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Sore Throat? Find out its causes and treatment – Pharyngitis.

Pharyngitis is a common swelling that causes sore throat. In this article, we’ll review the essentials of this ailment, including treatment.

In this reading, you will find the most important aspects of this condition—everything, its causes, diagnosis, and treatment. We even clarify terms like “strep throat” that are commonly used by patients. This, with the help of a certified medical doctor, but in the simplest of words. This way, you can quickly learn and understand every aspect of this common condition. 

What is the pharynx?

The pharynx, or as we all know it, the throat, is a fundamental anatomic structure. It is a passageway with a cone-like shape that connects oral and nasal cavities to the esophagus and larynx. It is made of muscle fibers and connective tissue that attach it to the base of the skull. These muscles help with swallowing and other essential functions of the pharynx. The role of the pharynx includes both respiratory and digestive functions. 

This figure shows the side view of the face. The different parts of the pharynx are color-coded and labeled.
Pharynx and its divisions

The pharynx has three divisions: the nasal pharynx, the oral pharynx, and the laryngeal pharynx. The nasal pharynx is the first portion and connects to nasal cavities, and the second portion, the oral pharynx. This second portion begins at the back of the mouth and continues down the throat to the epiglottis. This is a flap of tissue covering the airways when swallowing and redirects food to the esophagus.

In the oral pharynx, we also find the tonsils, two masses of lymphatic tissue. The nasal and oral pharynx connection is essential for humans: it lets us breathe from the nose and mouth. It also allows food to be passed to the esophagus through the nasal cavities if needed. The third region is the laryngeal pharynx, which regulates the passage of air and food to the lungs and the esophagus, respectively. 

What are pharyngitis and tonsillitis? 

Pharyngitis and tonsillitis are both swelling (which could be due to infectious diseases) in the throat. When the pharynx is the most affected, we call it pharyngitis. When the tonsils are the most affected, we call it tonsillitis. Nevertheless, the pharynx and the tonsils can be equally contrived; this is called pharyngotonsillitis.

Pharyngitis and tonsillitis are the most common causes of sore throat. They occur mostly due to infections, which can be caused by several microorganisms. I’ll mention them later in this writing. These infections can be very contagious and usually spread from close contact with infected individuals.

Both pharyngitis and tonsillitis are widespread conditions. On one side, pharyngitis affects around 16% of adults and 41% of children every year. For tonsillitis, the numbers estimate it affects from 15 to 25 children per 1000 every year. For both of them, they are accountable for more than 5 million doctor visits in both adults and children. 

What microorganisms cause pharyngitis and tonsillitis? 

Many microorganisms can cause throat infections like pharyngitis and tonsillitis. It is essential to know the cause of the infection in order to treat it properly. This sometimes is hard since the symptoms can be very similar, even if different germs cause them. The most common causes of pharyngitis and tonsillitis are: 

  •  Viral infections: Viral pharyngitis is the most common cause of throat infection. The viruses that most commonly cause viral sore throats include adenovirus, influenza virus, and Epstein-Barr virus (that causes infectious mononucleosis). Since viruses cause them, these types of pharyngitis will not get better with antibiotic treatment. 

In fact, gas pharyngitis is the most common bacterial form of pharyngitis.

  •  Bacterial infections: Bacterial pharyngitis is the second most common form of this condition. It is mainly caused by streptococcus bacterium, especially GAS (group A streptococci) like streptococcus pyogenes
  • Other common bacteria involved are Neisseria gonorrhea, Haemophilus influenza, and mycoplasma. There is also another rare bacterium that may cause sore throat, called Fusobacterium necrophorum. 

Other agents can cause pharyngitis, like parasites and fungi, but this is uncommon. External agents like cigarette smoke may also cause pharyngitis, but in this case, the cause is not infectious. 

What are the risk factors for it? 

As we mentioned before, infectious pharyngitis is a contagious disease. It can be spread from person to person through respiratory droplets. For this to happen, close contact with other individuals is necessary for disease transmission. The degree of chance of contagion is directly related to how much you could’ve been exposed. The most common risk factors for getting pharyngitis include: 

  •  History of contact with an infected person: This is no surprise. If you have been in close contact with someone infected, you are more likely to get the disease. 
  • Social situations with prolonged and close contact: The more people you hang out with, the higher the chance of getting the infection. 
  • Smoking: As we mentioned before, cigarette smoke can be irritative to your pharynx. 
  • Frequent upper respiratory infections: Like sinus or ear infections. Keep in mind that your nose, ears, and throat are connected and really close together. So, it isn’t rare for these infections to cause throat infections too. 
  • Attending daycare: Little kids are always more likely to develop these types of infections. So, what do you think happens when you put a bunch of them together? Exactly, and easier spread of the infection. 
  • Weakened immune system: Like any other infectious disease, a weak immune system has a hard time fighting these infections. In fact, having chronic pharyngitis or tonsillitis is an excellent clue to diagnosing an impaired immune system. 
  • Allergies: Especially the ones that affect your upper respiratory airways, like rhinitis. 
  • Cold season: The viruses that cause viral pharyngitis live longer in cold weather. This makes it easier for you to catch them during these seasons. 

Is this ailment a sexually transmitted disease?

This answer is tricky because it is yes and no at the same time; please allow me to explain better. It would depend on the microorganism and the way of contagion.

Non-sexual ways cause most of the viruses transmissions; therefore, in those cases, it is not a sexually transmitted disease (STD). But, some of them can have transmission by sexual contact, such as the herpes simplex virus, cytomegalovirus, human immunodeficiency virus (HIV), and human papillomavirus (HPV).

For bacteria happens the same; oral sex connection to bacterial infections in the throat is not a secret. The bacteria are Neisseria gonorrhoeaeChlamydia trachomatis, and Treponema pallidum (which can cause secondary syphilis). All these infections are considered STDs.

It depends on the microorganism, but some infections can represent a real threat to life later on. Therefore, taking the right measures before engaging in a sexual relationship or using male or female sexual protection is a must.

So the answer would be that not always pharyngitis is an STD, but it can certainly be one if you don’t protect yourself.

What are the symptoms of pharyngitis?

First, you need to know that it usually takes two to five days to get infected until symptom onset. Also, the symptoms that may be present in pharyngitis will depend on the microorganism causing it. The duration of the symptoms will also depend on the germ that caused the infection. We’ll briefly mention the symptoms that can appear in each case: 

  • Viral pharyngitis: The symptoms include the ones that appear in the common cold or flu. 
  • Sore, dry, and scratchy throat: This can be uncomfortable, but it’s not as painful as the throat pain in strep infections. 
  • Runny nose, sneezing, and coughing.
  • Headache.
  • Low fever, body aches, and chills.

In the case of infectious mononucleosis, the symptoms can include swollen lymph glands, severe fatigue, rash, and fever. 

Acute streptococcal pharyngitis; when the cause of the pharyngitis is a streptococcal infection, the symptoms are different, including:

  • Difficulty for swallowing 
  • Intense sore throat pain
  • Intensely red throat with white or grey patches can also be present in the tonsils, causing pharyngotonsillitis
  • High fever accompanied by chills
  • Swollen lymph nodes: specifically, the ones in your neck and below your jawline
  • Nausea and loss of appetite

Is sore throat the only symptom of the infection?

No, sore throat wouldn’t be the only symptom. There’re a lot of other symptoms related to the infection, depending on the microorganism.

The viral infection is prone to cause a runny nose, cough, nasal congestion, sore throat, and fever. Nevertheless, not all of the symptoms are present all the time, such as the fever, which is usually mild. These symptoms are, in a nutshell, keener to be on the nose. The nose can even discharge mucus, which is initially clear and then greener.

On the contrary, streptococcal pharyngitis has symptoms that could be more severe. Firstly, because bacteria, in general, can produce pus. Therefore, in this case, the location of the pus could be either locally or nearby as a peritonsillar abscess.

Furthermore, streptococcal pharyngitis symptoms are widespread in the whole body. The symptoms include the sudden onset of sore throat, painful swallowing, chills, severe fever rising more than 105 °F, headache, nausea, vomiting, and abdominal pain. As I said earlier in this article, strep-related infections have much more widespread and severe symptoms than viral infections.

In acute streptococcal pharyngitis, besides its sudden symptom onset, there are particular features visible a plain sight that can help to identify the infection. Your doctor would likely find the following during your thorough physical examination, such as swollen glands and swollen lymph nodes. Significantly, these lymph nodes are located in the front portion of the throat. Moreover, when the throat is examined inside, it is common to see tonsil minimal pus lesions. For that, the name exudative pharyngitis, for the streptococcal infection.

What does pharyngitis look like? 

This also may vary depending on the microorganism that’s causing the infection. Having someone look at your throat is a great way to find out if it’s, in fact, sore. You may find that the back of your mouth is abnormally red. This is the most common sign. Also, this can affect your tonsils (the two masses in each side of your throat). You can also see that it’s inflamed, which you probably already know by the difficulty or pain to swallow.

Finally, this may be the most critical finding: you can find white or even grey patches in your throat and tonsils. This is the easiest way to determine if you have a viral infection or a strep infection. You see, viral infections don’t cause these patches we’re talking about. If you have white patches in your throat or tonsils, you can be sure that the cause is strep bacteria. However, you still need to go to the doctor for a definite diagnosis and treatment. 

File:Strep throat2010.JPG
Strep Throat

What is the viral pharyngitis most similar to streptococcal pharyngitis?

Mononucleosis disease caused by the Epstein-Barr virus is a relatively common microorganism. When it appears, the symptoms are similar to the ones of the bacterial infections; therefore, it is a problem for further diagnosis and treatment. The likewise symptoms are fever, sore throat, malaise, nausea but without vomiting, and chills.

Furthermore, many of the features found by your medical doctor in the physical exam of the patient with streptococcal pharyngitis are also found in patients with this virus, such as swollen lymph nodes. Although there are characteristics of this viral infection that makes it unique. There could be some tenderness while touching the latter as an increase in the liver and spleen’s size.

What is most confusing for the mononucleosis infection is that it can cause both of them. While it is typical of the bacterium, in this case, streptococcus, to have exudative pharyngitis, the viral organisms cause non-exudative pharyngitis. So, when the Epstein-Barr virus causes exudative pharyngitis, it can be confused with streptococcal pharyngitis.

Moreover, 30% of patients with mononucleosis can also have streptococcus within their throat. So it is likely that a patient undergoing a microbiological test could mistakenly get a streptococcal pharyngitis diagnosis. When the mononucleosis causes nonexudative pharyngitis, the diagnosis is easy, resembling the typical affection by the viral organisms.

What’s the difference between pharyngitis and laryngitis? 

People often mistake pharyngitis and laryngitis. They are both upper respiratory tract infections. However, the affected structure is different. Therefore, the symptoms of these two conditions are various too. In pharyngitis, the pharynx becomes infected and/or inflamed. On the other side, in laryngitis, the larynx or voice box is the one affected.

As we said, the symptoms are very different. We already know that pharyngitis causes acute sore throat, difficulty swallowing, and redness or inflammation of the throat. Also, we already know that viral or bacterial infections almost always cause pharyngitis. Therefore, laryngitis’ symptoms include:

  • Loss or hoarseness of your voice.
  • Tingling sensation on the throat.
  • Persistent cough.

And the causes for laryngitis are mostly: exposure to a smokey or cold environment, allergies, or excessive use of your voice. Viral and bacterial infections can also cause laryngitis, but this is uncommon. 

Is viral pharyngitis strep throat? 

No. Viral pharyngitis is the infection or inflammation of the pharynx caused by viruses. Some viruses that cause it include adenovirus, influenza virus, and Epstein-Barr virus. Conversely, strep throat is a short term that refers to pharyngitis caused by streptococcus, a bacterium. This means that strep throat is always due to bacteria, specifically the streptococcus bacterium.

Still, not every bacterial pharyngitis is caused by streptococcus, but it is the most common cause. Also, not every case of pharyngitis is caused by bacteria. In fact, the significant majority of pharyngitis cases are caused by viruses. 

What are the complications of pharyngitis? 

The prognosis of pharyngitis is usually pretty good. Especially in viral infections, since they will go away on their own without extraordinary measures. But, in the case of bacterial infections, there can be complications if left untreated. 

  •  General complications: Mainly infections in another part of your respiratory tract. This includes sinus infections, ear infections, and pneumonia. Remember that these structures are pretty close together and connected, so bacteria can travel easily to any of them. 
  • Suppurative complications: These result from a spread of the bacteria through the blood or the lymphatic system. This is mostly related to GAS bacteria, but doctors think multiple bacteria can be involved too. These include peritonsillar abscess (pus collection around your tonsils) and retropharyngeal abscess (pus collection behind your pharynx). 
  • Nonsuppurative complications: These are very specific to GAS infections and include: Acute rheumatic fever, Kidney inflammation or damage, and toxic shock syndrome. 

The importance of an early and accurate streptococcal pharyngitis diagnose is that if it doesn’t receive treatment, there is a possibility for future complications. Complications have a division in suppurative and non-suppurative. This division means that some complications involve pus and others not, correspondingly.

Suppurative or local complications result from streptococcal pharyngitis without treatment that spreads to nearby structures. Some of them are retropharyngeal abscess, peritonsillar abscess, sinusitis, otitis media, and mastoiditis.

From the non-suppurative complications, there are acute rheumatic fever, rheumatic heart disease, and post-streptococcal glomerulonephritis. They usually develop between two or four weeks after the infection and strongly impact the patient in the short or long term. Receiving antibiotics is in association with a decrease in all these conditions, except for glomerulonephritis.

Is pharyngitis cancer?

Pharyngitis is an inflammation, mostly by a viral infection, but it isn’t cancer. However, some of the symptoms of a pharyngitis infection could also be in throat cancer (oropharyngeal cancer).

People with throat cancer can experience sore throat, but typically the symptom here would present differently from acute pharyngitis. It is a mild sore throat without any other particular symptom that has a long time and doesn’t go away. On the contrary, acute pharyngitis presents with bothering symptoms that make the patient seek help prematurely.

Suppose you are feeling any of these symptoms. In that case, you should consult your doctor or dentist because of their association with oral or throat cancer: changes in your voice, trouble opening your mouth, a cough that doesn’t go away, difficulty chewing or swallowing, and any changes in your lips as color, pain or function.

There are patient’s conditions that could tell even more than the symptoms themselves about this cancer. People over 65 years, and mostly male, can develop this cancer. Also, the behavior influences the outcome. The people that have more than four drinks per day and smoke tobacco significantly increase their chances of getting throat cancer.

How is pharyngitis diagnosed? 

If you think you have pharyngitis, you should go to the doctor. First, they will ask about your medical history and the symptoms you’ve been experiencing. They will probably ask if you had close contact with someone with similar symptoms. This is to know how likely you are to develop this condition. Then, your doctor will perform a physical examination.

Doctors will ask you to open your mouth, so they can have a more detailed look at your throat. They do this to see if it’s red, swollen or has any white or grey plaques. Keep in mind that they may also touch your neck, looking for swollen lymph nodes.

The presence of tonsillar-exudates is a sign of bacterial infection, so your doctor will look for them too. The diagnosis of this condition is primarily clinical. This means that doctors probably won’t need further laboratory tests or imaging studies. However, it’s essential to know which bacteria is causing the infection to get the proper treatment.

For the latter, doctors can perform a strep test. Since gas infection is the most common bacterial cause of pharyngitis, your doctors will look for streptococcus. They do this with a throat swab that will collect a sample of the exudate in your throat. Then, they will put the sample in a rapid antigen detection test. This is the simplest and quickest way to know if your infection is caused by streptococcus. 

Remember that most pharyngitis has a viral cause behind them, so don’t worry if your doctor doesn’t perform this test. 

What are the treatments for pharyngitis? 

Again, the treatment for pharyngitis will depend on the germ that caused it. This also happens with viral pharyngitis. As you already know, viral infections tend to get better on their own. However, doctors may prescribe you some medication. Not to cure the infection, but to make you feel a little better while it passes.

Some saltwater gargles will help with inflammation and will make you feel better. Also, pain relievers will decrease the pain and inflammation caused by the viral infection. 

On the other side, bacterial pharyngitis will always need antimicrobial therapy to get better. If you don’t take antibiotics, the bacteria will keep reproducing and even affect your body’s other tissues. The most commonly prescribed antibiotic therapy includes penicillin or amoxicillin. The duration of the treatment usually goes from 7 to 10 days. You must complete your treatment to avoid recurrence of the infection and possible chronic sore throat. So, even if you feel better after a couple of days, please finish your antibiotic treatment. 

Which antibiotic is best for pharyngitis?

Firstly, I should say that there aren’t specific antivirals for most viruses causing pharyngitis infection. Also, the use of antibiotics isn’t an indication of viruses, only bacteria.

The symptoms of streptococcal pharyngitis could disappear in three to four days without treatment, but antibiotics reduce the likelihood of complications. Treatment should last ten days, but a similar effect with lesser days has also been noted. Both oral penicillin V and amoxicillin are equally effective and first-line therapy for the infection.

What drink helps a sore throat? 

Anything nice and warm will help with a sore throat. Doctors believe that warmth is a mechanism to reduce inflammation a little bit. You can drink warm herbal teas or warm water with honey and lemon. Also, ginger tea works excellent since ginger has anti-inflammatory properties. You can even drink soup or a little bit of both of your choice.

Moreover, incorporate soft foods that will be easy to swallow, so you don’t stop eating during this period. Avoid crunchy or hard food since this can cause you more pain while swallowing. 

When should you contact your healthcare provider?

The symptoms will guide you if you are experiencing moderate to severe symptoms in the throat, such as pain, swallowing, and sore throat, mostly if you have a high fever and body aches. Then it would be great to get help from your healthcare provider.

Minor symptoms, mainly in the nose, like sneezing and stuffy nose, aren’t a reason for seeking medical assistance.

Do you want to know If you have this disease?

This tool is a Pharyngitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it the likelihood of their symptoms because of pharyngitis.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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