ConditionEar, nose & throat
Viral Pharyngitis (Viral Sore Throat)
Viral pharyngitis is inflammation of the throat (pharynx) caused by a virus. It is the most common cause of a sore throat, responsible for most cases in adults and many in children. It usually comes with cold symptoms such as a runny nose, cough and hoarseness, and gets better on its own within 5 to 7 days. Antibiotics do not help. Rest, fluids, pain relievers and throat lozenges ease symptoms. Strep throat, which needs antibiotics, is more likely with fever, swollen tonsils with white patches and no cough.
Also called: Viral sore throat, viral throat infection, acute viral pharyngitis
At a glance
- What it is
- A sore, inflamed throat caused by a virus.
- Common viruses
- Rhinovirus, adenovirus, coronaviruses (including COVID-19), influenza, RSV, Epstein-Barr virus (mono), enteroviruses.
- Symptoms
- Scratchy or painful throat, pain swallowing, runny nose, cough, hoarseness, mild fever.
- Duration
- Usually 5 to 7 days; mono can last 2 to 4 weeks.
- Treatment
- Supportive care; antibiotics are not effective.
When to get help
Call 911 or go to the ER
- Difficulty breathing, noisy breathing (stridor), drooling or inability to swallow saliva
- A muffled "hot potato" voice with severe one-sided throat pain and trouble opening the mouth (possible peritonsillar abscess)
- Stiff neck, severe headache or a rash that does not fade when pressed, with fever
See a doctor within a day or two
- Severe sore throat with fever above 38.3 °C (101 °F), swollen tender neck glands and no cough (possible strep throat)
- Unable to drink enough fluids, or signs of dehydration
- Sore throat with a sandpaper-like rash (possible scarlet fever)
Book a routine appointment
- Sore throat lasting more than 7 to 10 days
- Severe fatigue and swollen glands for more than a week (possible mono)
- Recurrent sore throats several times a year
Usually safe to manage at home
- Sore throat with a runny nose, cough or hoarseness and mild or no fever, improving over a few days
Common viral causes
| Virus | Clues |
|---|---|
| Rhinovirus and other cold viruses | Runny nose, sneezing, cough; mild |
| Adenovirus | Fever, sore throat and red eyes (pharyngoconjunctival fever), often in children |
| Influenza | Sudden fever, body aches, exhaustion |
| COVID-19 | Sore throat, cough, fever, loss of smell or taste |
| Epstein-Barr virus (mononucleosis) | Teens and young adults; severe sore throat, large neck glands, fatigue, sometimes enlarged spleen |
| Coxsackievirus (herpangina, hand-foot-and-mouth) | Small blisters or ulcers at the back of the throat; young children |
| Herpes simplex | Painful ulcers on the gums and front of the mouth |
| Acute HIV infection | Sore throat with fever, rash and swollen glands a few weeks after exposure |
Symptoms
- sore, scratchy or raw throat
- pain when swallowing
- runny or blocked nose (coryza), sneezing
- cough
- hoarse voice
- mild fever, aches and tiredness
- red throat, sometimes with mildly swollen tonsils
- tender neck glands
Viral pharyngitis vs strep throat
| Feature | Viral pharyngitis | Strep throat |
|---|---|---|
| Cough, runny nose, hoarseness | Common | Usually absent |
| Fever | Mild or none (higher with flu, mono) | Often above 38.3 °C (101 °F) |
| Tonsils | Red, sometimes swollen | Swollen, often with white patches |
| Neck glands | Mildly tender | Swollen and tender at the front of the neck |
| Age | Any | Most common in children 5 to 15 |
| Treatment | Supportive | Antibiotics |
Doctors use scoring systems (such as the Centor or McIsaac score) and a rapid strep test or throat culture to decide whether antibiotics are needed. Adults with clear cold symptoms usually do not need testing.
Diagnosis
Viral pharyngitis is diagnosed from symptoms and a look at the throat. Tests are used when strep, mono, COVID-19 or flu would change management:
- rapid strep test or throat culture
- mono spot test or EBV antibodies
- COVID-19 or flu tests
Treatment and home care
Antibiotics do not kill viruses and do not speed recovery. They cause side effects and contribute to resistance.
- pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose. Do not give aspirin to children or teenagers
- warm drinks such as tea with honey (not for babies under 12 months), or cold drinks and ice pops
- salt water gargles: half a teaspoon of salt in a cup of warm water, for older children and adults
- throat lozenges or sprays containing local anesthetics, for adults and older children (not for young children, who may choke)
- rest and fluids
- humidified air
- avoid smoking and smoke exposure
For mono, avoid contact sports for at least 3 to 4 weeks or as advised, because of the risk of spleen rupture.
Complications
Viral pharyngitis rarely causes complications. Uncommon problems include:
- secondary bacterial infection, such as sinusitis or ear infection
- dehydration in young children who refuse to drink
- airway swelling in mono (rare)
Prevention
- wash hands often
- avoid sharing cups and utensils
- cover coughs and sneezes
- stay up to date with flu and COVID-19 vaccines
Frequently asked questions
How long does viral pharyngitis last?
Most viral sore throats improve within 5 to 7 days. Sore throat from mono can last 2 to 4 weeks, with fatigue lasting longer. See a doctor if symptoms last more than 10 days or get worse.
How can I tell if my sore throat is viral or strep?
Viral sore throats usually come with a cough, runny nose or hoarseness. Strep throat more often causes a high fever, swollen tonsils with white patches, tender swollen neck glands and no cough. A rapid strep test can confirm it.
Do I need antibiotics for viral pharyngitis?
No. Antibiotics do not work against viruses and will not make you recover faster. They are only needed if a bacterial infection such as strep throat is confirmed.
What helps a viral sore throat feel better?
Pain relievers such as acetaminophen or ibuprofen, warm drinks with honey, cold fluids or ice pops, salt water gargles, lozenges and rest all help. Drinking plenty of fluids keeps the throat moist.
Sources
This guide was written from current patient and clinical guidance, including:
- Infectious Diseases Society of America: Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis
- CDC: Sore throat (antibiotic use)
- American Academy of Family Physicians: Pharyngitis: Approach to Diagnosis and Treatment
- NICE Guideline NG84: Sore throat (acute): antimicrobial prescribing
- MedlinePlus: Sore throat