Sore throat

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Sore throat
Pharyngitis.jpg
Viral pharyngitis, the most common cause of a sore throat.

Sore throat, also known as throat pain, is pain or irritation of the throat. [1] Usually, causes of sore throat include:

Contents

The majority of sore throats are caused by a virus, for which antibiotics are not helpful. [2] A strong association between antibiotic misuse and antibiotic resistance has been shown. [3]

For sore throat caused by bacteria (GAS), treatment with antibiotics may help the person get better faster, reduce the risk that the bacterial infection spreads, prevent retropharyngeal abscesses and quinsy, and reduce the risk of other complications such as rheumatic fever and rheumatic heart disease. [2] In most developed countries, post-streptococcal diseases have become far less common. For this reason, awareness and public health initiatives to promote minimizing the use of antibiotics for viral infections have become the focus. [2]

Approximately 35% of childhood sore throats and 5-25% of adults sore throats are caused by a bacterial infection from group A streptococcus. [2] Sore throats that are "non-group A streptococcus" are assumed to be caused by a viral infection. Sore throat is a common reason for people to visit their primary care doctors and the top reason for antibiotic prescriptions by primary care practitioners such as family doctors. [2] In the United States, about 1% of all visits to the hospital emergency department, physician office and medical clinics, and outpatient clinics are for sore throat (over 7 million visits for adults and 7 million visits for children per year). [2]

Definition

A sore throat is pain felt anywhere in the throat. [4]

Presentation

Symptoms of sore throat include:

Diagnosis

The most common cause (80%) is acute viral pharyngitis, a viral infection of the throat. [4] Other causes include other bacterial infections (such as group A streptococcus or streptococcal pharyngitis), trauma, and tumors. [4] Gastroesophageal (acid) reflux disease can cause stomach acid to back up into the throat and also cause the throat to become sore. [6] In children, streptococcal pharyngitis is the cause of 35–37% of sore throats. [7] [2]

The symptoms of a viral infection and a bacterial infection may be very similar. Some clinical guidelines suggest that the cause of a sore throat is confirmed prior to prescribing antibiotic therapy and only recommend antibiotics for children who are at high risk of non-suppurative complications. [8] [9] A group A streptococcus infection can be diagnosed by throat culture or a rapid test. In order to perform a throat culture, a sample from the throat (obtained by swabbing) is cultured (grown) on a blood agar plate to confirm the presence of group A streptococcus. [2] Throat cultures are effective for people who have a low bacterial count (high sensitivity), however, throat cultures usually take about 48 hours to obtain the results. [2]

Clinicians often also make treatment decisions based on the person's signs and symptoms alone. In the US, approximately 2/3rd of adults and half of children with sore throat are diagnosed based on symptoms and do not have testing for the presence of GAS to confirm a bacterial infection. [2]

Rapid tests to detect GAS (bacteria) give a positive or negative result that is usually based on a colour change on a test strip that contains a throat swab (sample). Test strips detect a cell wall carbohydrate that is specific to GAS by using an immunologic reaction. [2] Rapid testing can be performed in the doctors office and usually takes 5–10 minutes for the test strip to indicate the result. Specificity for most rapid tests is approximately 95%, however sensitivity is about 85%. [2] Although the use of rapid testing has been linked with an overall reduction in antibiotic prescriptions, further research is necessary to understand other outcomes such as safety, and when the person starts to feel better. [2]

Numerous clinical scoring systems (decision tools) have also been developed to support clinical decisions. Scoring systems that have been proposed include Centor's, McIsaac's, and the feverPAIN. [2] A clinical scoring system is often used along with a rapid test. [2] The scoring systems use observed signs and symptoms in order to determine the likelihood of a bacterial infection. [2]

Management

Sore or scratchy throat can temporarily be relieved by gargling a solution of 1/4 to 1/2 teaspoon salt dissolved in an 8-ounce or 230 ml glass of water. [10]

Pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help in the management of pain. [11] [12] The use of corticosteroids seems to increase slightly the likelihood of resolution and the reduction of pain, but more analysis is necessary to ensure that this minimal benefit outweighs the risks. [12] [13] Antibiotics probably reduce pain, diminish headaches and could prevent some sore throat complications; but, since these effects are small, they must be balanced with the threat of antimicrobial resistance. [14] It is not known whether antibiotics are effective for preventing recurrent sore throat. [15]

There is an old wives' tale that having a hot drink can help with common cold and influenza symptoms, including sore throat, but there is only limited evidence to support this idea. [16] If the sore throat is unrelated to a cold and is caused by for example tonsillitis, a cold drink may be helpful. [17]

There are also other medications like lozenges which can help people to cope with a sore throat.

Without active treatment, symptoms usually last two to seven days. [18]

Statistics

In the United States, there are about 2.4 million emergency department visits with throat-related complaints per year. [4]

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> An inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain.

<span class="mw-page-title-main">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

<span class="mw-page-title-main">Group A streptococcal infection</span> Medical condition

Group A streptococcal infections are a number of infections with Streptococcus pyogenes, a group A streptococcus (GAS). S. pyogenes is a species of beta-hemolytic Gram-positive bacteria that is responsible for a wide range of infections that are mostly common and fairly mild. If the bacteria enter the bloodstream an infection can become severe and life-threatening, and is called an invasive GAS (iGAS).

<i>Streptococcus pyogenes</i> Species of bacterium

Streptococcus pyogenes is a species of Gram-positive, aerotolerant bacteria in the genus Streptococcus. These bacteria are extracellular, and made up of non-motile and non-sporing cocci that tend to link in chains. They are clinically important for humans, as they are an infrequent, but usually pathogenic, part of the skin microbiota that can cause Group A streptococcal infection. S. pyogenes is the predominant species harboring the Lancefield group A antigen, and is often called group A Streptococcus (GAS). However, both Streptococcus dysgalactiae and the Streptococcus anginosus group can possess group A antigen as well. Group A streptococci, when grown on blood agar, typically produce small (2–3 mm) zones of beta-hemolysis, a complete destruction of red blood cells. The name group A (beta-hemolytic) Streptococcus is thus also used.

<span class="mw-page-title-main">Scarlet fever</span> Infectious disease caused by Streptococcus pyogenes

Scarlet fever, also known as scarlatina, is an infectious disease caused by Streptococcus pyogenes, a Group A streptococcus (GAS). It most commonly affects children between five and 15 years of age. The signs and symptoms include a sore throat, fever, headache, swollen lymph nodes, and a characteristic rash. The face is flushed and the rash is red and blanching. It typically feels like sandpaper and the tongue may be red and bumpy. The rash occurs as a result of capillary damage by exotoxins produced by S.pyogenes. On darker-pigmented skin the rash may be hard to discern.

<span class="mw-page-title-main">Streptococcal pharyngitis</span> Medical condition

Streptococcal pharyngitis, also known as streptococcal sore throat, is pharyngitis caused by Streptococcus pyogenes, a gram-positive, group A streptococcus. Common symptoms include fever, sore throat, red tonsils, and enlarged lymph nodes in the front of the neck. A headache and nausea or vomiting may also occur. Some develop a sandpaper-like rash which is known as scarlet fever. Symptoms typically begin one to three days after exposure and last seven to ten days.

<span class="mw-page-title-main">Common cold</span> Common viral infection of the upper respiratory tract

The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after exposure to the virus. These may include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days, but some symptoms may last up to three weeks. Occasionally, those with other health problems may develop pneumonia.

<span class="mw-page-title-main">Infectious mononucleosis</span> Common viral infectious disease

Infectious mononucleosis, also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adults, the disease often results in fever, sore throat, enlarged lymph nodes in the neck, and fatigue. Most people recover in two to four weeks; however, feeling tired may last for months. The liver or spleen may also become swollen, and in less than one percent of cases splenic rupture may occur.

<span class="mw-page-title-main">Pharyngitis</span> Inflammation of the back of the throat

Pharyngitis is inflammation of the back of the throat, known as the pharynx. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, difficulty swallowing, swollen lymph nodes, and a hoarse voice. Symptoms usually last 3–5 days, but can be longer depending on cause. Complications can include sinusitis and acute otitis media. Pharyngitis is a type of upper respiratory tract infection.

<span class="mw-page-title-main">Croup</span> Respiratory infection often caused by a virus

Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "barking/brassy" cough, inspiratory stridor and a hoarse voice. Fever and runny nose may also be present. These symptoms may be mild, moderate, or severe. Often it starts or is worse at night and normally lasts one to two days.

<span class="mw-page-title-main">Rheumatic fever</span> Post-streptococcal inflammatory disease

Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is involved in about half of the cases. Damage to the heart valves, known as rheumatic heart disease (RHD), usually occurs after repeated attacks but can sometimes occur after one. The damaged valves may result in heart failure, atrial fibrillation and infection of the valves.

<span class="mw-page-title-main">Laryngitis</span> Medical condition

Laryngitis is inflammation of the larynx. Symptoms often include a hoarse voice and may include fever, cough, pain in the front of the neck, and trouble swallowing. Typically, these last under two weeks.

<span class="mw-page-title-main">Upper respiratory tract infection</span> Medical condition

An upper respiratory tract infection (URTI) is an illness caused by an acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold. Most infections are viral in nature, and in other instances, the cause is bacterial. URTIs can also be fungal or helminthic in origin, but these are less common.

<span class="mw-page-title-main">Tonsillitis</span> Inflammation of the tonsils

Tonsillitis is inflammation of the tonsils in the upper part of the throat. It can be acute or chronic. Acute tonsillitis typically has a rapid onset. Symptoms may include sore throat, fever, enlargement of the tonsils, trouble swallowing, and enlarged lymph nodes around the neck. Complications include peritonsillar abscess (Quinsy).

<span class="mw-page-title-main">Peritonsillar abscess</span> Pus behind the tonsil due to an infection

Peritonsillar abscess (PTA), also known as quinsy, is an accumulation of pus due to an infection behind the tonsil. Symptoms include fever, throat pain, trouble opening the mouth, and a change to the voice. Pain is usually worse on one side. Complications may include blockage of the airway or aspiration pneumonitis.

<span class="mw-page-title-main">Respiratory tract infection</span> Infectious disease affecting nose, throat and lungs

Respiratory tract infections (RTIs) are infectious diseases involving the lower or upper respiratory tract. An infection of this type usually is further classified as an upper respiratory tract infection or a lower respiratory tract infection. Lower respiratory infections, such as pneumonia, tend to be far more severe than upper respiratory infections, such as the common cold.

<span class="mw-page-title-main">Rapid strep test</span> Test for strep throat

The rapid strep test (RST) is a rapid antigen detection test (RADT) that is widely used in clinics to assist in the diagnosis of bacterial pharyngitis caused by group A streptococci (GAS), sometimes termed strep throat. There are currently several types of rapid strep test in use, each employing a distinct technology. However, they all work by detecting the presence of GAS in the throat of a person by responding to GAS-specific antigens on a throat swab.

<span class="mw-page-title-main">Centor criteria</span> Tool for medical diagnosis of the throat

The Centor criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in patients complaining of a sore throat. They were developed as a method to quickly diagnose the presence of Group A streptococcal infection or diagnosis of streptococcal pharyngitis in "adult patients who presented to an urban emergency room complaining of a sore throat." The Centor criteria are named after Robert M. Centor, an internist at the University of Alabama at Birmingham School of Medicine.

<span class="mw-page-title-main">Acute exacerbation of chronic obstructive pulmonary disease</span> Medical condition

An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis (AECB), is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.

Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection affecting the lower layers of the skin (cellulitis) around the anus. It presents as bright redness in the skin and can be accompanied by pain, difficulty defecating, itching, and bleeding. This disease is considered a complicated skin and soft tissue infection (cSSTI) because of the involvement of the deeper soft tissues.

References

  1. ↑ "Sore throat - Symptoms and causes". Mayo Clinic. Retrieved 2022-04-24.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Cohen, Jérémie F.; Pauchard, Jean-Yves; Hjelm, Nils; Cohen, Robert; Chalumeau, Martin (June 2020). "Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat". The Cochrane Database of Systematic Reviews. 2020 (6): CD012431. doi:10.1002/14651858.CD012431.pub2. ISSN   1469-493X. PMC   7271976 . PMID   32497279.
  3. ↑ "Antibiotic resistance". www.who.int. Retrieved 2020-09-18.
  4. 1 2 3 4 Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. p. Chapter 30. ISBN   978-0-323-05472-0.
  5. 1 2 Hovav, K.; Pinto-Garcia, P. (13 October 2021). "Sore Throat Causes, Home Remedies, and When to Seek Care". GoodRx. Archived from the original on 27 January 2022. Retrieved 19 February 2022.
  6. ↑ "Sore Throat and Other Throat Problems-Topic Overview".
  7. ↑ Shaikh N, Leonard E, Martin JM (September 2010). "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis". Pediatrics. 126 (3): e557–64. doi:10.1542/peds.2009-2648. PMID   20696723. S2CID   8625679.
  8. ↑ "Group A Strep | Strep Throat | For Clinicians | GAS | CDC". www.cdc.gov. 2019-04-19. Retrieved 2020-09-18.
  9. ↑ "Clinical Practice Guidelines : Sore throat". www.rch.org.au. Retrieved 2020-09-18.
  10. ↑ "Does Gargling Wlth Salt Water Ease a Sore Throat?". WebMD.
  11. ↑ Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMC   1313826 . PMID   11127175.
  12. 1 2 de Cassan, Simone; Thompson, Matthew J.; Perera, Rafael; Glasziou, Paul P.; Del Mar, Chris B.; Heneghan, Carl J.; Hayward, Gail (1 May 2020). "Corticosteroids as standalone or add-on treatment for sore throat". The Cochrane Database of Systematic Reviews. 2020 (5): CD008268. doi:10.1002/14651858.CD008268.pub3. ISSN   1469-493X. PMC   7193118 . PMID   32356360.
  13. ↑ Sadeghirad, Behnam; Siemieniuk, Reed A C; Brignardello-Petersen, Romina; Papola, Davide; Lytvyn, Lyubov; Vandvik, Per Olav; Merglen, Arnaud; Guyatt, Gordon H; Agoritsas, Thomas (20 September 2017). "Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials". BMJ. 358: j3887. doi:10.1136/bmj.j3887. PMC   5605780 . PMID   28931508.
  14. ↑ Spinks A, Glasziou PP, Del Mar CB (Dec 9, 2021). "Antibiotics for treatment of sore throat in children and adults". Cochrane Database Syst Rev. 2021 (12): CD000023. doi:10.1002/14651858.CD000023.pub5. PMC   8655103 . PMID   34881426.
  15. ↑ Ng, Gareth JY; Tan, Stephanie; Vu, Anh N; Del Mar, Chris B; van Driel, Mieke L (2015-07-14). Cochrane ENT Group (ed.). "Antibiotics for preventing recurrent sore throat". Cochrane Database of Systematic Reviews. 2015 (7): CD008911. doi:10.1002/14651858.CD008911.pub2. PMC   8860619 . PMID   26171901.
  16. ↑ "Hot drinks ease cold and flu". National Health Service. 10 December 2008. Archived from the original on 8 August 2020. Retrieved 15 February 2019.
  17. ↑ Bathala S, Eccles R (March 2013). "A review on the mechanism of sore throat in tonsillitis". J Laryngol Otol (Review). 127 (3): 227–32. doi:10.1017/S0022215112003003. PMID   23317998. S2CID   20563591.
  18. ↑ Thompson, M; Vodicka, TA; Blair, PS; Buckley, DI; Heneghan, C; Hay, AD; TARGET Programme, Team (Dec 11, 2013). "Duration of symptoms of respiratory tract infections in children: systematic review". BMJ (Clinical Research Ed.). 347: f7027. doi:10.1136/bmj.f7027. PMC   3898587 . PMID   24335668.
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