I believe there are hundreds of young adults who have erroneously suffered tonsillectomy because of the tonsillitis of undiagnosed glandular fever. Sceptical GP (anonymous)
A sore or painful throat is one of the commonest symptoms encountered in general practice. The most usual cause is viral pharyngitis, which is self-limiting and usually only requires symptomatic treatment.
Pharyngitis Inflammation of pharynx ± tonsils.
Quinsy A peritonsillar abscess.
Tonsillitis Inflammation of tonsils only.
Key facts and checkpoints
In the National Morbidity Survey (UK)1 nine episodes per annum of acute pharyngitis or acute tonsillitis were diagnosed for every 100 patients.
Sore throats account for about 5% of consultations in general practice per annum.2
In one UK general practice it was the third most common new presenting symptom—5.4% of presenting problems.
Although throat infections are common from infancy, children under 4 years of age rarely complain of a sore throat.
Complaints of a sore throat are prevalent in children between 4 and 8 years and in teenagers.
Sore throats continue to be common up to the age of 45 and then decline significantly.
The common causes are viral pharyngitis (approximately 60–65%) and tonsillitis due to Streptococcus pyogenes (approximately 20%).
The sore throat may be the presentation of serious and hidden systemic diseases, such as blood dyscrasias, HIV infection and diabetes (due to candidiasis).
A very important cause is tonsillitis caused by Epstein–Barr mononucleosis (EBM). Treating this cause with penicillin can produce adverse effects.
As a general rule antibiotics should not be prescribed to treat a sore throat, excluding evidence of group A beta-haemolytic Streptococcus (GABHS) infection.3
Sore throat may be present as part of a complex of the common upper respiratory infections, such as the common cold and influenza. However, sore throat often presents as a single symptom. The pain is usually continuous and aggravated by swallowing. In those under 4 years of age the presentation of acute pharyngitis or tonsillitis may be confusing as the presenting complaints may be vomiting, abdominal pain and fever rather than sore throat and swallowing difficulty.
It is appropriate to consider sore throat as acute or chronic. Most presentations come as acute problems, the causes of which are listed in Table 73.1.
Causes of acute sore throat
|Favorite Table|Download (.pdf) Table 73.1
Causes of acute sore throat
|Beta-haemolytic streptococci (GABHS) |
|Diphtheria (rare) |
|Gonococcal pharyngitis |
|Haemophilus influenzae |
|Moraxella catarrhalis |
|Staphylococcus aureus (rare) |
|Syphilis (rare) |
|Acute ulcerative gingivitis (Vincent angina infection) |
|Severe–moderate soreness |
|Epstein–Barr mononucleosis |
|Herpes simplex pharyngitis |
|Mild–moderate soreness |
|Influenza virus |
|Human immunodeficiency virus |
|Varicella (chicken pox) |
|Other infections |
|Candida albicans, especially in infants |
|Mycoplasma pneumoniae |
|Chlamydia pneumoniae |
|Blood dyscrasias |
|Tobacco smoke |
|Antiseptic lozenges (oral use) |