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Pharyngitis: Causes, Symptoms and Treatment

Pharyngitis means inflammation of the pharynx, the back of the throat. It is the medical name for most sore throats, and the cause is usually a virus that settles by itself within a week.

Topic
ENT
Updated
Reading time
5 minutes
Reviewed by
Dr. Itziar Gotxi Erezuma · Medical doctor (ENT) · Bizkaia Medical Association no. 48/4809228

What is pharyngitis?

The pharynx is the muscular tube behind the nose and mouth that connects them to the oesophagus and the larynx. Pharyngitis is inflammation of its lining, producing pain, scratchiness and sometimes redness. When the tonsils are involved it is called tonsillitis (or pharyngotonsillitis); when the voice box is involved, laryngitis. Doctors also use the word for sore throats of any cause.

Causes

  • Viruses (about 70–85% of cases): rhinovirus, coronavirus including SARS-CoV-2, adenovirus, influenza, parainfluenza, RSV, Epstein–Barr virus (glandular fever), herpes simplex and coxsackie viruses.
  • Bacteria: group A Streptococcus (the most important), groups C and G streptococci, and rarely Fusobacterium, gonorrhoea, chlamydia or diphtheria.
  • Allergies and postnasal drip.
  • Reflux, including laryngopharyngeal reflux. See LPR.
  • Environmental irritants: smoke, vaping, pollution, dry air and alcohol.
  • Voice overuse and mouth breathing.
  • Rarely, tumours or other conditions with persistent one-sided symptoms.

Symptoms

  • Sore, scratchy or burning throat, worse on swallowing.
  • Redness of the back of the throat; sometimes swollen tonsils or white patches.
  • Fever, headache, body aches and tiredness.
  • Swollen glands in the neck.
  • Cough, runny nose, sneezing and hoarseness suggest a virus.
  • Bad breath, difficulty swallowing and ear pain (referred pain).

How doctors tell the cause

The pattern of symptoms is the best clue. A sore throat with cough, runny nose, hoarse voice or mouth ulcers is usually viral. A sudden severe sore throat with fever, tonsil exudate, tender front neck glands and no cough suggests strep, and a rapid antigen test or culture is advised. A very long or one-sided sore throat, persistent hoarseness or swallowing problems calls for an ENT examination of the throat and voice box.

Treatment

  • Fluids and rest.
  • Paracetamol or ibuprofen for pain and fever.
  • Lozenges, sprays and gargles for temporary relief.
  • Honey in warm drinks (over one year old) can soothe the throat.
  • Antibiotics only if a bacterial cause such as strep is confirmed.
  • Treat triggers: allergy, postnasal drip, reflux.
  • Stop smoking and avoid irritants.

How long does it last?

Viral pharyngitis normally lasts 3–7 days. Bacterial pharyngitis improves within 2–3 days of antibiotics. Glandular fever can last longer, with a sore throat for up to two weeks and fatigue for weeks or months. Non-infectious causes persist until the trigger is removed.

When pharyngitis keeps coming back

A sore throat that lasts more than 3–4 weeks or recurs often should be assessed. Common reasons include allergy, postnasal drip, reflux, smoking, voice misuse and sleep apnoea or mouth breathing. An ENT specialist can look at the throat and voice box with a flexible camera and recommend treatment for the cause.

Prevention

  • Wash hands frequently, and avoid sharing cups and utensils.
  • Avoid close contact with people with a sore throat.
  • Do not smoke; avoid second-hand smoke.
  • Keep indoor air humid in winter.
  • Stay hydrated and manage allergies.
  • Keep vaccinations current (flu, COVID-19).

When to see a doctor

  • Fever of 38.5 °C or more, or a severe sore throat with no cough.
  • Difficulty swallowing, drooling, breathing difficulty or a muffled voice (urgent).
  • Symptoms lasting more than 7–10 days or worsening.
  • Blood in saliva, a lump in the neck or hoarseness lasting more than four weeks.
  • A rash, joint pains or recurrent sore throats.
  • Immune problems, diabetes or recent chemotherapy.

Three common situations

Sore throat with runny nose, cough and mild fever: typical viral pharyngitis; fluids, pain relief and rest.

Sore throat in a young adult with exhausting fatigue and swollen glands: possible glandular fever; seek review, and avoid contact sports if the spleen is enlarged.

Morning sore throat with hoarseness and throat clearing for months: may be reflux or postnasal drip; arrange an ENT assessment.

Pharyngitis in babies, pregnancy and weak immunity

Babies and toddlers with a sore throat often refuse to feed and may drool; they need a clinical assessment if they have fever, are very irritable or are drinking less than usual. In pregnancy, paracetamol is usually the preferred painkiller, and any antibiotic should be chosen by a doctor. People with diabetes, immune suppression, cancer treatment or heart valve disease should seek early advice because infection can behave differently and complications are more likely.

Ways to calm an irritated throat day to day

Many people with a chronically irritated throat describe a constant urge to clear it. Try sipping water instead, humidify bedrooms, rinse the nose with saline if mucus drips from behind it and avoid very dry or smoky environments. Stopping smoking is the single most helpful step for long-term throat comfort. If symptoms persist for weeks, an ENT examination can identify reflux, allergy or other triggers.

Key points to remember

Pharyngitis is usually viral and improves in about a week. Treat symptoms, avoid unnecessary antibiotics and be alert to signs of complications. Persistent or recurrent symptoms deserve an assessment of the underlying cause.

This guide is for general information and does not replace an assessment by your own doctor or ENT specialist.

Questions about pharyngitis

These answers are general information and do not replace an examination or individual medical advice.

What is the difference between pharyngitis and tonsillitis?

Pharyngitis is inflammation of the back of the throat; tonsillitis is inflammation of the tonsils. They often occur together.

Is pharyngitis contagious?

Infectious pharyngitis is contagious through droplets and contact; allergic and irritant forms are not.

Do I need antibiotics for pharyngitis?

Only for bacterial causes such as strep throat, confirmed by a test.

How long does viral pharyngitis last?

Usually 3–7 days.

What helps a sore throat at night?

Humidify the room, drink fluids, take a painkiller before bed and raise your head slightly.

When is a sore throat serious?

With drooling, breathing difficulty, a muffled voice, neck swelling or symptoms lasting more than a week or two.

Sources

  1. NHS · Sore throat
  2. Cleveland Clinic · Sore throat (pharyngitis)
  3. CDC · Antibiotic use for sore throat and strep
  4. IDSA · Clinical practice guideline for group A streptococcal pharyngitis (2012)

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.