Getting to the Bottom of a Sore Throat
Melinda Ratini, DO, MS
First it’s that rough feeling, like you swallowed a bit of sandpaper. You know what’s next: a sore throat. Is it the start of a cold, strep — or something else?
“For most sore throats, you probably don’t need to see a doctor. You can treat it with over-the-counter remedies, take time off from work, and rest,” says Jeffrey A. Linder, MD, MPH. He’s an associate professor of medicine at Harvard Medical School.
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Here are some of the most common reasons people get a sore throat and tips for when to call your doctor.
Cold or Flu?
Most sore throats are caused by viral infections, such as a cold or flu. Often you’ll have other symptoms like a runny or stuffy nose, sneezing, cough, a mild fever, and fatigue.
It can be hard to tell the difference between a cold and flu, but the flu tends to cause worse symptoms, like high fever and muscle aches.
If your sore throat is from a virus, antibiotics won’t help. Instead, gargle with warm salt water and use over-the-counter treatments like lozenges and sprays.
The Dreaded Strep
Strep throat is an infection caused by bacteria. Symptoms can include throat pain, white patches on your tonsils, swollen lymph nodes in your neck, and fever. When you have strep throat, you usually don’t have a runny nose or cough.
Anyone can get strep throat, but children between the ages of 5 and 15 tend to get it most often. In adults, only 10% of sore throats are caused by strep, says Linder.
To find out if you have it, your doctor may swab the back of your throat to do a rapid strep test. If it’s positive, your doctor will prescribe an antibiotic.
Getting to the Bottom of a Sore Throat
Something You Ate?
When acid from your stomach comes up through your esophagus — the tube that carries food from the mouth to the stomach — your throat can get sore and irritated. Known as acid reflux, this is one of the most overlooked causes of sore throats.
“If you feel fine besides the sore throat and don’t have, for example, a fever, you might have acid reflux,” says Gordon J. Siegel, MD. He’s an assistant clinical professor of otolaryngology-head and neck surgery at Northwestern University Feinberg School of Medicine.
People with acid reflux may also have a dry cough, trouble swallowing, and feel like they have a lump in their throat.
If you have acid reflux, your doctor may suggest some lifestyle changes, like switching to a low-fat, high protein diet, and limiting alcohol and coffee. Over-the-counter medication may help, or your doctor may prescribe you something.
Allergies: Sore Throat Surprise
A runny nose can lead to post-nasal drip, when mucus runs down the back of your throat.
If you think allergies are the cause of your sore throat, sneezing, and runny nose, try an over-the-counter allergy medication. If that doesn’t bring relief, talk with your doctor about other treatment options.
When to Call Your Doctor
- If your sore throat is severe.
- You have a sore throat isn’t better after 3 days.
- You’ve had a fever higher than 100.4 F for more than 2 days.
- You have other medical problems such as asthma, heart disease, HIV, diabetes, or are pregnant. You may be at a higher risk of complications from infections from a sore throat.
Seek emergency medical help if you have a sore throat and have trouble breathing or swallowing.