• What causes a sore throat?
• What can I do at home for a sore throat?
• What is Strep throat and why is it different?
• When should I seek medical care for a sore throat?
• What if I have multiple episodes of strep throat?
• Sore Throat At A Glance

What causes a sore throat?

A sore throat can have many causes. Some of these are listed below:

1. Many common viruses, and even the viruses that cause mononucleosis (mono) and the flu, can cause a sore throat. Some of the viruses that cause a sore throat can produce blisters in the mouth and throat ("aphthous stomatitis").
2. Breathing through the mouth can produce throat dryness and soreness.
3. Sinus drainage may cause a sore throat.
4. A sore throat can also be caused by bacteria. The two most common bacteria to cause as sore throat are Streptococcus (which causes strep throat) and Arcanobacterium haemolyticum. Arcanobacterium causes sore throats mainly in young adults and is sometimes associated with a fine red rash .
5. A sore throat that lasts for more than 2 weeks can be a sign of a serious illness, such as throat cancer or AIDS.

What can I do at home for a sore throat?

Generally, sore throats must run their course (Exception: Strep throat will be addressed below). Salt water gargles, hard candies, sprays (for example, Chloraseptic) and lozenges can provide temporary pain relief. (Caution: Lozenges and hard candy are a choking hazard for children. Avoid their use in young children.) A humidifier may be helpful in relieving symptoms, especially in sore throats caused by mouth breathing and dry air. Acetaminophen or ibuprofen may help control the pain.

For adults, if your nose is plugged, nasal sprays, such as AFRIN, may be used for 2-3 days to prevent mouth breathing. It is NOT a good idea to use these products for more than a couple of days; you may become dependent on them. Other decongestant products, such as Sudafed, may be helpful. If you have health problems such as heart disease or high blood pressure, contact your health care professional before using these products.

What is Strep throat and why is it different?

Strep throat is caused by the Streptococcus bacteria, which is the same bacteria that causes rheumatic fever. Only 5%-10% of adult sore throats are caused by strep while about 15%-40% of sore throats in children are related to strep. For this reason, many health care professionals will recommend a "rapid strep" test for a patient with a sore throat. The "rapid strep" test can usually be done in the office and takes 15-20 minutes. If the result is negative, it is often followed with a strep culture. If either of these is positive, the sore throat is generally treated with penicillin or another antibiotic.

A major objective of treating Strep throat is to prevent the development of rheumatic fever, a serious illness that can cause joint pain and heart valve damage. However, antibiotics do not necessarily hasten the resolution of the sore throat itself and antibiotics are of no help for a sore throat unless it is found to be caused by strep. Another strep related illness, scarlet fever, can cause a rash, but will not cause heart injury or joint pain.

When should I seek medical care for a sore throat?

1. If you have been in contact with someone with strep throat and you have a sore throat, it is reasonable to have a strep test done.
2. If your sore throat is not associated with cold symptoms or is associated with a fever, swollen "glands" (lymph nodes), or white patches on the back of your throat, you should have a strep test done.
3. Any sore throat that has a sudden onset and is associated with a fever should be seen by a health care worker.
4. Pain with swallowing is to be expected with a sore throat. However, if you are having trouble swallowing liquids, you should be examined.
5. If your sore throat persists for more than a week, medical attention should be sought.
6. If you have a sore throat and the front of your neck is sore, you should be seen by a health care professional.

What if I have multiple episodes of strep throat?

There are a number of situations in which a child or adult can have multiple positive strep tests.

1. The first, and most common, is that the strep bacteria were never eradicated in the first place. The child did not get all of the doses of the medication prescribed. Unless a child gets a full 10 day course of penicillin or erythromycin , the strep throat will not clear. Even missing a dose or two can be a problem. One solution to this problem, and one I dislike, is to give the child a shot of penicillin (if not allergic). This is painful and is best avoided if it can be assured that the child will receive all of the doses by mouth.
   
   
2. The child is a "carrier" of strep. There are individuals who have strep in their throats all of the time as part of their normal bacteria. If the child did not have a sore throat with the positive strep tests (or even if he or she did) he or she could be a carrier. It may be that your child's sore throat was caused by a virus and he or she just happens to have strep in his/her throat as a carrier.
   
   
3. There are no Strep (of the throat kind) that are resistant to penicillin. However, other bacteria in the throat can secrete an enzyme (penicillinase) that breaks down penicillin. This can be overcome by using a drug that is resistant to this enzyme, such as cephalexin (Keflex).
   
   
4. The child may just be unlucky and have contracted a series of strep infections. This may occur if there is a carrier in the family or in school. In fact, dogs have been known to be carriers!
   
   
5. If none of the above is the case, the whole family should be tested for strep and see if there is an asymptomatic carrier (a carrier who does not have symptoms of a sore throat).

Sore Throat At A Glance

• Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home.
• Any sore throat that has a rapid onset and is associated with a fever or tenderness of the front of the neck may be serious and should be seen by a health care professional.
• Any sore throat that causes you to have difficulty swallowing (not just pain with swallowing) or breathing should be seen by a health care professional.
• Any sore throat that lasts for more than a week should be evaluated by a health care professional.

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