A sore throat is very common, especially during the colder months. Most sore throats are caused by viral infections and often resolve without treatment within 7-10 days. However, some persistent sore throats may require medical attention and treatment with antibiotics if caused by a bacterial infection like strep throat.
What Causes a Sore Throat?
There are several potential causes of a sore throat:
- Viral infections – Viruses like cold viruses, flu viruses, coxsackieviruses, HIV, mono, etc. are the most common cause of sore throats. Viral sore throats often get better on their own.
- Bacterial infections – Strep throat caused by group A strep bacteria accounts for 5-15% of sore throats in adults. Strep requires antibiotics for treatment.
- Allergies – Allergies to pollen, pet dander, dust mites, molds, etc. can cause postnasal drip and throat irritation.
- Dryness – Dry indoor air, mouth breathing, medications, and medical conditions can dry out and irritate the throat.
- Smoking and pollution – Cigarette smoke and air pollution irritate the throat lining.
- Gastroesophageal reflux disease (GERD) – Stomach acid backing up into the esophagus can irritate the throat.
- Injury – Trauma to the voice box, swallowing hazards like fish bones, or burns from hot liquids can damage the throat.
Common Symptoms
Sore throat symptoms may include:
- Pain or scratchiness in the throat that worsens when swallowing or talking
- Swollen, red tonsils
- White patches on the tonsils
- Pain or trouble swallowing
- Hoarse, muffled voice
- Swollen lymph nodes in the neck
- Fever
- Bad breath
- Headache
- Body aches
- Nausea or vomiting, especially in small children
- Watery eyes and runny nose (with viral sore throats)
When to See a Doctor
You should see a doctor if you have any of the following:
- Fever over 101°F
- Pus or redness in the throat
- Swollen lymph nodes in the neck
- Fatigue or body aches
- Earache
- Rash
- Blood in saliva or phlegm
- Trouble breathing or swallowing
- Persistent sore throat lasting more than 1 week (2 weeks for kids)
- Frequent recurring sore throats
- Hoarseness lasting over 2 weeks
- Lump feeling in the neck
- New or worsening immune system problems
Seeking prompt medical care is recommended if you have severe throat pain or difficulty swallowing that prevents you from drinking fluids. These can be signs of a throat abscess that needs drainage or epiglottitis which can block the airway.
Will a Viral Sore Throat Go Away on Its Own?
The majority of sore throats are caused by viruses and will go away on their own within 7-10 days without antibiotics. The viruses most often responsible for viral sore throats include:
- Rhinovirus – causes about 35-50% of sore throats and is the most common cause of the common cold.
- Coronavirus – 10-15% of colds. Novel coronavirus also causes COVID-19 illness.
- Parainfluenza – 10-15% of colds and is one cause of croup in young kids.
- Respiratory syncytial virus (RSV) – common in winter, especially in infants.
- Adenovirus – causes about 5-10% of colds and may provoke conjunctivitis.
- Influenza – flu viruses cause seasonal influenza and flu-like illnesses.
- Epstein-Barr virus (EBV) – causes mononucleosis (“mono”).
- Herpes simplex virus (HSV) – oral herpes viruses can cause pharyngitis.
- HIV – acute HIV infection may initially seem like the flu.
- Enterovirus – coxsackieviruses may cause viral pharyngitis.
The natural course of most viral sore throats is to peak in severity around days 3-5 and then gradually improve. Complete recovery often takes 7-10 days but can be longer, especially with certain viruses.
Getting ample rest, drinking fluids, gargling with salt water, using throat lozenges/sprays, taking OTC pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil), and using humidifiers can help relieve viral sore throat symptoms while it runs its course. However, prescription anti-viral medications are not typically used for viral pharyngitis in otherwise healthy individuals.
Can a Bacterial Sore Throat Resolve Without Antibiotics?
Bacterial infections cause a relatively small proportion of sore throats, but do require antibiotic treatment. The main bacterium responsible for bacterial sore throats is group A streptococcus, which causes strep throat.
Strep throat will not improve on its own without antibiotic treatment. Taking a full antibiotic course as prescribed is important for curing strep infection and preventing complications like rheumatic fever or glomerulonephritis.
Other bacteria that can cause sore throats requiring antibiotics include:
- Group C or G streptococcus
- Mycoplasma pneumonia
- Chlamydia pneumonia
- Gonorrhea
- Corynebacterium (diphtheria)
- Arcanobacterium
How to Tell if It’s Viral or Bacterial?
Distinguishing between viral and bacterial sore throats based on symptoms alone is difficult. There is significant overlap in symptoms. However, some patterns can help differentiate the two:
Viral Sore Throat | Bacterial Sore Throat |
---|---|
Often accompanies cold symptoms like stuffy/runny nose, cough, sneezing | Generally no cold symptoms present |
Develops slowly, starting mild and worsening over a few days | Comes on suddenly, severe pain right away |
No fever or low-grade fever | Moderate to high fever common |
swollen glands | Swollen, tender glands in neck |
Fatigue sometimes present | Fatigue, body aches common |
Patchy white tonsils | Bright red, swollen tonsils with pus |
Usually improves in 7-10 days | Persistent pain without improvement |
However, a strep test is required to confirm strep throat. This involves a quick swab of the throat to detect streptococcus bacteria. Rapid antigen detection tests can provide results within minutes. Throat cultures take longer (48 hours) but are more accurate.
When Are Antibiotics Needed?
Antibiotics are only recommended for bacterial sore throats, especially those caused by group A streptococcus. The antibiotic treatment of choice is penicillin or amoxicillin. Penicillin allergy patients can use cephalosporins, macrolides, or clindamycin.
Antibiotics may also be warranted if:
- You are at high risk for complications from strep (e.g. heart conditions, immunosuppression)
- You have a severe bacterial sore throat
- You are in a setting with streptococcus outbreaks, like the military or college dorms
- You have repeated strep throat infections
However, antibiotics are not necessary for most routine viral sore throats. Taking antibiotics when not needed can promote antibiotic resistance and destroy healthy gut bacteria. Many medical groups advise against overprescribing antibiotics for sore throats.
How to Treat a Viral Sore Throat
For sore throats caused by cold and flu viruses, treatment focuses on relieving symptoms while your body fights off the virus. Helpful measures include:
- Rest – Get extra sleep and avoid strenuous activity.
- Fluids – Drink water, broths, herbal tea, juices to stay hydrated.
- Salt water gargles – Helps reduce swelling and soothe pain.
- Humidifier – Adds moisture to the air, which can ease a sore throat.
- OTC pain relievers – Acetaminophen or ibuprofen helps relieve throat pain.
- Cough drops/throat sprays – Provides temporary numbness and lubrication.
- Chicken soup – The warm broth can be soothing.
- Avoid irritants – Don’t smoke, drink alcohol, or pollute air.
Severe dehydration, inability to drink, or breathing difficulties are medical emergencies requiring immediate care.
How Long Does a Viral Sore Throat Last?
The typical duration of a viral sore throat is:
- Days 1-3: throat pain starts, often worsening
- Days 3-5: peak of throat pain and symptoms
- Days 5-7: gradual improvement begins
- Days 7-10: throat pain resolves in most cases
- Days 10-14: full recovery, some residual cough possible
However, this timeline can vary. Some people start feeling better within 3-4 days, while some viral sore throats last 2 weeks or more. Kids often recover faster than adults.
You should see a doctor if severe pain, difficulty swallowing, or fever persist beyond 48 hours without improvement. Call immediately if breathing becomes difficult.
Can Certain Foods or Drinks Help?
Certain foods, drinks, and ingredients may help soothe a sore throat by coating and lubricating the throat lining. Options to try include:
- Broths – Warm broth from chicken or vegetables can be comforting.
- Garlic – Contains anti-inflammatory and antimicrobial properties.
- Honey – Has antibacterial effects and coats the throat.
- Ginger – Soothes inflammation and upset stomach.
- Peppermint tea – Relaxes throat muscles and clears nasal congestion.
- Apple cider vinegar – Contains acetic acid to fight bacteria.
- Popsicles – Cold treat can numb sore throat.
- Yogurt – Soft, cool food is easy to swallow.
Avoid spicy, acidic, or scratchy foods that can further irritate the throat. Cool soft foods are best.
When Are Home Remedies Not Enough?
While most viral sore throats improve with home comfort measures, see a doctor right away if you experience:
- Difficulty breathing
- Trouble swallowing saliva, water or foods
- Inability to drink enough fluids
- Severe pain that prevents sleep or eating
- Fever over 101°F that won’t respond to medication
- Pus/white spots on the tonsils
- Blood in saliva or phlegm
- Fatigue, body aches, rash or joint pain
- Stiff neck or swelling under the jaw
- Hoarseness or muffled voice lasting over 2 weeks
Emergency care is needed for breathing difficulties, intense throat swelling, dehydration or high fever in children. Adults over 50 should also have persistent sore throats evaluated to rule out possible cancers.
When to Call 911
Seek emergency help by calling 911 or going to the ER if you have:
- Trouble breathing, feeling like your throat is closing up
- Sudden difficulty swallowing saliva
- High fever with stiff neck and confusion
- Inability to swallow any liquids
- Stridor – harsh, raspy breathing sounds
These can be signs of a throat or epiglottis infection compromising the airway, which requires emergency care.
How to Prevent Viral Sore Throats
You can reduce your risk of developing a viral sore throat by:
- Washing hands frequently
- Disinfecting shared surfaces and objects
- Avoiding close contact with sick people
- Avoiding touching your eyes, nose and mouth
- Practicing good cough/sneeze etiquette
- Getting an annual flu shot
- Taking immune supporting vitamins like vitamin C and zinc
- Quitting smoking and avoiding secondhand smoke
- Using a humidifier to moisten dry indoor air
Key Points
- Most sore throats are caused by viruses and resolve within 7-10 days without treatment.
- Strep throat and some other bacterial infections require antibiotics for treatment and cure.
- See a doctor for severe throat pain, high fever, trouble swallowing, or lack of improvement after 1 week.
- Managing viral sore throats involves rest, hydration, salt water gargles, throat lozenges, OTC pain relief, humidifiers.
- Eating soothing foods like broth, yogurt, ginger, honey and garlic may help relieve sore throat discomfort.
- Practice good hygiene and avoid irritants to help prevent viral pharyngitis.
The Bottom Line
The majority of sore throats are caused by viruses and will resolve on their own within 7-10 days with supportive self-care. However, bacterial infections like strep throat require antibiotics for treatment and cure. Seek medical care promptly if your sore throat is accompanied by high fever, pus, trouble swallowing, or difficulty breathing. With rest and proper care, most otherwise healthy people can treat viral sore throats at home until they run their course.