See also Strep throat.

Pharyngitis () is, in most cases, a painful inflammation of the pharynx, and is colloquially referred to as a sore throat. Infection of the tonsils (tonsillitis) and/or larynx (laryngitis) may occur simultaneously, which can make eating painful and near impossible.

About 90% of cases are caused by viral infection, with the remainder caused by bacterial infection and, in rare cases, oral thrush (fungal candidiasis e.g. in babies). Some cases of pharyngitis are caused by irritation from elements such as pollutants or chemical substances.

Causes

The pharynx is often the first site of infection. This is because viruses and bacteria often settle in this part of the body after a person inhales dust or water vapour containing the microorganism. Infection can also arise when a person touches their nose or mouth after having touched an object shared with another person with the disease. The foreign invader reproduces rapidly after settling on the body tissue.

Viral sore throats

These comprise about 90% of all infectious cases and can be a feature of many different types of viral infections.

• Adenovirus - the most common of the viral causes. Typically the degree of neck lymph node enlargement is modest and the throat often does not appear red, although is very painful.
• Orthomyxoviridae which cause influenza - present with rapid onset high temperature, headache and generalised ache. A sore throat may be associated.
• Infectious mononucleosis ("glandular fever") caused by the Epstein-Barr virus. This may cause significant lymph gland swelling and an exudative tonsillitis with marked redness and swelling of the throat. The heterophile test can be used if this is suspected.
• Herpes simplex virus can cause multiple mouth ulcers.
• Measles
• Common cold virus: rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often extreme pain.

Bacterial sore throats

Group A streptococcal

The most common bacterial agent is streptococcus. Unlike adenovirus, there tends to be greater generalized symptoms and more signs to find. Typically enlarged and tender lymph glands, with bright red, inflamed, and swollen throat of sudden onset with severe pain (often the patient finds it painful to talk or swallow), the patient may have a high temperature, headache, and aching muscles (myalgia) and joints (arthralgia). White or yellow spots on the back of the throat may be present on exam. These spots may also appear on the tonsils when those glands are involved.

It may be impossible to distinguish between viral and bacterial causes of sore throat.^[1]

Coughing is usually absent in strep throat though a dry, nonproductive cough (similar to how a person clears his or her voice) may appear in some patients; in addition coughing may appear when there is co-infection with a virus. A stuffy nose is also considered uncommon and is more likely due to a virus instead of the strep bacteria.

Some immune-system meditated complications may occur:

• Scarlet fever with its vivid rash, although the milder disease seen after the 1950s suggests that the bacteria may have mutated to less virulent illness and some doctors now call this scarlatina (literally a "little scarlet fever")
• Historically the most important complication was of the generalized inflammatory disorder of rheumatic fever which could later result in Rheumatic heart disease affecting the valves of the heart. Antibiotics may reduce the incidence of this complication to under one-third.

^[2]However the incidence of rheumatic fever in developed-regions of the world remains low even though the use of antibiotics has been declining.^{[3] [4]}This may be a result of a change in the prevalence of various strains of bacteria. In underdeveloped regions, untreated streptococcal infection can still give rise to rheumatic heart disease and may be due to environmental factors, or reflect a genetic predisposition of the patient to the disease.

• Post-streptococcal glomerulonephritis is an inflammation of the kidney. It is disputed whether antibiotics might reduce^[5] the small risk of this or not.^[2]
• Very rarely there may occur a secondary infection behind the tonsils which may cause a life-threatening septicaemia (Lemierre's syndrome)

Diphtheria

Diphtheria is a potentially life threatening upper respiratory infection caused by Corynebacterium diphtheriae which has been largely eradicated in developed nations since the introduction of childhood vaccination programs, but is still reported in the Third World and increasingly in some areas in Eastern Europe. Antibiotics are effective in the early stages, but recovery is generally slow.

Treatment

There are three types of treatment?symptomatic, remedial and preventive. Symptomatic treatments are aimed at reducing pain and symptoms. Remedial treatments attempt to cure pharyngitis by reducing its spread and speeding up the healing process. Preventive treatments attempt to block the start of an infection.

Remedial treatments are mostly effective for bacterial infections such as streptococcal infections. For viral infections, even with treatment, most cases of pharyngitis will still settle spontaneously within a few days. Hence the most popular method of treatment is symptomatic. Many preventive treatments are also remedial, thus those two treatments will be listed in the same section.

Twenty-two non-antibiotic managements for sore throat have been studied in controlled trials.^[6]Analgesics are among the most effective, but there are many simple measures that can also be used.

Symptomatic treatments

• Analgesics such as NSAIDs can help reduce the pain associated with a sore throat.^[6]
• Cayenne pepper is said to provide effective short term relief when mixed with water and gargled.^[7][8]
• Throat sprays such as Cepacol and Chloraseptic.
• Throat lozenges (cough medicine) are often used for short-term pain relief.
• Avoid foods and liquids highly acidic in nature, as they will provoke temporary periods of intense pain
• Warm tea (true or herbal) or soup can help temporarily alleviate the pain of a sore throat.
• Mouthwash (when gargled) reduces the pain but only for a brief time.
• Drinking heavy amounts of liquid reduces the pain for a short time.
• Peppermint candy might help with some cases as well as other hard candies. It will reduce the pain for a short time.
• Yogurt has been shown to help alleviate the pain temporarily as well as vanilla ice cream. But other dairy products such as milk will hurt your throat.
• Gargling with warm saline solution may help reduce mucus and the pain.^[9]

Remedial and preventive treatments

Performing remedial treatments early when the throat begins to feel scratchy may help keep the infection from spreading to the rest of the throat and back of the mouth, which can result in difficulty in swallowing. Treatment should begin the first or second day of the illness. However, if it is a cold or the flu, the infection may still continue to spread to other areas such as the ears through the eustachian tube (causing an earache) and to the lungs through the trachea (causing a cough). Healthy people who will be in frequent contact with someone with pharyngitis may also try the measures below, of which some can be also be preventive, to help inhibit the start of an infection.

• The use of antibiotics is a helpful remedial treatment when a bacterial infection is the cause of the sore throat. For viral sore throats, antibiotics have no effect and thus viral sore throats are only treated by controlling or relieving symptoms until the virus runs its course.^[2] Some doctors may prescribe antibiotics for patients at risk of developing severe complications (such as bacterial pneumonia), but this is not common anymore due to the emergence of antibiotic-resistant bacteria. Antiviral drugs do not decrease the length of illness and are not used except in cases when the patient's immune system is compromised.
• Swallowing a couple of teaspoons of raw lemon or lime juice several times a day may help destroy microorganisms in bacteria-related throat infections. This remedy should be started during the first or second day of sickness as citric acid can irritate your throat tissues after the Pharyngitis becomes too widespread. If this is the case, you may try a diluted solution of lemon, honey and tea (or lemon with hot water).^[9][10]

References

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