Throat Infections (Pharyngitis and Tonsillitis)

Types of throat infection

Viral vs strep throat

Doctors use scoring systems such as the Centor or McIsaac criteria (fever, tonsil exudate, tender front neck glands, absence of cough, and age) to decide who should be tested.

Other causes

• Infectious mononucleosis: severe sore throat, very large tonsils, swollen glands at the back of the neck, fatigue, enlarged spleen. Teens and young adults
• Influenza and COVID-19: sore throat with fever, aches, cough
• Adenovirus: sore throat with pink eye
• Herpangina and hand, foot and mouth disease: blisters at the back of the mouth in children
• Sexually transmitted infections: gonorrhea and, less often, syphilis or HIV can infect the throat
• Fungal infection (thrush), in people with weakened immunity or using inhaled steroids
• Diphtheria: a gray membrane over the throat, rare in vaccinated populations

Symptoms

• sore, scratchy or painful throat, worse when swallowing
• red, swollen throat or tonsils, sometimes with white patches
• fever and chills
• swollen, tender glands in the neck
• hoarse voice
• headache and body aches
• in children: belly pain, nausea, refusing to eat

Diagnosis

• examination of the throat, neck and ears
• rapid antigen detection test for strep, results in minutes
• throat culture if the rapid test is negative in a child or teen, because rapid tests can miss some cases
• molecular (PCR) tests for strep, flu and COVID-19
• mono test and blood count when suspected
• CT for suspected abscesses

Testing is generally not recommended in children under 3 or when symptoms clearly suggest a virus.

Treatment

Viral infections

Antibiotics do not help. Most improve within 5 to 7 days.

• rest and plenty of fluids
• acetaminophen (paracetamol) or ibuprofen for pain and fever, following the label dose. No aspirin for children or teenagers
• warm salt-water gargles
• cold drinks, ice pops and soft foods
• throat lozenges or sprays for adults and older children
• honey in warm drinks for anyone over 1 year
• antiviral medicine for flu or COVID-19 in people at high risk

Strep throat

• antibiotics, usually penicillin or amoxicillin for 10 days, or alternatives for penicillin allergy
• people are no longer contagious after about 12 hours of antibiotics
• finish the full course to prevent complications such as rheumatic fever

Recurrent tonsillitis

Tonsillectomy may be considered for frequent, well-documented episodes, for example at least 7 in 1 year, 5 a year for 2 years, or 3 a year for 3 years, or for complications such as abscess.

Complications

• dehydration
• ear and sinus infections
• peritonsillar and deep neck abscesses
• after strep: scarlet fever, rheumatic fever, post-streptococcal glomerulonephritis and, rarely, PANDAS

Prevention

• wash hands often and avoid sharing cups and utensils
• cover coughs and sneezes
• keep up to date with flu, COVID-19 and routine childhood vaccines
• stay home until fever-free, and for strep, until at least 12 hours after starting antibiotics

Frequently asked questions

How do I know if my throat infection is viral or bacterial?

Viral infections usually come with a cough, runny nose or hoarseness and start gradually. Strep throat often starts suddenly with fever, swollen tender neck glands, white patches on the tonsils and no cough. Only a strep test can confirm it.

Do throat infections need antibiotics?

Most do not, because they are caused by viruses. Antibiotics are only needed for bacterial infections such as confirmed strep throat. Using antibiotics for viral infections does not help and causes side effects and resistance.

How long does a throat infection last?

Viral throat infections usually improve within 5 to 7 days. Strep throat improves within 1 to 2 days of starting antibiotics. Mono can cause a sore throat for 1 to 2 weeks and tiredness for longer. See a doctor if it lasts more than a week.

What is the fastest way to soothe a throat infection?

Pain relievers such as acetaminophen or ibuprofen, warm salt-water gargles, cold or warm fluids, honey (over age 1), lozenges for older children and adults, and rest help most. For strep throat, starting antibiotics speeds recovery.

When is a throat infection serious?

Seek emergency care for difficulty breathing, drooling, inability to swallow saliva, a muffled voice, inability to open the mouth, or a stiff neck. These can signal an abscess, epiglottitis or other serious complications. See also throat swelling.