person to person, the health care provider will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, laboratory tests will be performed.

If mononucleosis is suspected, the doctor may do a mono spot test to look for antibodies indicating the presence of the Epstein-Barr virus. The test is inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine increased lymphocytes and the presence of specific antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. As frustrating as it may be to the patient, viral sore throat is best left to run its course without drug treatment. Antibiotics are ineffective against viruses. They do not shorten the length of the illness, nor do they lessen the symptoms.

Sore throat caused by a streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for ten days. Patients need to take the entire course of antibiotic prescribed, even after symptoms of the sore throat improve. Incomplete treatment may lead to the relapse of the symptoms. Occasionally a single intramuscular injection of long-acting penicillin G is administered instead of ten days of oral treatment. In cases of penicillin allergy, cephalexin, cefuroxime, or cefprozil are the preferred alternative antibiotics that are recommended. These medications generally cost under fifteen dollars.

Mononucleosis, being a viral infection, is self-limiting with no means of therapeutic control. Rest, a healthy diet, plenty of fluids, avoiding strenuous exercises and competitive sports are recommended. The acute phase of infection is treated with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren). Nearly 90% of mononucleosis infections are mild. The infected person does not normally get the disease again.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If sore throat is caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment.

Home care for sore throat

Regardless of the cause of a sore throat, there are some home care steps that can be taken to ease discomfort. These include:

• Taking acetaminophen or ibuprofen for pain. Aspirin should not be given to children because of its association with increased risk for Reye's syndrome, a serious disease.
• Gargling with warm double strength tea or warm salt water made by adding one teaspoon of salt to eight ounces of water.
• Drinking plenty of fluids, but avoiding acid juices like orange juice, which can irritate the throat. Sucking on popsicles is a good way to get fluids into children.
• Eating soft, nutritious foods like noodle soup and avoiding spicy foods.
• Refraining from smoking.
• Resting until the fever is gone, then resuming strenuous activities gradually.
• Often minimizing the dryness by using room humidifier may improve the symptoms of sore throat, especially in pediatric population.
• Antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Alternative treatment

Alternative treatment focuses on easing the symptoms of sore throat using herbs and botanical medicines.

• Aromatherapists recommend inhaling the fragrances of essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris), eucalyptus (Eucalyptus globulus), sage (Salvia officinalis), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and turmeric (Curcuma longa) powder, or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri) internally for infection or drinking ginger (Zingiber officinale), slippery elm (Ulmus fulva), sage or marshmallow tea for pain. Also fresh juice of Echinacea along with the root of goldenseal may have a soothing effect on the throat. The tannins found in blueberries, blackberries, and red raspberries have also been shown to be effective for sore throats
• Homeopaths may treat sore throats with superdilute solutions of Lachesis, Belladonna, Phytolacca, or yellow jasmine (Gelsemium).
• Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A, and beta-carotene supplements.

Prognosis

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children the symptoms may last only a week, but in adolescents the symptoms last longer. Adults over age 30 have the most severe and long-lasting symptoms. Adults may take up to six months to recover. In all age groups, fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the patient should immediately seek emergency medical care.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. If left untreated, strep throat may lead to scarlet fever, rheumatic fever resulting in rheumatic heart disease, or glomerulonephritis. Scarlet fever is a combination of sore throat with rash of sand paper consistency that may appear in the lower abdomen and gradually spread to the trunk. Rheumatic fever is marked by inflammation and pain in the joints. In severe cases, inflammation of the heart valves can lead to heart failure. Glomerulonephritis is inflammation of glomeruli, which serve as filters in the kidney. The damaged filters result in red urine due to the release of red blood cells. The treatment for this disorder is aimed at controlling the symptoms. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until after they have been taking antibiotics for 24 hours.

Health care team roles

Sore throat may not always need medical intervention, but persistent sore throats and accompanying symptoms should not be ignored. A general physician helps in determining whether the sore throat is a result of a viral or bacterial infection. A thorough physical examination followed by laboratory tests in cases of a doubtful bacterial infection is performed. If a bacterial sore throat is diagnosed by the physician, antibiotics are prescribed. Health care professionals, including the pharmacists, play a key role in cautioning the patient regarding the potential allergic reactions associated with the intake of antibiotics. Some of these reactions may be serious and need immediate medical intervention.

There may be lingering symptoms or changes in the symptoms after visiting the doctor. Some of the concerns will be:

• persistent fever
• continuing and severe sore throat
• discomfort in opening the mouth wide
• dizziness

In such cases, a doctor's advice is highly recommended. In addition, health care professionals will provide the best resources for nutrition, suggestions for pain relievers, and effective home remedies for viral sore throats.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• Washing hands well and frequently.
• Avoiding close contact with someone who has a sore throat.
• Not sharing food and eating utensils with anyone.

• Cleaning the environmental surfaces with a disinfectant.
• Not smoking.
• Avoiding polluted air.
• Using a room humidifier at home during the winter months when the dryness is maximum.
• Avoiding exposures to sudden and frequent changes in temperatures (in winter, being exposed to severe cold outside and heated room within the home).

KEY TERMS

Antigen— A foreign protein to which the body reacts by making antibodies.

Conjunctivitis— An inflammation of the membrane surrounding the eye; also known as pinkeye.

Lymphocyte— A type of white blood cell. Lymphocytes play an important role in fighting disease.

Pharynx— The pharynx is the part of the throat that lies between the mouth and the larynx or voice box.

Tonsils— Fleshy tissues located on either side of the back of the throat.

Toxin— A poison. In the case of scarlet fever, the toxin is secreted as a byproduct of the growth of the streptococcus bacteria and causes a rash.

Resources

BOOKS

Cummings, Stephen, and Dana Ullman. "Sore Throats." Everybody's Guide to Homeopathic Medicine. Health World Online, 〈http://www.healthy.net〉.

Harrison's Principles of Internal Medicine, 14th ed. Vol. 1. New York: McGraw-Hill, 1998.

PERIODICALS

National Institute of Allergy and Infectious Diseases. The Common Cold Fact Sheet. 〈http://www.niaid.nih.gov/factsheets/cold.htm〉 (March 26, 2001).

OTHER

"Laryngitis." Virtual health fair. March 19, 2001. 〈http://www.vfair.com/conditions/laryngitis.htm〉.

"Mononucleosis." Virtual health fair. March 19, 2001. 〈http://www.vfair.com/conditions/mononucleosis.htm〉.

"When you have a sore throat." American Family Physician〈http://www.aafp.org/afp/970100ap/970100a.htm〉.

Sore throat

Definition

Sore throat is a painful inflammation of the mucous membranes lining the pharynx.

Description

Sore throat is also called pharyngitis. It is a symptom of many conditions, but is most often associated with colds or influenza . Sore throat may be caused by either viral or bacterial infections or environmental conditions. Most sore throats heal without complications, but they should not be ignored, as some develop into serious illnesses.

Sore throats can be either acute or chronic. Acute sore throats are more common than chronic sore throats. They appear suddenly and last from three to about seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

Transmission

The way in which a sore throat is transmitted depends on the agent causing the sore throat. Viral and bacterial sore throats are usually passed in the same way as the common cold : sneezing, coughing, sharing drinking glasses or silverware, or in any other way germ particles can easily move from one person to another. Some sore throats are caused by environmental factors or allergies . These sore throats cannot be passed from one person to another.

Demographics

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent.

About 10 percent of children who go to the doctor each year have pharyngitis. Forty percent of the time that children are taken to the doctor with a sore throat, the sore throat is diagnosed as viral. An antibiotic cannot help to cure a virus; a virus has to be left to run its course.

In about 30 percent of the cases for which children are taken to the doctor, bacteria are found to be responsible for the sore throat. Many of these bacterial sore throats are cases of strep throat . Sore throats caused by bacteria can be successfully treated with antibiotics . In about 40 percent of these cases of pharyngitis, it is never clear what caused the sore throat. In these cases it is possible that the virus or bacteria was not identified, or that other factors such as environment or post-nasal drip may have been responsible.

Causes and symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever , or swollen lymph glands. Proper treatment depends on understanding the cause of the sore throat.

Viral sore throat

Viruses cause most sore throats. Cold and flu viruses are the main culprits. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis ). Cold symptoms usually accompany a viral sore throat. These can include a runny nose, cough , congestion, hoarseness, conjunctivitis , and fever. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that causes sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea , vomiting , and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age 10 and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the coxsackie virus, an infected person develops a sudden sore throat that is accompanied by a substantial fever, usually between 102–104°F (38.9–40°C). Tiny grayish-white blisters form on the throat and in the mouth. These fester and become small ulcers. Throat pain is often severe, interfering with swallowing. Children may become dehydrated if they are reluctant to eat or drink because of the pain. In addition, children with herpangina may vomit, have abdominal pain, and generally feel very ill.

One other common cause of a viral sore throat is mononucleosis. Mononucleosis occurs when the Epstein-Barr virus infects one specific type of lymphocyte. The infection spreads to the lymphatic system, respiratory system, liver, spleen, and throat. Symptoms appear 30–50 days after exposure.

Mononucleosis, sometimes called the kissing disease, is extremely common. It is estimated that by the age of 35–40, 80–95 percent of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as mononucleosis in this age group. One of the main symptoms of mononucleosis is a severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test.

Bacterial sore throat

Fewer sore throats are caused by bacteria than are caused by viruses. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat. Anyone can get strep throat, but it is most common in school age children.

Noninfectious sore throat

Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as breathing secondhand smoke, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. Children who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

When to call the doctor

If the child has had a sore throat and fever for more than 24 hours, a doctor should be contacted so a strep test can be performed. Identifying and treating strep throat within about a week is vital to preventing rheumatic fever . If the child has had a sore throat, even without fever, for more than 48 hours, the doctor should be consulted. If the child has trouble swallowing or breathing, or is drooling excessively (in small children), emergency medical attention should be sought immediately.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to know what has caused it without laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats do develop into serious diseases. Because of this, it is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea , or abdominal pain.

Diagnosis of a sore throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis . Since both bacterial and viral sore throat are contagious and pass easily from person to person, the doctor will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

If mononucleosis is suspected, the doctor may do a mono spot test to look for antibodies indicating the presence of the Epstein-Barr virus. The strep test is inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine the presence of antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. Viral sore throats are best left to run their course without drug treatment, because antibiotics have no effect on a viral sore throat. They do not shorten the length of the illness, nor do they lessen the symptoms.

Sore throat caused by streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication, although other antibiotics are also effective if the child is allergic to penicillin. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed, even after symptoms of the sore throat improve. If it is unlikely that the parent will be able to ensure that the child will take the full course of antibiotics, a one-time injection of antibiotics can be administered instead. Cessation of the antibiotic early can lead to a return of the sore throat.

Because a virus causes mononucleosis, there is no specific drug treatment available. Rest, a healthy diet, plenty of fluids, limiting heavy exercise and competitive sports , and treatment of aches with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren) will help the illness pass. Nearly 90 percent of mononucleosis infections are mild. The infected person does not normally get the disease again.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If a sore throat is caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment.

Home care for sore throat

Regardless of the cause of a sore throat, there are some home care steps that people can take to ease their discomfort. These include:

• taking acetaminophen or ibuprofen for pain (aspirin should not be given to children because of its association with increased risk for Reye's syndrome , a serious disease)
• gargling with warm double strength tea or warm salt water made by adding 1 tsp of salt to 8 oz (237 ml) of water
• drinking plenty of fluids, but avoiding acid juices such as orange juice, which can irritate the throat (sucking on popsicles is a good way to get fluids into children)
• eating soft, nutritious foods like noodle soup and avoiding spicy foods
• resting until the fever is gone, then resuming strenuous activities gradually
• using a room humidifier to make sore throat sufferers more comfortable
• using antiseptic lozenges and sprays with caution, as they may aggravate the sore throat rather than improve it

Alternative treatment

Alternative treatment focuses on easing the symptoms of sore throat using herbs and botanical medicines.

• Aromatherapists recommend inhaling the fragrances of the essential oils of lavender (Lavandula officinalis ), thyme (Thymus vulgaris ), eucalyptus (Eucalyptus globulus ), sage (Salvia officinalis ), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and tumeric (Curcuma longa ) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri ) internally for infection or drinking ginger (Zingiber officinale ) or slippery elm (Ulmus fulva ) tea for pain.
• Homeopaths may treat sore throats with superdilute solutions of Lachesis, Belladonna, Phytolacca, or yellow jasmine (Gelsemium ).

Nutritional concerns

Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A, and beta-carotene supplements. Although it may hurt to swallow, it is very important that the child does not become dehydrated. Sucking on popsicles or drinking warm broth can help. If the child shows any signs of dehydration he or she should be taken to the doctor.

Prognosis

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children, the symptoms may last only a week, but in adolescents the symptoms usually last longer. In all age groups, fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the individual should seek emergency medical care immediately.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. Untreated strep throat has the potential to cause scarlet fever , kidney damage, or rheumatic fever. Scarlet fever causes a rash and can cause high fever and convulsions. Rheumatic fever causes inflammation of the heart and damage to the heart valves. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until they have taken antibiotics for 24 hours.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• washing hands well and frequently
• avoiding close contact with someone who has a sore throat
• not sharing food and eating utensils with anyone
• staying out of polluted air

Parental concerns

Viral sore throats usually resolve themselves fairly quickly although they may be very uncomfortable. If the child has a fever and sore throat for more than 24 hours it may be a sign of a bacterial infection and the child should be taken to the doctor. Prompt treatment with antibiotics for strep throat is important because it can prevent rheumatic fever, a serious disease that can cause damage to the heart.

KEY TERMS

Antigen —A substance (usually a protein) identified as foreign by the body's immune system, triggering the release of antibodies as part of the body's immune response.

Lymphocyte —A type of white blood cell that participates in the immune response. The two main groups are the B cells that have antibody molecules on their surface and T cells that destroy antigens.

Pharynx —The throat, a tubular structure that lies between the mouth and the esophagus.

See also Common cold; Mononucleosis.

Resources

PERIODICALS

"Coughs, Colds, and Sore Throat." Practice Nurse v.26, i.2 (July 25, 2003): 38.

Dinelli, D.L. "Sore Throat and Difficulty Breathing." American Family Physician 63, no. 11 (June 1, 2001): 2255.

"Sore Throat." The Journal of the American Medical Association 291, no. 13 (April 7, 2004): 1664.

Vincent, Miriam T., Celestin, Nadhia, Hussain, Aneela N. "Pharyngitis." American Family Physician 69, no. 6 (March 15, 2004): 1465.

Tish Davidson, A.M.

Sore Throat

Definition

Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza. Sore throat may be caused by either viral or bacterial infections or environmental conditions. Most sore throats heal without complications, but they should not be ignored because some develop into serious illnesses.

Description

Almost everyone gets a sore throat at one time or another, although children in child care or grade school have them more often than adolescents and adults. Sore throats are most common during the winter months when upper respiratory infections (colds) are more frequent.

Sore throats can be either acute or chronic. Acute sore throats are the more common. They appear suddenly and last from three to about seven days. A chronic sore throat lasts much longer and is a symptom of an unresolved underlying condition or disease, such as a sinus infection.

Causes and symptoms

Sore throats have many different causes, and may or may not be accompanied by cold symptoms, fever, or swollen lymph glands. Proper treatment depends on understanding the cause of the sore throat.

Viral sore throat

Viruses cause 90-95% of all sore throats. Cold and flu viruses are the main culprits. These viruses cause an inflammation in the throat and occasionally the tonsils (tonsillitis ). Cold symptoms almost always accompany a viral sore throat. These can include a runny nose, cough, congestion, hoarseness, conjunctivitis, and fever. The level of throat pain varies from uncomfortable to excruciating, when it is painful for the patient to eat, breathe, swallow, or speak.

Another group of viruses that cause sore throat are the adenoviruses. These may also cause infections of the lungs and ears. In addition to a sore throat, symptoms that accompany an adenovirus infection include cough, runny nose, white bumps on the tonsils and throat, mild diarrhea, vomiting, and a rash. The sore throat lasts about one week.

A third type of virus that can cause severe sore throat is the coxsackie virus. It can cause a disease called herpangina. Although anyone can get herpangina, it is most common in children up to age ten and is more prevalent in the summer or early autumn. Herpangina is sometimes called summer sore throat.

Three to six days after being exposed to the virus, an infected person develops a sudden sore throat that is accompanied by a substantial fever usually between 102-104°F (38.9-40°C). Tiny grayish-white blisters form on the throat and in the mouth. These fester and become small ulcers. Throat pain is often severe, interfering with swallowing. Children may become dehydrated if they are reluctant to eat or drink because of the pain. In addition, people with herpangina may vomit, have abdominal pain, and generally feel ill and miserable.

One other common cause of a viral sore throat is mononucleosis. Mononucleosis occurs when the Epstein-Barr virus infects one specific type of lymphocyte. The infection spreads to the lymphatic system, respiratory system, liver, spleen, and throat. Symptoms appear 30-50 days after exposure.

Mononucleosis, sometimes called the kissing disease, is extremely common. It is estimated that by the age of 35-40, 80-95% of Americans will have had mononucleosis. Often, symptoms are mild, especially in young children, and are diagnosed as a cold. Since symptoms are more severe in adolescents and adults, more cases are diagnosed as monomucleosis in this age group. One of the main symptoms of mononucleosis is a severe sore throat.

Although a runny nose and cough are much more likely to accompany a sore throat caused by a virus than one caused by a bacteria, there is no absolute way to tell what is causing the sore throat without a laboratory test. Viral sore throats are contagious and are passed directly from person to person by coughing and sneezing.

Bacterial sore throat

From 5-10% of sore throats are caused by bacteria. The most common bacterial sore throat results from an infection by group A Streptococcus. This type of infection is commonly called strep throat. Anyone can get strep throat, but it is most common in school age children.

Pharyngeal gonorrhea, a sexually transmitted bacterial disease, causes a severe sore throat. Gonorrhea in the throat is transmitted by having oral sex with an infected person.

Noninfectious sore throat

Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as heavy smoking or breathing second-hand smoke, heavy alcohol consumption, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.

Diagnosis

It is easy for people to tell if they have a sore throat, but difficult to know what has caused it without laboratory tests. Most sore throats are minor and heal without any complications. A small number of bacterial sore throats do develop into serious diseases. Because of this, it is advisable to see a doctor if a sore throat lasts more than a few days or is accompanied by fever, nausea, or abdominal pain.

Diagnosis of a sore throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis. Since both bacterial and viral sore throat are contagious and pass easily from person to person, the doctor will seek information about whether the patient has been around other people with flu, sore throat, colds, or strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

If mononucleosis is suspected, the doctor may do a mono spot test to look for antibodies indicating the presence of the Epstein-Barr virus. The test in inexpensive, takes only a few minutes, and can be done in a physician's office. An inexpensive blood test can also determine the presence of antibodies to the mononucleosis virus.

Treatment

Effective treatment varies depending on the cause of the sore throat. As frustrating as it may be to the patient, viral sore throat is best left to run its course without drug treatment. Antibiotics have no effect on a viral sore throat. They do not shorten the length of the illness, nor do they lessen the symptoms.

Sore throat caused by a streptococci or another bacteria must be treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed, even after symptoms of the sore throat improve. Stopping the antibiotic early can lead to a return of the sore throat. Occasionally a single injection of long-acting penicillin G is given instead of 10 days of oral treatment. These medications generally cost under $15.

Because mononucleosis is caused by a virus, there is no specific drug treatment available. Rest, a healthy diet, plenty of fluids, limiting heavy exercise and competitive sports, and treatment of aches with acetaminophen (Datril, Tylenol, Panadol) or ibuprofen (Advil, Nuprin, Motrin, Medipren) will help the illness pass. Nearly 90% of mononucleosis infections are mild. The infected person does not normally get the disease again.

In the case of chronic sore throat, it is necessary to treat the underlying disease to heal the sore throat. If a sore throat caused by environmental factors, the aggravating stimulus should be eliminated from the sufferer's environment.

Home care for sore throat

Regardless of the cause of a sore throat, there are some home care steps that people can take to ease their discomfort. These include:

• taking acetaminophen or ibuprofen for pain; aspirin should not be given to children because of its association with increased risk for Reye's Syndrome, a serious disease
• gargling with warm double strength tea or warm salt water made by adding 1 tsp of salt to 8 oz (237 ml) of water
• drinking plenty of fluids, but avoiding acid juices like orange juice, which can irritate the throat (sucking on popsicles is a good way to get fluids into children)
• eating soft, nutritious foods like noodle soup and avoiding spicy foods
• refraining from smoking
• resting until the fever is gone, then resuming strenuous activities gradually
• a room humidifier may make sore throat sufferers more comfortable
• antiseptic lozenges and sprays may aggravate the sore throat rather than improve it

Alternative treatment

Alternative treatment focuses on easing the symptoms of sore throat using herbs and botanical medicines.

• Aromatherapists recommend inhaling the fragrances of essential oils of lavender (Lavandula officinalis), thyme (Thymus vulgaris ), eucalyptus (Eycalyptus globulus ), sage (Salvia officinalis ), and sandalwood.
• Ayurvedic practitioners suggest gargling with a mixture of water, salt, and tumeric (Curcuma longa ) powder or astringents such as alum, sumac, sage, and bayberry (Myrica spp.).
• Herbalists recommend taking osha root (Ligusticum porteri ) internally for infection or drinking ginger (Zingiber officinale ) or slippery elm (Ulmus fulva ) tea for pain.
• Homeopaths may treat sore throats with superdilute solutions Lachesis, Belladonna, Phytolacca ), yellow jasmine (Gelsemium ), or mercury.
• Nutritional recommendations include zinc lozenges every two hours along with vitamin C with bioflavonoids, vitamin A, and beta-carotene supplements.

Prognosis

Sore throat caused by a viral infection generally clears up on its own within one week with no complications. The exception is mononucleosis. Ninety percent of cases of mononucleosis clear up without medical intervention or complications, so long as dehydration does not occur. In young children the symptoms may last only a week, but in adolescents the symptoms last longer. Adults over age 30 have the most severe and long lasting symptoms. Adults may take up to six months to recover. In all age groups fatigue and weakness may continue for up to six weeks after other symptoms disappear.

In rare cases of mononucleosis, breathing may be obstructed because of swollen tonsils, adenoids, and lymph glands. If this happens, the patient should immediately seek emergency medical care.

Patients with bacterial sore throat begin feeling better about 24 hours after starting antibiotics. Untreated strep throat has the potential to cause scarlet fever, kidney damage, or rheumatic fever. Scarlet fever causes a rash, and can cause high fever and convulsions. Rheumatic fever causes inflammation of the heart and damage to the heart valves. Taking antibiotics within the first week of a strep infection will prevent these complications. People with strep throat remain contagious until after they have been taking antibiotics for 24 hours.

Prevention

There is no way to prevent a sore throat; however, the risk of getting one or passing one on to another person can be minimized by:

• washing hands well and frequently
• avoiding close contact with someone who has a sore throat
• not sharing food and eating utensils with anyone
• not smoking
• staying out of polluted air

Resources

BOOKS

Berktow, Robert, editor. The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: Merck Research Laboratories, 1992.

KEY TERMS

Antigen— A foreign protein to which the body reacts by making antibodies

Conjunctivitis— An inflammation of the membrane surrounding the eye; also known as pinkeye.

Lymphocyte— A type of white blood cell. Lymphocytes play an important role in fighting disease.

Pharynx— The pharynx is the part of the throat that lies between the mouth and the larynx or voice box.

Toxin— A poison. In the case of scarlet fever, the toxin is secreted as a byproduct of the growth of the streptococcus bacteria and causes a rash.