Sore throat - triggers and treatments to soothe and repair

Let’s talk you through possible causes, alongside what to expect in terms of symptoms and things you might find on examining yourself.

Viral infection

This is by far the most common cause of a sore throat. Both viral and bacterial infections can be painful, and cause the glands in the front of your neck to become inflamed. But a viral infection is more likely to bring multiple symptoms, like a blocked or runny nose, sticky or streaming eyes, blocked or painful ears and a cough, making up all the components of the common cold. You may have a mild fever but don’t usually feel too unwell.

Rhinoviruses, adenoviruses, coronaviruses and enteroviruses are all responsible for this, and they usually appear in autumn or winter. Other common childhood viral diseases like hand foot and mouth, croup, measles, mumps and chickenpox can also cause a sore throat.

You may lose your voice if it affects the larynx, making up the voicebox, and this is termed laryngitis. There’s no cure, as such, but it helps to keep yourself well and soothe symptoms until you recover. And we don’t usually test which virus is responsible.

COVID-19 and flu infections

Some viral infections can be serious, such as flu, caused by the influenza virus, or COVID-19, caused by a coronavirus. You will feel very unwell with flu, likely feverish and bedbound, with a poor appetite and likely a dry cough. COVID-19 varies between people, and between strains, and whether you’ve been vaccinated or not, but a sore throat is now considered one of the first signs of infection. A dry forceful cough and fever were more common signs in the early strains of this virus, but do not occur in everyone in the subsequent strains.

Flu is not routinely tested unless you need admission, and COVID-19 is now tested by self-bought lateral flow tests, or given your symptoms and any known contacts.

Again, antibiotics will have no effect on these viruses, they need time, rest and recuperation for your body to clear them. They may be a serious prospect for those with lung, heart, kidney or other serious long-term health conditions.

Glandular fever

Glandular fever, also called infectious mononucleosis, this is caused by EBV (Epstein-Barr virus), and can make people feel really unwell. Known as the kissing disease for its contagious spread via saliva, it’s most common in those in their teens and early 20s. The throat can be very painful and inflamed, with very enlarged tender glands at the front of the neck. Most feel feverish, shivery, tired and want to remain in bed, and the fatigue can last for some time after the sore throat has resolved. This can be tested for by a swab or a blood test.

Strep throat

Streptococcus pyogenes is a bacteria that can cause a sore throat, and this may require a course of antibiotics to help recover and reduce any complications. Key signs include white spots of pus dotted on the tonsils and one or both tonsils very enlarged. You won’t have any of the usual cold symptoms, like cough and runny nose, but you are likely to have a fever and enlarged neck glands.

A swab can confirm the diagnosis, or your doctor may feel that strep throat is likely, based on symptoms and a formal scoring system. Strep pyogenes accounts for a third of sore throats in children and 10% of those in adults.

Certain other bacteria can be sexually transmitted, such as gonorrhoea or HIV, to cause a sore throat. These require tests to confirm and antibiotics for your and any partners, to clear.

Epiglottitis and quinsy

The epiglottis is a hard flap of tissue that acts as a train signal, switching one way to allow food to go down to the stomach and not the lung, and the other way to allow breathing into the lungs and not the stomach.

Occasionally this can become infected with bacteria and very swollen. Key signs include severe pain, making it difficult to open your mouth for examination, or to speak or swallow – people speak in very low volumes, creating as little movement to enunciate words as possible, and they may be drooling as they can’t swallow. Severe swelling can make the neck very sore, breathing difficult or noisy (stridor gives a high-pitched whistling sound owing to narrowed airways) and it can bring on a high fever. This is a very serious condition that requires urgent hospital treatment, as it threatens your airways. It’s important you get to the emergency department quickly with these signs. This can be treated with strong antibiotics.

Similar symptoms are seen with quinsy, an uncommon condition where an abscess (collection of pus) forms at the back of the throat, causing severe pain and difficulty swallowing, speaking and breathing.

Irritants and allergies

Irritants can be found in the environment, such as dust, smoking, industrial and cleaning chemicals, depending on your workplace, or air pollution. These can irritate your throat, causing you to constantly clear it or they can develop into a cough.

Allergies are generated from within you, as an over-response by your immune system to a potential threat, such as pollen, mould or animal dander. They can cause a constant clearing that can make the throat sore, a chronic cough, or nasal congestion can drip down, irritating the back of the throat as the postnasal drip. Hay fever and asthma are allergy-related and a sore throat may be a sign that you need stronger treatment.

Dry throat

The mouth and throat are lubricated with saliva, but this may dry up in certain conditions, especially if they cause open-mouthed breathing, such as nasal congestion, asthma, snoring, obstructive sleep apnoea or autoimmune condition Sjogren’s syndrome.

It may also be caused by environmental factors like central heating, overuse of the dehumidifier or dry hot weather conditions. You might notice dry scratchy eyes, too.

Constant cough

An ongoing cough can cause a sore throat, as you’re constantly having to clear it. Poorly controlled asthma, long COVID, a smoker’s cough or COPD (smoking-related lung disease) and untreated reflux disease (where stomach acid comes up the oesophagus), can all cause a chronic cough and sore throat.

Injury

We’ve all had that feeling of food catching in our throat if we haven’t chewed it enough, and certain foods, especially hard dry foods like toast, crisps, crackers, or an overcooked pizza base, can cause a scratch that can continue to hurt for several days.

Talking and shouting

Perhaps it was shouting over the din at a party, giving numerous lectures or singing for your supper at a karaoke bar, these activities can all cause a strain on the vocal cords and surrounding muscles. They need a few days of rest to recover.

Cancer

Rarely a persistent sore throat may be a sign of cancer of the throat, larynx or tongue. Other pointers to look out for are weight loss, increasing difficulty swallowing, or difficulty swallowing food and now liquids, or regurgitating them. Viral sore throats are very common, so it’s important to give yourself time to get over any infection (or any other cause) before considering whether cancer is a possibility. Then it’s an urgent visit to your doctor.

The vast majority of sore throats are viral in nature, and will usually resolve on their own without treatment. But there are several types of products available at the pharmacy that can reduce the severity of symptoms.

Pain relief - Oral paracetamol is a good option for both adults and children. For children, an oral solution or suspension (such as Calpol) can reduce pain and any associated fever. Soluble paracetamol may be a good option for adults, too, if standard paracetamol tablets are too bulky and painful to swallow.

Anti-inflammatories for swollen glands or painful swallowing - Adults can take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, and they can choose the formulation from tablets, orodispersible or soluble. Nurofen for Children (ibuprofen suspension) may be helpful to relieve pain in children.

Alternatively, you may wish to target an area directly with topical anti-inflammatories containing flurbuprofen or benzydamine. These reduce pain and inflammation directly in the mouth and throat, as they come in the form of lozenges (Strefen or Difflam), throat rinses (Difflam SoreThroat Rinse) or throat sprays such as Difflam Spray. Difflam Spray is safe for use on children’s sore throats, too.

Throat numbing products - Some throat sprays contain a local anaesthetic (such as lidocaine or benzocaine) and a mild antiseptic, for quick and direct pain relief in the throat. This helps soothe and may be useful just before eating and drinking, to reduce pain when swallowing. Ultra Chloraseptic and Covonia throat sprays are two examples. Sucking on sweets may be preferred, and numbing and antiseptic lozenges include Strepils lozenges, containing active ingredients dichlorobenzyl alcohol and amylmetacresol.

Demulcents - These coat the back of the mouth and throat to relieve soreness and irritation. These drug-free products come as soothing lozenges (like Soothers, Covonia Double Impact lozenges or similar). Glycerol syrup or simple linctus (and there’s also a paediatric version for children). A spoonful of honey can have the same effect.

A sore throat can last up to 7 days, and your symptoms can evolve over this time. As a general rule of thumb, selecting several products that relieve symptoms in different ways is a good approach, but beware of doubling up on the same types of treatments.

Simple measures can make an impact on your sore throat, whatever the cause.

Fluids

Hydration is important, as always, especially with a fever and fighting an infection. But fluids warm or cool can help soothe the throat. Some prefer a spoon or two of honey in green tea or hot water, others add lemon or ginger, and many say it seems to lubricate the throat and clear congestion. Others find a cool or iced drink provides more relief.

Keep a glass of water next to the bedside if a dry mouth or open mouth-breathing is a problem.

Foods

Keep foods soft and cool, so they pass down easily. Examples include jelly, yoghurt with soft or pureed fruits, mashed potato, soup, fruit smoothies or ice cream. Hot food and drink should be avoided, as they can burn an area that’s already sensitive.

Lozenges

Sucking on Strepsils or hard sweets can be a good way to lubricate the throat and soothe any dry or scratchy feeling. Some natural non-medicated lozenges contain honey and lemon, others contain menthol to open up the airways. For inflammation like tonsillitis, sucking on ice cubes or an ice lolly may bring some relief.

Throat spray

One study found that an echinacea and sage throat spray helped relieve a sore throat at least as well as a medicated version containing a local anaesthetic. As this is a drug-free option, this may be worth a try.

Marshmallow root

The Ancient Greeks apparently swore by marshmallow root, which contains a gelatinous substance called mucilage. This forms a gel with water to coat the mouth and throat, soothing it and protecting it from further harm. The version found in the soft spongy sweets is not thought to contain these healing properties, so save them for a night by the campfire.

Rest your voice

This is especially if overuse is a factor in your sore throat. It’s worth the investment, so your voice box can bounce back quicker. Vocalzones can help with a lost voice.

Air humidifier

This can be a good option if you have a dry throat, chronic cough, or a condition like asthma. It works especially well if you open mouth-breathe at night, to bring a bit more moisture to the air you breathe in. You can buy a unit to provide this, or pop a cup of water on the radiator or take a steamy shower before bed.

Dental hygiene

Good oral hygiene is encouraged especially with a dry mouth, as lack of saliva puts you at risk of bacteria build-up. Twice daily gentle tongue brushing can help, alongside your usual brushing and flossing.

Saline gargle

Gargle with warm, salty water to gently remove any pus build-up with tonsilitis at the back of the throat.

Smoking

Avoid smoking and smoky places, as this can irritate the throat further and make any cough worse.

Nearly half of all viral or bacterial sore throats improve after 3 days, without requiring a doctor’s opinion or a prescription.

There are certain exceptions to this. If you think you or your child has symptoms of a strep throat and are feeling very unwell, they may require antibiotics to reduce symptoms and prevent complications, so book an urgent appointment with their doctor. Any signs of epiglottitis or quinsy – drooling, severe pain, difficulty speaking, swallowing or breathing, or a noisy whistling as you breathe in – you need to attend the emergency department with urgency.

If you’ve had a sore throat for more than three weeks but no obvious cold or infection, you should book an appointment with your doctor. This is especially so with any weight loss, progressive difficulty swallowing food and drink, or regurgitation.

In all instances, your doctor is likely to take your vitals like temperature, heart rate and tissue oxygen levels, and examine the back of the throat and glands in the neck. They may take a swab to confirm diagnosis of a bacterial infection.

If they are concerned that cancer could be a cause, they will act quickly to get you referred to a specialist Ear, Nose and Throat team, who use an endoscope to look in the back of the throat and take tissue samples.