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December 4, 2011 at 11:06 PMComments: 0 Faves: 0

Do I Need To See A Doctor For My Sore Throat?

By Jeffrey VanWingen M.D. More Blogs by This Author

There are very few people who have never experienced a sore throat. 

In fact, in my practice it is one of the most common problems that I see. While many causes of a sore throat exist, the vast majority are harmless and short-lived, namely the common cold.  Yet, most people I see for the symptoms believe they have strep throat and ask "Do I need to be tested?" 

This blog will highlight common causes of a sore throat and discuss s, which symptoms actually warrant a  doctor's visit.

Sore Throat Terminology

To start, a primer on the language of the sore throat is important. 

  • The pharynx is essentially the area of the back of the throat.  It includes:
    • the tonsils,
    • the uvula (that thing that hangs down) and...
    • the soft palate
  • Inflammation/infection of this area is called pharyngitis
  • The tonsils, though part of the pharynx, can become inflamed leading to the more specific classification of tonsillitis
  • The larynx is the voice box, further down the throat from the pharynx. 
  • Laryngitis  is an infection or inflammation of the larynx and involves hoarseness in addition to a sore throat.

As stated before, most all sickness-related sore throats are caused by viral infections.  To help with this diagnosis, other symptoms are important to consider. 

Laryngitis

Sore Throat * Excess Mucous * Runny Nose * Sneezing * Cough * Weakened or Lost Voice

In this particular sickness, the infection occurs in the mucous-making tissue of the back of the nose and throat.  This causes production of a lot of mucous which can bring about the typical runny nose, sneezing and cough.  While the runny nose is caused by mucous coming toward the nose outlet, it can also go the other way, down the throat.  Even though mucous is slimy and slippery, it can be quite irritating to the back of the throat, especially if it sits there during sleep.  This irritation causes the sore throat. 

In a viral upper respiratory infection, the sore throat is often worse in the morning and improves as the day goes on.  As that mucous is cleared and routine swallowing keeps the area moist, the pain generally improves.  When examined, the back of the throat appears irritated and red. When associated with a weakened or lost voice (laryngitis), the illness is most surely a viral infection. 

Strep Tonsillitis or Viral Tonsilitis

Sore Throat * White spots on Tonsils *  Headache *Abdominal Pain *  Fever * Enlarged Lymph Nodes

When the inflammation and pain is more focused on the tonsils, tonsillitis is considered.  In this case it is important to distinguish between strep tonsillitis and non-strep (usually viral) tonsillitis.  Unfortunately, enlarged tonsils with white pockets are not so helpful in making this distinction.  These findings can be present with viral or strep infections.  Sometimes those white patches are actually food that is caught and breaking down in the crypts of the tonsils.  Often a headache and pain in the abdomen can be seen with strep.  Again, however, these findings are not consistent.  Fever and enlarged lymph nodes in the neck are also non-specific and can be seen with either cause of tonsillitis. 

Is it Step or Non-Strep Tonsilitis? The best way to distinguish strep from non-strep is a test that can be done in a doctor's office.  This involves taking a swab sample of the tonsil and running a "rapid strep" test.  This test is for the most part accurate but if a false negative test is suspected another swab will be done and sent to a lab to be cultured for the strep bacteria.  While this test is considered the more accurate "gold standard" test, results take about 48 hours.  A rapid strep, on the other hand, takes about five minutes to produce an answer. 

Strep Treatment: If strep is discovered, antibiotics are prescribed. 

Penicillin, or a relative of penicillin, is the drug of choice to treat strep.  People often feel significantly better the next day after beginning treatment.  The most important reason to treat the strep infection, however, is the prevention of secondary strep complications. 

Potential Strep Complications: In these rare but serious cases, the body's immune system fights the step by recognizing it's structure.  When the immune system floods the body looking for the strep, parts of our body can mimic the strep in structure. 

  • Kidney Problems. One example of this occurs in the kidneys and is called pyelonephritis.  With proper treatment, this often resolves with no complications. 
  • Rheumatic Fever. A more serious example is rheumatic fever.  Rheumatic fever occurs when the immune system attacks a valve in the heart, mistaking it for strep.  This can set the stage for valve problems that may require open-heart surgery down the line. 
  • Scarlet Fever. Another complication can occur from strep through a toxin produced by the bacteria.  This toxin, along with the strep itself, produce a syndrome called scarlet fever.  Symptoms of scarlet fever include the typical sore throat, a fine sand-paper like rash on the body and perhaps a bright red tongue.  While scarlet fever was once potentially life-threatening, treatment with antibiotics prevents any serious consequences. 
  • Tonsil Abscess. Strep throat can also be complicated by the development of an abscess within the tonsil.  This is treated surgically.  While the body will fight off strep tonsillitis in due course, quick diagnosis and treatment with antibiotics cut down on the potential for serious complications.

Mononucleosis or "Mono"

Sore Throat * Extreme Fatigue * Enlarged Lymph Nodes * Fever * Enlarged Spleen

Another cause of tonsillits is mononucleosis (commonly called mono). 

The sore throat and inflammation of the tonsils are part of a syndrome that includes extreme fatigue, enlarged lymph nodes in the neck, a fever and perhaps an enlarged spleen.  Mono is more common in adolescents and young adults.  It is caused by a virus and only supportive care is warranted.  Resolution of symptoms can take months.  A blood test confirms the diagnosis. 

Complications of Mono: A diagnosis of mono is important due to the long-term nature of the illness, the  transmission potential, and the danger a ruptured spleen if the person engages in contact sports.  Additionally, if mono is mistreated with a penicillin antibiotic, a rash can develop. 

Do I Need to See a Doctor For My Sore Throat?

The causes of a sore throat not associated with an acute infectious process are many.  These causes range from allergies, to stomach acid reflux, to a yeast infection to HIV. Yet, sore throats are very common. Viral infections are most often the cause and will resolve with watchful waiting or supportive treatment.

So. When should you call your doctor?

  • If a cause is not forthcoming or the sore throat does not resolve quickly on its own, see a doctor.
  • If symptoms leave the possibility for a strep infection, see a doctor for testing and treatment in order to prevent complications. 
  • If the sore throat is persistent without a known cause, see a doctor for further evaluation.

Photo Credit: Micah Taylor

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