Sore Throat as a Symptom: Causes and Treatment—What Helps Relieve a Sore Throat, and When Should You See a Doctor? How a Sore Throat Develops

In most cases, a sore throat and difficulty swallowing are caused by inflammation of the throat (pharyngitis).

Types of pharyngitis that are difficult to distinguish from one another include:

• pharyngitis in the strict sense (inflammation of the pharyngeal mucosa),
• rhinopharyngitis (inflammation of the nasopharynx),
• acute tonsillitis (acute inflammation of the tonsils), and
• pharyngolaryngitis (inflammation of the throat extending to the beginning of the trachea)

Pharyngitis is caused primarily by viruses (especially rhinoviruses and coronaviruses). Bacteria are a much less common cause.

A sore throat can be a symptom of influenza.

However, the following are even more typical of influenza:

• a sudden onset of illness
• fever or chills
• cough
• pain in the muscles, limbs, and head, as well as
• a severe feeling of illness

Only rarely is a sore throat or pharyngitis caused by mononucleosis (Pfeiffer’s glandular fever).

In such cases, the sore throat typically occurs along with a fever and severe swelling of the lymph nodes. However, some people affected have almost no symptoms.

But it’s not just viruses and bacteria that can cause a sore throat. Overuse of the voice from loud shouting or yelling, as well as talking a lot, can also be to blame.

In addition, irritation of the throat lining caused by (secondhand) smoking, inhaling chemicals or dust, or dry air can cause the pain.

Irritation can also result from gastroesophageal reflux (the backflow of stomach acid through the esophagus into the larynx).

Although rare, acute thyroiditis (inflammation of the thyroid gland) or tumors can also trigger a sore throat and difficulty swallowing. Inflammation of the thyroid gland causes pain in the front of the neck.

Sore throats caused by HIV infection, gonorrhea, or diphtheria are also rare.

Pharyngitis (inflammation of the throat) very often heals without any further treatment. Complications (e.g., peritonsillar abscesses and acute rheumatic fever) occur only very rarely. 

A peritonsillar abscess is a purulent inflammation of the tissue around the tonsils that breaks through the tonsil capsule. It usually presents with a sore throat on one side and/or difficulty swallowing, difficulty opening the mouth, ear pain, and fever.

If, in addition to a sore throat, you experience shortness of breath and/or difficulty breathing or severe difficulty swallowing, you should see a doctor immediately.

You should also see a doctor if the pain does not improve or lasts longer than seven days. Caution is always advised for individuals who are immunocompromised or seriously ill.

For sore throats that are not caused by pharyngitis, the doctor must, of course, treat the underlying condition—such as treating the stomach in cases of gastroesophageal reflux disease (GERD). Read on to learn what you can do for pharyngitis.

For a sore throat, warmth and tried-and-true home remedies like tea with honey often help.

There are no scientific studies proving the effectiveness of traditional home remedies. However, they can often provide relief from symptoms.

Among the most commonly recommended home remedies for sore throats and difficulty swallowing are:

• Drinking plenty of fluids, e.g., “hot lemon”
• Gargling with salt water (1/4 teaspoon of salt dissolved in a glass of water) or chamomile/sage tea
• Warm, moist throat compresses
• Sucking on lozenges to moisten the throat. Sage lozenges are particularly effective here.
• Humidifying the air in the room

Of course, it’s also recommended to:

• Resting and avoiding strenuous physical activity
• No (secondhand) smoking
• Taking it easy on your voice, especially if you’re hoarse—but don’t whisper

Over-the-counter medications

There are a number of over-the-counter medications for sore throats available on the market. These cannot shorten the duration of a sore throat, but they can often alleviate the symptoms.

Acetaminophen or ibuprofen can be used to relieve symptoms. Regular use during the days when symptoms are most severe is most effective. However, it’s important to follow the age-appropriate dosage.

Lozenges, gargle solutions, and throat sprays containing local antiseptics and/or local anesthetics or antibiotics are generally not recommended.

Local antiseptics only work on the surface, whereas the infection primarily occurs in deeper layers. The bactericidal/bacteriostatic effect of some over-the-counter medications is of no benefit for sore throats, which are mostly caused by viruses.

Prescription Medications

In most cases, sore throats are caused by viruses. Antibiotics are ineffective in such cases, as they only combat bacteria. The indiscriminate use of antibiotics is not recommended.

Furthermore, sore throats usually resolve on their own without any further intervention. However, over-the-counter pain relievers can be used to alleviate symptoms.

In cases of more severe illness or the presence of certain risk factors, however, antibiotic treatment may be advisable or even necessary. This is particularly true if a streptococcal infection is detected in a throat swab.

What are the most common causes of a sore throat?

Sore throats usually develop as part of a cold caused by viruses or bacteria, typically as a pharyngitis. Dry air, irritants, or heartburn can also inflame the mucous membrane in the throat. In children, sore throats occur particularly frequently in the context of an infection. A medical evaluation is advisable if throat pain persists for a long time or worsens significantly.

When should you see a doctor for a sore throat?

It’s advisable to see a doctor if you have a severe sore throat, a high fever, or pain when swallowing. You should also see a doctor if a sore throat lasts longer than a week or gets worse. Warning signs such as shortness of breath, severe difficulty swallowing, or unusual swelling require immediate evaluation. Especially in children or people with weakened immune systems, it’s better to seek medical evaluation sooner rather than later.

What home remedies help with a sore throat?

Many people can relieve their symptoms by gargling with salt water, drinking warm beverages, breathing in moist air, and applying a throat compress. Sucking on hard candies moistens the mucous membranes and reduces throat irritation. Resting and avoiding a dry, irritating cough can also significantly alleviate cold symptoms. Although home remedies are not scientifically proven, they are often found to be helpful.

Are antibiotics effective for a sore throat?

Antibiotics are effective only against bacterial infections, such as strep throat. Since sore throats are often caused by viruses, antibiotics are not appropriate in these cases. The German Society for General Medicine recommends using antibiotics only when specifically indicated. However, treatment may be necessary in cases of high fever, purulent coating on the tonsils, or a positive swab test.

What should you do if a sore throat is particularly severe when swallowing?

If you have severe difficulty swallowing, soft foods, warm drinks, and pain-relieving medications such as ibuprofen can help. If pain when swallowing is accompanied by hoarseness, a cough, or irritation of the mucous membranes, rest is important. Sore throats without a fever are usually caused by a virus and can be effectively treated with symptomatic relief. If a sore throat occurs suddenly and is very severe, a medical examination should be conducted.