Sore throat

A sore throat is pain, irritation, or a scratchy feeling in your throat. It may hurt more when you swallow or talk. The medical term is pharyngitis, meaning inflammation of the throat.

Most sore throats are caused by viruses, including those that cause colds, flu, and COVID-19. They usually improve without antibiotics. Other possible causes include bacterial infections, allergies, dry air, smoke, and acid reflux.

Symptoms alone cannot always show what is causing a sore throat. White patches, redness, or severe pain do not necessarily mean that you need antibiotics like amoxicillin or doxycycline.

Your throat may feel raw, dry, burning, or scratchy. Swallowing food, drinks, or saliva may be uncomfortable. Your voice may sound hoarse if your voice box is also irritated.

You may notice:

• Redness at the back of the throat
• Swollen tonsils
• White spots or coating on the tonsils
• Tender or swollen glands in the neck
• Bad breath
• Fever, cough, runny nose, headache, or tiredness

Cough, a runny nose, hoarseness, and red eyes are more often seen with a viral infection. Group A strep, a type of bacteria, may cause sudden throat pain, fever, swollen neck glands, and painful swallowing. However, a throat examination alone may not reliably separate strep from a viral illness.

Common causes include viral respiratory infections. Colds, flu, COVID-19, and several other viruses can inflame the throat. These infections may also cause coughing, congestion, fever, muscle aches, or tiredness.

Group A strep can cause strep throat. It is more common in school-aged children than in adults. Not everyone with throat pain needs a strep test; this depends on age, symptoms, exposure, and local medical guidance.

Non-infectious irritation is also common. Possible triggers include allergies, mucus dripping down the throat, dry indoor air, smoking, vaping, air pollution, loud or prolonged talking, and breathing through the mouth.

Less common causes include glandular fever, also called infectious mononucleosis, which can cause marked tiredness and swollen glands. Acid reflux may irritate the throat, particularly after meals or when lying down. Mouth ulcers, oral thrush, and some infections passed through oral sexual contact can also cause throat symptoms.

A sore throat that continues for several weeks may occasionally be related to ongoing inflammation or a growth in the throat. This is not a common explanation, but persistent symptoms should be checked, especially with lasting hoarseness, a neck lump, or unexplained weight loss.

Urgent causes are uncommon. An abscess, meaning a pocket of infection near a tonsil, may cause rapidly worsening one-sided pain, a muffled voice, drooling, or difficulty opening the mouth. Severe swelling around the airway can cause noisy or difficult breathing and requires emergency care.

Call emergency services now if you have:

• Trouble breathing, noisy breathing, or a feeling that your airway is closing
• Swelling of the lips or tongue with throat tightness
• Inability to swallow saliva, especially with drooling
• Blue, grey, or unusually pale lips or skin
• Severe weakness, confusion, or difficulty waking

Seek same-day medical care if you cannot drink enough, are passing much less urine, or have rapidly worsening pain or swelling. One-sided throat pain with a muffled voice or difficulty opening your mouth also needs prompt assessment.

Book a routine appointment if your sore throat is not improving after about a week, keeps returning, or comes with persistent fever. Arrange an assessment for symptoms lasting several weeks, a neck lump, ongoing hoarseness, unexplained weight loss, or a weakened immune system.

Babies and young children may not describe throat pain. Seek medical advice if a child is not drinking, has fewer wet nappies, is unusually sleepy, or appears to be getting worse.

A healthcare professional may ask when the pain started and whether you have fever, cough, congestion, rash, reflux, or recent contact with someone who was ill. They may examine your mouth, tonsils, neck glands, ears, and breathing.

If strep throat is possible, a throat swab may be used for a rapid antigen test, molecular test, or laboratory culture. Depending on age and local guidance, a negative rapid test may sometimes be followed by a culture.

Testing for COVID-19, flu, glandular fever, or another infection may be considered when your symptoms or medical history suggest it. Persistent or unusual symptoms may need an examination by an ear, nose, and throat specialist. This can include looking at the throat and voice box with a thin flexible camera.

Treatment depends on the cause. Viral sore throats usually improve with time and supportive care.

You can try:

• Drinking regularly, using warm or cool fluids for comfort
• Eating soft or cool foods if swallowing hurts
• Gargling warm salt water if you can do so safely
• Using throat lozenges if they are not a choking risk
• Avoiding smoke, vaping, and other throat irritants
• Resting your voice and using a humidifier in dry rooms

Honey may soothe coughing and throat irritation, but it must not be given to a child younger than 12 months.

Paracetamol or ibuprofen may reduce pain and fever when used according to the label. Check with a pharmacist or healthcare professional if you are unsure whether a medicine is suitable for you. Children and teenagers should not take aspirin for a viral illness unless specifically advised by a clinician.

Antibiotics do not treat viral infections. They may be prescribed when testing or clinical assessment supports a bacterial cause such as strep throat. If prescribed, take them exactly as directed and do not use leftover or shared antibiotics.

A sore throat caused by a viral infection often starts improving within several days and usually settles within about a week. Cough or tiredness may last longer than the throat pain.

A bacterial infection may also improve on its own, but confirmed strep throat is often treated with antibiotics to reduce spread and the risk of complications. Improvement should follow, although the exact timing differs between people.

Get medical advice if symptoms worsen rather than improve, return soon after treatment, or repeatedly interfere with eating, sleeping, school, or work.

Is a sore throat contagious?

The symptom itself is not contagious. Viral and bacterial infections that cause it can spread through respiratory droplets, close contact, or contaminated hands. Allergies, reflux, and dry air are not contagious.

Do white spots mean I need antibiotics?

No. White spots can occur with bacterial infections, viral infections, or other conditions. A healthcare professional may recommend a throat swab before deciding whether antibiotics are appropriate.

Should I stay home?

Stay home if you have a fever, feel too unwell for normal activities, or may have a contagious respiratory infection. Follow local public health advice for COVID-19, flu, or confirmed strep throat.

Can recurrent sore throats lead to tonsil removal?

An isolated sore throat does not usually lead to tonsil surgery. If severe tonsillitis keeps returning or causes major problems, a clinician can review the pattern and discuss whether specialist assessment is appropriate.