Definition

Pharyngitis, also known as a sore throat, is inflammation of the pharynx, the part of the throat behind the mouth. This condition can cause itching, discomfort, or a dry sensation in the throat, often accompanied by difficulty swallowing.

A bacterial or viral infection can cause pharyngitis. It is a common condition and rarely causes other complications. Viral pharyngitis usually resolves on its own within a week or more. Identifying the cause of pharyngitis can help choose the appropriate treatment to speed up recovery.

Causes

Infections

• Viral infections: The most common cause of pharyngitis. It is usually caused by viruses that cause colds or flu (Influenza and Parainfluenza viruses). Depending on the type of virus, symptoms usually disappear on their own within a week to 10 days. Pharyngitis can also result from:
• Coxsackie virus
• Epstein-Barr virus, which can cause mononucleosis and symptoms that can last for months
• Coronavirus disease (Covid-19)
• Adenovirus
• Rhinovirus
• Bacterial infections: The most common bacterial cause of pharyngitis is group A Streptococcus. Other bacteria that can cause pharyngitis include:
• Chlamydia trachomatis
• Neisseria gonorrhoeae
• Corynebacterium

Tonsillitis

Inflammation of the tonsils can also cause symptoms of pharyngitis. Tonsils are two small organs located at the back of the throat that function as part of the immune system. Tonsillitis occurs when the tonsils become infected and inflamed due to bacterial or viral infections.

Allergies

Allergic reactions to pollen, dust, pet dander, or mold can make your throat dry and itchy. Pharyngitis due to allergies is caused by postnasal drip, where mucus from the nose drips down the back of the throat, irritating it and causing pain.

Acid reflux

People with Gastroesophageal Reflux Disease (GERD) may feel a burning sensation and pain in the throat due to stomach acid rising into the throat.

Irritation

Eating spicy foods, smoking, and drinking hot beverages can irritate or cause an unpleasant sensation in your throat.

Excessive dryness

Sleeping with your mouth open can cause you to wake up with a sore throat. A blocked nose due to a cold, flu, or allergies can force you to breathe through your mouth, causing throat dryness.

Other causes

Although less common than the conditions and microbes mentioned above, the following can also cause pharyngitis:

• Abscess (pus-filled pocket) around the tonsils
• Infection of the epiglottis (a structure that covers the airway when swallowing)
• Presence of a tumor around the throat

Risk factor

Although anyone can develop pharyngitis, several factors can increase your risk, such as:

• Age: Most common in children and teenagers, especially those aged 3 to 15 years, who are more susceptible to bacterial pharyngitis.
• Exposure to tobacco smoke and smoking habits: These can irritate the throat and increase the risk of developing oral, throat, and vocal cord cancer.
• History of allergies: Allergies to dust, mold, or pet dander can increase the risk of pharyngitis.
• Exposure to chemical irritants: Such as fossil fuel combustion residues and household chemicals, can irritate the throat.
• Contact with pharyngitis patients: Viral or bacterial pharyngitis can easily spread, especially in crowded areas.
• Weakened immune system: This makes a person more susceptible to infections. Common causes of weakened immunity include:
• HIV
• Diabetes
• Steroid or chemotherapy treatments
• Stress
• Fatigue
• Poor diet

Symptoms

Symptoms of pharyngitis usually appear within two to five days after infection. Symptoms can vary depending on the underlying cause. Signs and symptoms of pharyngitis include:

• Pain or itching in the throat
• Sore throat that worsens when swallowing or talking
• Difficulty swallowing
• Pain and swelling in the glands in the neck or jaw
• Fever
• Cough
• Runny nose
• Sneezing
• Muscle aches
• Headache
• Nausea or vomiting

Diagnosis

To diagnose pharyngitis, your doctor will start by asking about your symptoms, other health conditions, and potential risk factors. Then, the doctor will perform a physical examination, which may include:

• Inspecting the throat for white or gray patches, swelling, and redness
• Checking the ears and nose
• Gently palpating the neck to check for swollen lymph nodes
• Listening to your breathing with a stethoscope

Pharyngitis is usually diagnosed based on symptoms and physical examination results. However, your doctor may suggest additional tests if indicated, such as:

• Throat swab test: If bacterial pharyngitis is suspected, a throat swab may be taken to collect mucus samples and examined in the laboratory.
• Blood tests: If another cause of pharyngitis is suspected, a complete blood count may be done to determine if you have another type of infection.

Management

The treatment for pharyngitis depends on the underlying cause. If caused by a bacterial infection, antibiotics like Amoxicillin or Penicillin may be prescribed. Antibiotics can help reduce symptoms and prevent complications. It's important to complete the full course of antibiotics as prescribed to ensure the infection is completely treated and to prevent recurrence.

Viral pharyngitis does not respond to antibiotics and usually resolves on its own. Over-the-counter medications like Paracetamol or Ibuprofen can help alleviate pain and fever.

Additionally, several measures can help speed up recovery, such as:

• Getting plenty of rest
• Staying hydrated by drinking enough fluids
• Sucking on throat lozenges to relieve throat discomfort
• Gargling with salt water
• Changing your toothbrush
• Drinking warm beverages like tea, lemon water, or broth

Complications

Complications from pharyngitis are rare. When they occur, they are usually related to the body's response to group A Streptococcus bacterial infection, such as:

• Peritonsillar abscess: A pus-filled pocket near the tonsils
• Retropharyngeal abscess: A pus-filled pocket located behind the throat
• Lymphadenitis: Inflammation of the lymph nodes in the neck
• Mastoiditis: Infection of the mastoid bone behind the ear
• Acute rheumatic fever: An inflammatory condition affecting the heart, joints, skin, or brain
• Post-streptococcal glomerulonephritis: Damage to small blood vessels in the kidneys after a streptococcal infection

Prevention

The best way to prevent pharyngitis is to avoid the causative germs and practice good hygiene and healthy living. Steps to take include:

• Washing your hands thoroughly for at least 20 seconds, especially after using the toilet, before and after eating, and after coughing or sneezing
• Avoiding touching your face, particularly your eyes, nose, or mouth
• Not sharing food, drinking glasses, or utensils
• Using tissues when coughing or sneezing and discarding them properly, followed by handwashing
• Using alcohol-based hand sanitizers when soap and water are not available
• Regularly cleaning and disinfecting phones, doorknobs, light switches, remote controls, and computer keyboards
• Avoiding close contact with people who are sick or have symptoms of pharyngitis

When to see a doctor?

Consult a doctor if you experience pharyngitis symptoms accompanied by any of the following:

• Symptoms lasting more than 10 days
• Severe pain or difficulty swallowing
• Difficulty breathing
• Rash
• Inability to drink
• Difficulty opening your mouth
• Voice changes