Is fatigue causing your sore throat? Can an ear infection cause a sore throat? Learn about the causes of your sore throat symptoms and treatment options.
7 most common cause(s)
Sore throat symptoms
Your throat is itchy, scratchy and painful. You wish you didn't have to swallow. It feels as if someone is scraping your throat with coarse sandpaper. Maybe you're coughing. Maybe you're not. Either way, sore throat equals misery.
Common accompanying symptoms of sore throat
In addition to sore throat symptoms, you might also have:
- Fever
- Hoarseness
- Loss of your voice
- A reddened throat
- Pus on your tonsils
- Other cold and flu symptoms
- Difficulty eating and drinking
- White patches on the back of your throat
It does not matter that it is not likely to last more than a few days it will feel like forever. Your sore throat symptoms might be due to an infection, acid reflux, or something else it doesn't matter you just want relief. To understand what might bring you relief, you'll need to know what is causing the sore throat. Let's see what the culprit might be...
Causes of a sore throat
Viral infections
The common cold and the flu are both viral infections, and yes, they can both make your throat sore. Antibiotics cannot cure viral infections. You'll have to wait it out (unless you have the flu and early enough in the course, drugs can shorten the severity and duration of flu symptoms).
Bacterial infections
The most common bacterial offender is Group A Streptococcus (aka "strep throat"). Strep throat can be treated and cured with antibiotics. Strep throat, if untreated, can cause complications such as rheumatic fever, which can then lead to rheumatic heart disease (which can damage heart valves). Strep throat can also cause scarlet fever.
Gastroesophageal reflux disease (GERD)
Repeated exposure to regurgitated acids of reflux can irritate the tissue lining your throat. On rare occasions, this might be treated with antibiotics.
Other conditions that can cause a sore throat
Other causes of a sore throat include:
- Smoking
- Seasonal and environmental allergies
- Dry air, especially in the winter
- Recent trauma due to surgery, a choking incident: Or accidentally swallowing something like a bone
This list does not constitute medical advice and may not accurately represent what you have.
Viral throat infection
A sore throat is most often caused by the same viruses that cause influenza and the common cold. The illness spreads when an infected person coughs or sneezes, and then someone else inhales the airborne virus or touches a surface where it has landed.
Those most at risk for viral sore throat are children, smokers, those who work indoors with others, and anyone with a weakened immune system.
Symptoms include throat irritation; pain when swallowing or talking; red, swollen tonsils; fever; body aches; and cold-like symptoms of cough, sneezing, and runny nose.
If symptoms do not clear up within 24 hours – especially in children – a medical provider should be seen. A persistent sore throat can be a symptom of serious illness such as mononucleosis, measles, chickenpox, or croup.
Diagnosis is made through physical examination and throat swab.
Treatment involves rest, fluids, and over-the-counter pain relievers. Do not give aspirin to children. Antibiotics only work against bacteria and cannot help against a viral illness.
The best prevention is frequent and thorough handwashing.
Strep throat requiring throat swab
Strep throat, or "strep," is a sore throat specifically caused by the bacteria Streptococcus pyogenes, also called group A streptococcus.
The illness spreads when an infected person coughs or sneezes and then someone else inhales the airborne bacteria, or touches a surface where it has landed and then touches their own face.
Children are most susceptible but anyone can be infected.
Symptoms include sudden throat pain, fever, headache, rash, body aches, and red, swollen tonsils. These symptoms can be caused by other illnesses, so a sample is taken by gently rubbing a sterile cotton-tipped swab over the back of the throat.
Testing will identify the organism responsible so that treatment with the appropriate antibiotic can begin. Be sure to finish all of the medication as directed, even after feeling better.
Untreated strep throat can lead to ear infections, kidney disease, scarlet fever, and rheumatic fever. These are serious illnesses. If strep throat is suspected, the person should see a doctor as soon as possible.
Rarity: Common
Top Symptoms: fatigue, nausea, sore throat, fever, rash
Symptoms that always occur with strep throat requiring throat swab: sore throat
Symptoms that never occur with strep throat requiring throat swab: general weakness
Urgency: Primary care doctor
Pharyngitis
A sore throat is most often caused by the same viruses that cause influenza and the common cold. The illness spreads when an infected person coughs or sneezes, and then someone else inhales the airborne virus or touches a surface where it has landed.
Those most at risk for viral sore throat are children, smokers, those who work indoors with others, and anyone with a weakened immune system.
Symptoms include throat irritation; pain when swallowing or talking; red, swollen tonsils; fever; body aches; and cold-like symptoms of cough, sneezing, and runny nose.
If symptoms do not clear up within 24 hours – especially in children – a medical provider should be seen. A persistent sore throat can be a symptom of serious illness such as mononucleosis, measles, chickenpox, or croup.
Diagnosis is made through physical examination and throat swab.
Treatment involves rest, fluids, and over-the-counter pain relievers. Do not give aspirin to children. Antibiotics only work against bacteria and cannot help against a viral illness.
The best prevention is frequent and thorough handwashing.
Mononucleosis infection
Mononucleosis, or "mono," is a viral infection that can cause fatigue, fever, sore throat, and swollen lymph nodes. Sometimes this infection is referred to as the "kissing disease" because people catch the virus by contact with others' saliva. This can happen when kissing and sharing utensils/food/drink. People usually start to feel better within 1-2 weeks, but it can take a month or more to feel completely back to normal.
You should visit your primary care physician in the next 1-2 days. While fatigue is usually more profound in mono infections, the symptoms are similar to strep throat, so it's important to confirm the diagnosis. A throat swab can be done to look for strep throat. Blood tests can check for mono, but even if you have mono, the test might not show the infection until 2 weeks after your symptoms started. Treatment revolves around treating your symptoms in order to stay as comfortable as possible. This may include resting, staying well hydrated and taking acetaminophen or ibuprofen to reduce your pain or fever. Because mono can cause the spleen to get abnormally large, it is important to avoid strenuous physical activity or contact sports for at least one month.
Rarity: Common
Top Symptoms: fatigue, headache, loss of appetite, abdominal pain (stomach ache), cough
Urgency: Primary care doctor
Influenza
Influenza, or "flu," is a contagious respiratory illness caused by viruses. It is spread through the air by coughing, sneezing, or even talking.
Anyone can get the flu, but those who are very young, over 65, and/or have pre-existing medical conditions are most at risk for complications.
Symptoms include fever, chills, cough, sore throat, body aches, and extreme fatigue. The symptoms may appear very suddenly.
Flu can bring on secondary bacterial infections in the lungs or ears. Dehydration is a great concern because the patient rarely wants to eat or drink.
Diagnosis is usually made by symptoms. There are tests that use a swab taken from the nose or throat, but they are not always accurate or necessary.
Treatment consists mainly of good supportive care, which means providing the patient with rest, fluids, and pain-relieving medication such as ibuprofen. Do not give aspirin to children.
Antibiotics cannot help with the flu, since antibiotics only work against bacteria. There are anti-viral medications that a doctor may prescribe.
The best prevention is an annual flu shot.
Rarity: Common
Top Symptoms: fatigue, headache, loss of appetite, cough, muscle aches
Symptoms that never occur with influenza: headache resulting from a head injury
Urgency: Phone call or in-person visit
Common cold
The common cold is a contagious viral infection that can cause cough, congestion, runny nose, and sore throat. Most adults catch two to three colds per year, and kids can get more than eight colds each year.
Rest and drink plenty of fluids. Colds are contagious and can easily spread to other people, so if possible, avoid close contact with others, such as hugging, kissing, or shaking hands. Colds typically resolve within 7 to 10 days.
Acid reflux disease (GERD)
Gastroesophageal reflux disease is also called GERD, acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.
Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.
Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.
If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.
Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.
Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.
Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.
Canker sore in the throat
Canker sores are also called aphthous stomatitis, aphthous ulcers, or mouth ulcers. They are not the same as "cold sores."
The exact cause of canker sores is not known. Viruses, allergies, and auto-immune response may all play a role, as well as stress, smoking, and poor diet.
Symptoms include small, flat, painful gray or white sores on the inner lining of the cheeks and on the gums and roof of the mouth. They may also appear on the tonsils in the back of the throat. The sores usually last for three to four days.
Anyone with canker sores should see a medical provider. The sores often recur and can interfere with quality of life.
Diagnosis is made through physical examination.
There is no actual cure for canker sores, though the symptoms can be treated to ease the discomfort. Managing stress, stopping smoking, and improving diet can help to prevent a recurrence. The sores usually heal on their own within 10 to 14 days.
Rarity: Uncommon
Top Symptoms: sore throat, pain with swallowing, sore/ulcer in the throat, severe pain when swallowing
Symptoms that always occur with canker sore in the throat: sore throat, pain with swallowing
Symptoms that never occur with canker sore in the throat: fever, cough
Urgency: Self-treatment
Strep throat needing antibiotics
Strep throat is a bacterial throat infection that can make your throat feel sore and scratchy. Only a small portion of sore throats are the result of strep throat.
Rarity: Common
Top Symptoms: fever, fatigue, nausea, sore throat, muscle aches
Symptoms that always occur with strep throat needing antibiotics: fever, pain with swallowing, sore throat
Symptoms that never occur with strep throat needing antibiotics: general weakness
Urgency: Primary care doctor
Sore throat treatments and relief
When a sore throat is an emergency
Seek medical care if you have a sore throat and:
- Drooling
- Your tongue is swollen
- You are having trouble breathing: Or are making stridorous noises
- You can't open your mouth all the way
- There is a rash anywhere on your skin
- Your neck is stiff
At-home treatments for a sore throat
Beyond using an antibiotic to treat a bacterial infection or waiting for a virus to pass, there is relief.
- Gargling with salt water
- Drinking slippery elm tea or eating : FYI, too much slippery elm can cause diarrhea
- Sucking on throat lozenges that have a mild anesthetic: Such as Cepacol lozenges
- Humidifying the air
- Staying indoors on days when the pollution index is high: Also, to cool off while inside, use the air conditioner instead of opening the windows (the air conditioner will filter some of the pollution out of the air)
- Drink lemon tea with honey
- Take pain medication: Such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
- Suck on ice cubes
FAQs about sore throat
How do you know if you have Strep Throat?
Strep throat can be tested using a throat swab. Strep throat or streptococcal pharyngitis is often accompanied by red eyes, a persistent cough, fever, inflamed mucous membranes in the nose, and nausea. You may also find white pus along the tonsils on either side of the throat.
What causes scratchy throat?
A "scratchy throat" is caused by inflammation of the throat. Specifically, the tonsils within the throat. The tonsils are masses of lymphoid tissue (similar to lymph nodes) for white blood cells (immune cells) in the body. When you become ill, your immune system is activated. The lymph nodes of the immune system swell as white blood cells from all over the body converge to fight a local infection. In the case of a scratchy throat, an upper respiratory tract infection is present and may cause pain or tightness because of the swelling of tonsils and surrounding tissue.
What does a sore throat look like?
A sore throat may look different depending on the cause, but most commonly, it is accompanied by an angry, red throat and tonsils on either side of the throat as well as swelling on either side or both sides. There are multiple patterns of appearance associated with a sore throat. For example, some illnesses cause a white, chunk pus-like material along either side of the throat, others cause "cobblestoning" or a series of red bumps along the back of the throat like brick cobblestones. There is no single appearance of a sore throat.
What causes pus pockets in the throat?
Pus is caused by your body fighting an infection, and when you have a sore throat caused by an infection, pus pockets can collect in the throat. Pus pockets on either side of the throat can be a sign of tonsillitis, an infection of the tonsils. They are present particularly in infections of streptococcal bacteria, and are a sign of bacterial infection, as opposed to viral infections like the flu and the common cold.
What is tonsillitis?
Tonsillitis is a swelling of the tonsils usually caused by a bacterial infectione. It can involve a buildup of pus on one or both tonsils on either side of the throat. The tonsils are essentially branching "police stations" in the body in which white blood cells or "cops" of the body congregate. They may become swollen during an infection and may even become infected themselves. When they become infected with a bacteria, this is called tonsillitis. Pus is often present because pus is a collection of dead white blood cells and dead bacterial pathogens.
Questions your doctor may ask about sore throat
- Any fever today or during the last week?
- Do you have a cough?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Have there been changes in your voice?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
- Vorvick LJ. Strep Throat. U.S. National Library of Medicine: MedlinePlus. Updated November 13, 2018. MedlinePlus Link.
- Kocher JJ, Selby TD. Antibiotics for Sore Throat. American Family Physician. 2014;90(1):23-24. AAFP Link.
- Fass R. Overview: Symptoms of GERD. iffgd. Updated March 5, 2016. iffgd Link.
- Strep Throat: All You Need to Know. Centers for Disease Control and Prevention. Updated November 1, 2018. CDC Link.
- Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. NCBI Link.