It often starts as a little tickle in the back of the throat. But before you know it, you feel like you swallowed fire. Does this mean you’ve caught a cold - or worse, the flu?
“You should see a doctor if it really hurts to swallow, or you’ve had a bad sore throat with a fever for more than four days," says Dr. Olveen Carrasquillo, a primary care physician at the University of Miami Health System. "Walk-in clinics and urgent care centers are pretty good about assessing the cause of a sore throat. For people having these symptoms, we don’t want patients doing their own exams and coming to their own diagnoses."
Is it a cold, the flu, or strep throat?
“The vast majority of sore throats are caused by the common cold,” which is a virus and can’t be treated with antibiotics. With the common viral cold, people often also have nasal congestion, a cough, sneezing, and irritated eyes. “That’s what we like to hear patients reporting,” says Dr. Carrasquillo, “because we can assume the issue is viral in nature. A sore throat caused by a cold virus usually gets better in three to four days, and you don’t need to run to the ER or your doctor in this case.”
If you have a cold, prescription antibiotics aren’t going to help.
The best way to respond to a cold is to get some much-needed rest and treat the sore throat symptoms until they pass.
- Gargle with warm salted water or sipping tea with lemon and honey for some relief
- You can take acetaminophen (Tylenol) or ibuprofen (Advil)
- Suck on throat lozenges or use throat-numbing sprays
- Stay hydrated
- Keep your throat and nasal passages from getting dry with a saline nose spray.
With the flu, you may get a sore throat, but you’re more likely to get high fevers and body aches.
“The flu is more severe than the common cold. It can knock you out, making it feel impossible to go to work or school. Usually, with the flu, a sore throat isn’t the worst symptom.”
Most people with seasonal flu can recover by treating their symptoms with over-the-counter and at-home remedies. “However, for the elderly and other high-risk groups,” Dr. Carrasquillo said, “there are anti-viral medicines that, if taken within the first 48 hours, can help shorten the duration of symptoms” to prevent the flu from developing into a more serious condition.
“Strep throat must be treated differently,” Dr. Carrasquillo warns.
“The onset of this type of sore throat is sudden (acute) and often more severe than what you get with a cold. With strep throat, people also have a slight fever, swollen lymph nodes, and inflamed tonsils with white plaque. Your doctor or an urgent care center can administer a rapid strep test. If the test comes back positive, we treat with antibiotics and typically see symptom improvement within two days.”
What else can make my throat hurt?
Other causes can range from gastroesophageal reflux disease (GERD) to tonsillitis. In addition, your throat may hurt due to sinus allergies/irritants, or even a cancerous tumor or sexually transmitted infection (STI). For those in vocally demanding professions (athletics coaches, teachers, and fitness instructors), vocal cord strain can cause throat pain. To make the right diagnosis, your doctor may ask questions about issues and behaviors that seem unrelated to a sore throat.
“GERD is common, so we ask patients, ‘Is the throat pain worse after you eat?’ We ask about stomach acidity and burning in the chest and throat,” says Dr. Carrasquillo. If GERD is the cause, you’ve got to successfully reduce the acid reflux to allow the throat membranes to heal. Over-the-counter and prescription-strength medications can help reduce stomach acid production. Some lifestyle changes, like dietary changes, quitting smoking, and getting more exercise, can be effective in reducing chronic acid reflux. Plus, you don't have the side effects of taking acid-reducing medications long-term.
Another cause that’s fairly common, especially among young adults, is mononucleosis, or mono, which is caused by a different type of virus spread through saliva. “In cases of mono, the tonsils are very swollen. There’s not much we can do to treat mono,” says Dr. Carrasquillo, but the sore throat associated with this virus typically clears up within one to two weeks. The infection remains active and contagious for about two months.
In rare cases ...
Dr. Carrasquillo says that for patients at a higher risk for STIs, a sore throat can be a sign of secondary syphilis, or gonorrhea or chlamydia, which can be contracted from oral sex. Following a diagnosis, these STIs can be cleared up with antibiotics. Also, if a sore throat is accompanied by skin ulcers or a rash, it could be a sign of acute HIV infection.
“These diagnoses are rare when a patient is complaining primarily of a sore throat,” Dr. Carrasquillo said, “but we have them in the back of our minds. If a patient does not have signs of a cold, their strep test is negative, or their sore throat is chronic, we have to think about other things and ask about their sexual history and other potential risk factors.”
Dana Kantrowitz is a contributing writer for UMiami Health News.