“Sore Throat” is one of the most common symptoms we see in primary care, urgent care, and the E.R. We can usually deal with it in a few minutes. The following outlines what our thought-process might include, although many of us may usually confine our effort to the first three “Most Common Causes” below. That usually works out fine, but may rarely prove unfortunate.
Causes of Sore Throat (Pharyngitis)
| xxxxxxxxFIRST 1-3 DAYS | xxxLASTING 4-5 DAYS OR MORE |
|---|---|
| xxxxxMost Common Causes โข Covid-19 โข Common Simple Viruses โข Strep Throat xxxxxWe Send to E.R. (very rare) โข Peritonsillar Abscess * โข Deep Tissue Infection ** โข Diphtheria ** โข Neutropenia ** โข Tularemia ** โข Rabies ** xxxxxxWe Should Never Forget โข Acute (Primary) HIV * Life-threatening, & uncommon ** Life-threatening & very rare | โข Covid-19 [only if ill less than 10 days] โข Strep Throat [unlikely after 3 days] โข Mononucleosis โข Acute (Primary) HIV โข Gonorrhea โข Herpes simplex ? โข Syphilis (secondary stage) โข “We Send to E.R.” (see 1st Column) xxxxxxxLong-Standing Duration โข Allergic Rhinopharyngitis (“allergies”) โข Gastroesophageal Reflux (GERD) x x x x |
First 3 Days of Illness
1. Covid-19 a possibility. Every office & clinic has its own way of testing; patients usually not allowed inside.
2. But Sore Throats may be Life-Threatening (need IV antibiotics / surgery / hospitalization)
- Can’t open mouth / drooling (& fever)ย — Peritonsillar Abscess / Deep Infection, Diphtheria, Tularemia [Peritonsillar Abscess, see Pictures 2 & 3; Diphtheria, same link Picture 4]
- Many large blistersย (Neutropenia)
- Rabies risk in last 3 months (animal bite; saw a bat in the room)
- We send the above to the E.R. for diagnosis and treatment
3. Would test for Strep Throat if 3 or 4 of the following:
- Fever
- Pus on throat or tonsils [see Picture 1]
- Swollen glands (lymph nodes)
- NO cough or runny nose
4. Otherwise, it’s a Simple Virus (90% of sore throats)
- Gets better on its own, antibiotics don’t help
5. Some Exceptions
- If risk for having gotten HIV from someone between 9-30 days ago, see Acute HIV
- If exposed 3 or more weeks ago, order regular HIV Test (not finger test nor home test)
- If exposed under 3 weeks ago, order HIV RNA test (viral load)
- If had oral sex with a man in the last 3 months, test for Gonorrhea of the throat
- Severe sore throat with high fever โ examine for signs of Peritonsillar Abscess
- If frequent episodes sore throat with blisters, test for Herpes Simplex
After 4 Days of Illness
1. Consider Life-Threatening Causes (very rare; need IV antibiotics / surgery / hospitalization)
2. If there’s a cough or runny nose, it’s all a virus. But certainly test for Covid.
3. If NO Cough, NO runny nose:
- Test for Strep (though usually unlikely after 3 days)
- Complete Blood Count and Liver Function Tests for Mononucleosis
- Test for Gonorrhea of throat if oral sex with a man
- Consider Acute HIV: see above
- Other uncommon diseases possible (see main text)
If long-standing Sore Throat (weeks or months), may diagnose & treat for either:
- Allergic Rhinopharyngitis (commonly called “allergies”) (see Allergy Medicines)
- Esophageal Reflux (GERD) (see Antacid Medicines)
For more in-depth explanations and discussions, see: