Inflammation of the throat can be a vexing problem for people. Should I skip work or school to get checked out? Is this serious enough to interrupt my life? How long should I wait for an apt.? How serious is it if I don’t get treated?
Sore throats can be caused by bacteria, viruses, fungus, allergies, esophageal reflux or a few other less common things. Symptomatic treatment exists for most causes of sore throat, even if antibiotics are not indicated. The rapid strep test used in many doctor’s offices, emergency departments and urgent care centers is 91% sensitive which means that if it is positive it is probably correct. It is not a perfect test, but paired with an exam by an experienced clinician most cases of strep will be discovered. Right now, the recommendation is to treat pharyngitis caused by strep with an antibiotic. Strep throat usually presents with fever, swollen glands, white spots on tonsils, rapid onset of symptoms and often the patient does not exhibit other symptoms of an upper respiratory infection like ear pain, runny nose or cough. Having those other symptoms does not make a strep infection impossible but it is less likely. It is important to note that treatment of strep throat with an antibiotic is not a “magic bullet.” In fact, studies show that antibiotics only shorten the duration of the illness by 16 hours! The main reason we treat with antibiotics is to prevent disease spread and secondary complications like rheumatic fever.
Viral sore throats can be very painful and sometimes even have visible ulcers on the back of the throat. They can also present with fever but usually are associated with headache, runny nose, muscle aches and fatigue in addition to the pain in the throat. On occasion a viral sore throat will be treated with an antiviral medication but more often the patient is counselled on over the counter remedies to help combat the symptoms while their bodies are fighting off the infection.
Fungal sore throats can be serious and painful. Sometimes they present in people who are immunocompromised and sometimes they are the first sign of a more serious underlying condition. Sometimes they are caused by the use of steroid sprays that are prescribed for asthmatics. These infections look different and are treated with different medications. Most experienced physicians know how to diagnose and treat this kind of sore throat.
Especially in the spring and fall but not exclusively, patients will suffer from post nasal drip caused by allergies. When an experienced clinician looks at the throat, he or she may remark that they are seeing “cobble stoning” or clear post nasal drip. This “dripping” is what causes a very irritated and painful sore throat, and are physical findings associated with allergies. Again, different medications are prescribed to help control the symptoms of allergies that may cause symptoms of pain in the throat. Most of these patients will present complaining of sneezing, an itchy palate, itchy eyes, an annoying cough or runny nose.
Laryngitis is most often seen in sore throats caused by allergies and viruses. It is best treated with fluids and voice rest.
Less often a cough and sore throat may be the presenting symptoms for esophageal reflux even in patients without heart burn. Again, this diagnosis is treated very differently form strep.
So, if you have a sore throat and don’t want to wait for an apt. with your PCP or go to an ED where the more seriously ill patients have priority, come to a Doctor’s Express for a rapid strep test and an expert examination and advice on what is causing your symptoms and how to treat them.