Why is My Throat Sore?

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Updated June 2022

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 got a cold, the flu, or something more serious?

“You should see a primary care doctor or go to an urgent care if you’ve had persistent sore throat with fever for more than four days or if you feel like you are having trouble swallowing,” says Christine D'Aguillo, M.D., an otolaryngologist (ear, nose, and throat specialist/ENT) with the University of Miami Health System. “Most cases of sore throat can be treated by your primary care physician or local urgent care doctor.”

Is it a cold, COVID-19, or something else?

Viral illness, such as a head cold, is the most common cause of sore throat. Allergies are another common culprit. With the common viral cold, people often also have nasal congestion, a cough, sneezing, and irritated eyes. 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, 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 seasonal 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. Prescription anti-viral medicines can, if taken within the first 48 hours, help shorten the duration and severity of flu symptoms. Complications from the flu are more common for the elderly and those with compromised immune systems.

A sore throat can also be a sign of COVID-19. If you think you may have the coronavirus, you should get tested and, if positive for the infection, isolate yourself to help prevent the spread.

When is a sore throat more serious?

“You should see a specialist (like an ENT) if you’ve had a sore throat for greater than three weeks without improvement despite medical treatment,” Dr. D’Aguillo says.

Another more serious type of sore throat is strep throat, which often comes with 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, you can be treated with antibiotics and should see symptom improvement within two days.

Strep throat is a type of tonsillitis, which means inflammation of the tonsils. “Removal of the tonsils (tonsillectomy) is usually done as a last resort if medical treatment fails,” Dr. D’Aguillo says. “The vast majority of people with a sore throat do not need to have their tonsils removed.”

If you have a history of recurrent episodes of strep, if one tonsil is much larger than the other, or if you’ve had a peritonsillar abscess (PTA) that required drainage, then it’s time to see an ENT. “PTA usually starts as strep throat then rapidly progresses and is worse on one side,” Dr. D’Aguillo says. “With PTA, you may notice one tonsil is much larger than the other, your soft palate is asymmetric, and you have trouble swallowing. It usually requires drainage of the abscess, which can be done in the ER.”

Other causes of sore throat include:

  • gastroesophageal reflux disease (GERD)
  • mononucleosis (“mono”), a virus that commonly spreads among young people
  • tonsil stones
  • sexually transmitted infection (syphilis, gonorrhea, and chlamydia can be spread through oral sex)
  • HIV infection
  • cancerous tumor
  • smoking/vaping
  • vocal cord strain (common among those in vocally demanding professions, like athletics coaches, teachers, and fitness instructors)
  • exposure to a strong chemical irritant
  • chronic dry mouth/dry throat (triggered by medications, salivary gland dysfunction, or marijuana use, among other causes)

“As ENTs, we commonly see patients with recurrent strep throat, GERD, vocal cord strain, PTA, and cancer,” says Dr. D’Aguillo.

The treatment approach is different for each of these causes. That’s why a medical exam, including a throat swab, is likely needed to diagnose the cause. Your doctor will review your medical history and may ask questions about issues and behaviors that seem unrelated to a sore throat. Then they can determine the best approach for symptom management, minimizing damage to the throat, and avoiding esophageal issues. When a patient complains of a sore throat without other signs of a cold and a strep test is negative, healthcare providers start considering other, less common causes.


Updated by Dana Kantrowitz, contributor.