Common sore throat or worse?

We all know that raw, scratchy feeling in the back of the throat. The cause may be as simple as dry winter air, seasonal allergies or the onset of a cold. But sometimes the culprit is an infection called tonsillitis, most commonly caused by a virus, and less often caused by group A streptococcus bacteria – which can be dangerous if untreated. Tonsillitis is a painful infection of the tissue masses on either side of the throat. It’s not always easy to distinguish between viral and bacterial tonsillitis, but there are signs that may provide clues that you have a bacterial streptococcus infection – also sometimes called strep throat - rather than a viral sore throat.

Are there unusual spots?

Mum has the right idea when she asks her children to say "Ahhh'. Looking inside the throat can reveal important clues about what's causing the pain. Bacterial tonsillitis often produces white patches in the throat and on the tonsils, as well as red, swollen tonsils. Pus may be seen in the back of the throat.

Are there cold symptoms?

Coughing and postnasal drip can make your throat feel bad, but these symptoms are less likely to occur with bacterial tonsillitis. When nasal congestion, runny nose, coughing and other cold symptoms accompany a sore throat, a cold virus is usually to blame.

How high is the temperature?

Colds sometimes cause a high temperature, but it's generally low grade. A sore throat with a fever over 38°C (100.4 °F) increases the likelihood of bacterial tonsillitis. However, bacterial tonsillitis can be present even with little or no high temperature.

Are the lymph nodes swollen?

Bacterial tonsillitis may cause the lymph nodes in the neck to become swollen and tender. The lymph nodes are responsible for trapping and destroying germs. When part of the body is infected, the nearest lymph nodes tend to swell as they carry out their job.

How much does it hurt?

A sore throat caused by a cold can be pretty painful, but it usually goes away after a couple of days. Tonsillitis tends to be more severe and persistent. The pain may be so bad, it's hard to swallow. In some cases, tonsillitis may cause nausea, a lack of appetite or pain in the head and stomach.

Is there a rash?

A less common sign of bacterial strep infection is a rash that appears on the neck and chest, eventually spreading to the rest of the body. When this rough, sandpaper-like rash develops, the infection is known as scarlet fever. This is now very rare in the UK and cases are usually mild. Although the full-body rash may be alarming, it will start to fade after a few days. Antibiotic treatment can help protect against complications of strep infection.

Colds & antibiotics: Just say no

You can't get rid of a sore throat caused by a cold with antibiotics. That's because colds are caused by viruses, and antibiotics only work against bacteria. Also, taking antibiotics unnecessarily can contribute to the growing problem of microbial resistance. When bacteria are frequently exposed to antibiotics, they may become "superbugs" that can't be treated with standard medications.

Throat swab

To decide whether a sore throat is caused by bacteria or a virus your GP may take a swab of the affected tissues and send it to the lab to have it checked for the presence of bacteria. A blood test can also be used to check if antibodies are present. Minor strep infections are very common. More serious invasive strep is much rarer affecting only about one in every 33,000 people. It's estimated that one in every four sore throats is caused by a Strep A infection.

Antibiotics for strep

Antiobiotics are not usually prescribed for bacterial tonsillitis. They are usually only given if you are more vulnerable to infection, due to a weakened immune system or a serious health issue such as heart disease. In that case, your GP may prescribe a 10 day course of antibiotics. You’ll probably feel better in a day or two, but it’s vital to take the entire course of antibiotics anyway, otherwise some of the bacteria may survive. Remember, your infection can still be contagious until 24 hours of taking antibiotics, so wash your hands often, and don’t share utensils. Also, make sure you throw away your toothbrush after you’ve had a strep infection.

Antibiotics for bacterial tonsillitis

Antiobiotics are not usually prescribed for bacterial tonsillitis. They are usually only given if you are more vulnerable to infection, due to a weakened immune system or a serious health issue such as heart disease. In that case, your GP may prescribe a 10 day course of antibiotics. You’ll probably feel better in a day or two, but it’s vital to take the entire course of antibiotics anyway, otherwise some of the bacteria may survive. Remember, your infection can still be contagious until 24 hours of taking antibiotics, so wash your hands often, and don’t share utensils. Also, make sure you throw away your toothbrush after you’ve had a strep infection.

Humidifier or vapouriser

Breathing in steam from a humidifier or vapouriser can keep a sore throat moist and cut down on pain. You can get the same result by leaning over a sink with hot running water. Drape a towel over your head to trap the steam and breathe deeply. Try this for 5 to 10 minutes several times a day, taking care not to scald yourself.

Warm compress

Try placing a warm heating pad against the outside of your throat. Or make your own warm compress by wetting a towel with hot water. This may be especially soothing if you have tender lymph nodes in the neck.

Soothing foods

If you need an excuse to eat ice cream, a sore throat is a good one. The cold has a numbing effect, and the creamy texture makes it easy to swallow. This comfort food is also great for cheering up young (and not-so-young) patients. Other soothing foods include milk shakes, jelly or warm soup.

Hydration

As a high temperature and painful swallowing can lead to dehydration, it's important to increase your intake of fluids to avoid it. Water and ginger drinks are good choices. Avoid citrus drinks if these cause further irritation to an inflamed throat.

Pain relief

Over-the-counter pain relievers, like paracetamol or ibuprofen, can temporarily relieve the pain of a sore throat. Remember not to give aspirin to children under 16 because of the risk of the rare but potentially fatal Reye's syndrome.

Sore throat sprays and lozenges

You can soothe a painful sore throat with a numbing spray or lozenge. You can also buy lozenges over the counter that contain flurbiprofen. A recent study found these lozenges could help reduce sore throat symptoms and may help you feel better quickly, but more research is needed. Sucking on ice cubes can also give some relief. You can even carry a travel-size throat spray in your handbag or briefcase for relief while on the move.

Decongestants

If you have a cold, and fluid draining from your nose is what's irritating your throat, you might want to try a decongestant nasal spray or oral decongestant, which can dry up postnasal drip and give your throat some relief. People with certain medical conditions and people taking certain medicines may need to avoid the use of decongestants. Seek medical advice if you have concerns.

Persistent sore throat

If a sore throat lasts over a week or gets worse, seek medical advice, even if a throat swab came back negative. It's possible for a throat swab to miss bacteria, and you may need to be retested. A persistent sore throat could also be a sign of heartburn, glandular fever (mononucleosis) or another condition. In some cases, a sexually transmitted infection may be to blame.

More reading on sore throats

• Sore throat? Is it a cold, or tonsillitis?
• Bacterial tonsillitis symptoms and treatment
• Soothing your child's cold
• Flu or cold symptoms?
• Slideshow: Is it a cold or is it the flu?