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Sore Throat


Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Reviewed/Revised May 2023
Topic Resources

Sore throat is pain in the back of the throat.

A sore throat can be very painful and is usually worsened by swallowing.

Many people with a sore throat refuse to eat or drink. Sometimes pain is also felt in the ear because nerves to the back of the throat run very close to nerves from the ear.

Causes of Sore Throat

A sore throat usually results from infection (see table ). The most common cause is

  • Tonsillopharyngitis

Much less common but more serious causes of sore throat are

  • Abscess

  • Infection of the epiglottis (epiglottitis)

  • Tumors

Abscess, epiglottitis, and tumors are of particular concern because they may block the airway.

Throat irritation and mild soreness can also be caused by dryness, irritants, gastroesophageal disease (GERD), and vocal strain (such as from yelling).


Tonsillopharyngitis Throat Infection Infections of the throat and/or tonsils are common, particularly among children. Throat infections are usually caused by a virus but may be caused by bacteria such as streptococcal bacteria... read more Throat Infection is infection of the tonsils (patches of lymphoid tissue at the back of the throat) and the throat (pharynx). Doctors may use the term tonsillitis when the tonsils are particularly inflamed or the term pharyngitis when the tonsils are not particularly inflamed or when people who have no tonsils have a sore throat.

Tonsillopharyngitis is usually caused by a virus, typically one of the same viruses that causes the common cold Common Cold The common cold is a viral infection of the lining of the nose, sinuses, and throat. Many different viruses cause colds. Usually, colds are spread when a person's hands come in contact with... read more . Most common colds begin with a mild sore throat. A less common viral cause is acute mononucleosis Infectious Mononucleosis Epstein-Barr virus causes a number of diseases, including infectious mononucleosis. The virus is spread through kissing. Symptoms vary, but the most common are extreme fatigue, fever, sore throat... read more Infectious Mononucleosis (caused by the Epstein-Barr virus), which occurs mainly in children and young adults. The coronavirus that causes COVID-19 COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more and other coronaviruses Coronaviruses and Acute Respiratory Syndromes (MERS and SARS) Coronaviruses are a large family of viruses that cause respiratory illness ranging in severity from the common cold to fatal pneumonia. There are many different coronaviruses. Most of them cause... read more can also cause a sore throat. Rarer still, sore throat can be part of the initial infection with human immunodeficiency virus (HIV) or due to chronic fungal infections in people with HIV infections, such as thrush.



The epiglottis is a small flap of tissue that closes the entrance to the voice box and windpipe during swallowing. The epiglottis can become infected by certain bacteria (epiglottitis Epiglottitis Epiglottitis is a bacterial infection of the epiglottis and surrounding tissues. Epiglottitis may block the windpipe (trachea) and be fatal. The main symptoms are severe sore throat and noisy... read more Epiglottitis ). This infection causes severe pain and swelling. The swelling can close off the windpipe, particularly in infants and children. Epiglottitis used to occur mainly in children and usually was caused by Haemophilus influenzae type B (HiB) bacteria. Now, in areas where most children are vaccinated against HiB, epiglottitis is quite rare in children, but HiB is still a cause in adults and unvaccinated children.

Evaluation of Sore Throat

Not every sore throat requires immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with a sore throat, certain symptoms and characteristics are cause for concern. They include

When to see a doctor

People who have warning signs should go to the hospital right away.

People with a sore throat but no warning signs should call their doctor. People who have typical cold symptoms and mild to moderate discomfort may be advised to stay at home and treat their symptoms Treatment Sore throat is pain in the back of the throat. A sore throat can be very painful and is usually worsened by swallowing. Many people with a sore throat refuse to eat or drink. Sometimes pain... read more Treatment with over-the-counter (OTC) remedies. People with severe pain and/or other symptoms (such as fever, extreme fatigue, or a productive cough) typically should be seen right away.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination helps them decide what, if any, tests need to be done (see table ).

During the medical history, doctors ask about the following:

  • Symptoms of a runny nose, cough, and difficulty swallowing, speaking, or breathing

  • Whether the person has had any general feeling of severe fatigue before the sore throat (suggesting mononucleosis)

  • Whether the person has had a previous episode of mononucleosis (people rarely get mononucleosis twice)

  • Whether people have any risk factors for gonorrhea (such as recent oral-genital sexual contact) or HIV infection (such as unprotected sex, multiple sex partners, or intravenous drug abuse)

During the physical examination, doctors focus on the nose and throat. However, if doctors suspect epiglottitis in children (because there are warning signs and no evidence of a cold), they do not examine the throat in their office because inserting a tongue depressor may cause a spasm that triggers complete airway blockage.

If epiglottitis is not suspected, doctors do the following:

  • Look in the mouth to see whether the throat and/or tonsils are red, whether there are white patches (exudate) on the tonsils, and whether there are any bulges suggesting an abscess

  • Examine the neck for enlarged, tender lymph nodes

  • Feel the abdomen for an enlarged spleen, which may occur in people with mononucleosis



The need for tests depends on what doctors find during the history and physical examination, particularly whether warning signs are present.

Possible tests include

  • Rapid strep screening (for children)

  • Throat culture (for adults)

  • Flexible fiberoptic laryngoscopy

  • X-rays of the neck

A doctor's first concern is to recognize which people might have epiglottitis. Stridor and drooling are warning signs, particularly in people who appear ill or with difficulty breathing. In such cases, people should not have x-rays. Instead, the doctor looks down the throat with a thin, flexible viewing tube inserted through the nose (flexible fiberoptic laryngoscopy). Because children are more likely to have sudden, complete blockage of their airway when their throat is examined, doctors minimize this danger by doing this examination only in the operating room, where advanced airway equipment and personnel are available. Adults who do not appear seriously ill and have no respiratory symptoms may have neck x-rays to look for a swollen epiglottis or have flexible fiberoptic laryngoscopy done in the emergency department or a specialist's office.

Despite what many people think, it is difficult for doctors to distinguish a strep throat from a sore throat caused by a virus based only on appearance. Both may cause a very red throat with white patches. Thus, unless people clearly have just a cold, doctors usually do tests to diagnose strep throat. There are two types of test, a rapid strep antigen test and a throat culture. Both tests are done on a sample taken from the back of the throat with a swab. The rapid strep antigen test can be done in the doctor's office in about 20 minutes. The rapid test is usually done only in children. If results are positive, children are treated for strep throat with antibiotics. If results are negative, another sample is sent to the laboratory for culture (growing microorganisms on a special gel so that there are enough to identify). If adults need testing for strep throat, doctors usually do only a throat culture because adults may have another bacterial infection that would not be identified by the rapid antigen test.

An abscess is often noticeable during the doctor's examination. The doctor can both diagnose and treat the abscess by inserting a small needle into the swollen area after spraying the throat with an anesthetic. If pus comes out, an abscess is confirmed, and the doctor removes as much pus as possible. If the location and extent of an abscess are unclear, computed tomography (CT) of the neck is performed.

Doctors do blood tests for mononucleosis or HIV only when they suspect people have one of these infections.

Treatment of Sore Throat

Doctors treat any specific cause of sore throat. For example, people with strep throat or other bacterial infections are given antibiotics.

It is important to relieve the pain of sore throat so that people can eat and drink. Ibuprofen or acetaminophen helps relieve pain and fever. People in severe pain may require the short-term use of opioids (such as oxycodone or hydrocodone). Warm saltwater gargles and throat lozenges or throat sprays (such as those containing benzocaine, lidocaine, or dyclonine) may temporarily help relieve pain, but they should be taken only in the prescribed amount, not any more than prescribed. Before their appetite returns, providing soup is a good way to keep children well hydrated and nourished when swallowing is painful.

Key Points

  • Most sore throats are caused by viral tonsillopharyngitis and resolve without treatment.

  • Occasionally, sore throats are caused by certain bacteria (particularly streptococci) and result in strep throat.

  • It is difficult for doctors to distinguish viral from bacterial causes of tonsillopharyngitis without testing.

  • Abscess and epiglottitis are rare but serious causes of sore throat.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Dazidox , Endocodone , ETH-Oxydose, Oxaydo, OXECTA, OxyContin, Oxydose , OxyFast, OxyIR, Percolone, Roxicodone, Roxybond, XTAMPZA
Hysingla ER, Zohydro
Advocate Pain Relief Stick, Americaine, Anbesol, Anbesol Baby , Anbesol Jr , Banadyne-3, Benzodent, Benz-O-Sthetic, Boil-Ease, Cepacol Sensations, Chloraseptic, Comfort Caine , Dry Socket Remedy, Freez Eez, Little Remedies for Teethers, Monistat Care, Orabase, OraCoat CankerMelts, Orajel, Orajel Baby, Orajel Denture Plus, Orajel Maximum Strength, Orajel P.M., Orajel Protective, Orajel Severe Pain, Orajel Swabs, Orajel Ultra, Oral Pain Relief , Oticaine , Otocain, Outgro, Pinnacaine, Pro-Caine, RE Benzotic, Topex, Topicale Xtra, Zilactin-B
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Ela-Max, GEN7T, Glydo, Gold Bond, LidaMantle, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , Lidomar , Lidomark, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
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