When to Worry About a Sore Throat

a man and woman with sore throats

The winter season has certainly arrived—with snot dripping, cough droplets swarming, temperatures spiking, and sick people moaning. Germs are spreading faster than wildfire as I write. And a sore throat is often where the story all begins.


The winter season seems to also trigger allergies, asthma, and holiday dietary indiscretions. Therefore, many of you reading this may be wondering why you seem to have developed a sore throat. Is it a bug? And if so, what does it mean? And what if it comes and goes, or remains persistent for days or weeks? How do you know if your sore throat is something serious and when should you see your doctor?

To answer these questions and more, let’s review some of the top causes of a sore throat.

Causes of a Sore Throat

  1. Viruses
  2. Strep Throat
  3. Allergies
  4. Acid Reflux

Let’s review each cause a bit further.

1. Viruses

Okay, so in the winter time, there’s no doubt that viral illnesses are the very top cause of an acute sore throat. What do I mean by acute? Well…not chronic. Something that develops rather suddenly, and often resolves rather quickly.

Viruses, like in the common cold, often begin by attacking the throat. Some people feel it more than others, but it has the potential to be quite distressing and downright dreadful. The viral sore throat that often signals the beginning of a viral illness often lasts only several days, and then begins to dissipate once the runny, stuffy, snotty nose symptoms appear. But those first few days are often the worst. The typical viral course worsens each day from onset, peak somewhere between day three to day five, and then gradually improves each day after. Most people feel much better somewhere between day seven and day ten.

No one said that viruses are not nasty—sometimes they’re even more of a nuisance than bacteria. But unfortunately they don’t have a cure like bacteria do, and once plagued with it, it must simply play out its course. Kuddos to the next upcoming millionaire who will develop a cure for a virus.


2. Strep Throat

The most common bacteria invading the throat are by Streptococcus Pyogenes, otherwise known as “strep throat.” Strep throat is not nearly as common as viruses when infecting the throat, and is more commonly found in children and adolescents rather than adults.

It is, however, another acute cause of sore throat. So what’s the difference between strep throat and a viral illness, you may be wondering? Here are some other features more commonly seen in strep:

  • Fever
  • Lymph node enlargements around the neck and throat
  • Pustules on the tonsils in the back of the throat

Here’s a dead giveaway that the culprit is unlikely to be strep: there’s no nasal symptoms or cough with strep. It’s simply a sore throat with fever, very unlike the common cold.

A simple swab of the throat will often reveal strep, but there are two types. One is referred to as a “rapid strep” test that not all doctor’s offices will carry, but most urgent cares do. It can give an estimate of whether or not it’s strep, and provides a result right away. However, it’s not the gold standard, and can produce false positives. The best test for strep is a throat culture swab, but it can take a few days to provide a result. Most doctors will run that throat culture anyway if the rapid strep test is positive.

Penicillin or Amoxicillin can eradicate strep more quickly, but strep throat typically also resolves on its own within two to five days even without treatment, believe it or not. Our immune system carries some tough soldiers to combat many infections. But we do recommend antibiotics if strep is discovered.

3. Allergies

One of the more chronic or intermittent causes of sore throat is allergies. Allergic stimuli in the air, such as pollen or dust, trigger our immune system to combat these foreign invaders when breathed in. Then, as an inflammatory response, our nasal passages produce fluid. Once built up, the fluid has to go somewhere. Either it drips down our nostrils and out of our face, or down the back of the throat (or often both). This drip in the back of the throat is called “postnasal drip.” Yes, this means you are swallowing your snot. Unpleasant thought, but nevertheless a reality for many of us. The same phenomenon also occurs in the common cold.


Postnasal drip can irritate the back of the throat, hence causing a sore throat. If the allergies come and go, your sore throat can also come and go. It is usually milder than more acute causes, such as with viruses and strep. But it can linger much longer. It can also cause “clearing of the throat” or even a persistent cough.

Postnasal drip can irritate the back of the throat, hence causing a sore throat.

4. Acid reflux

Postnasal drip drips from the top down into the throat, but contents from below can also regurgitate in the opposite direction (upward) to irritate that same region. Acid reflux is another cause of a chronic or intermittent sore throat.

The stomach is connected to the throat via a long tube called the “esophagus.” A special muscle called the “lower esophageal sphincter,” or LES, wraps around the lower part of the esophagus where it joins the stomach. Certain foods (citrus, caffeine, spicy foods, mint, blueberries, tomatoes, soda, greasy foods, etc.) and irritants (such as cigarette smoke) relax this sphincter more than they should, and food contents easily escape the stomach upward.

Acid reflux can erode and irritate the throat, causing pain and discomfort. Like postnasal drip, it can also cause a chronic, annoying cough in addition to the sore throat.

When to Worry About A Sore Throat

As seemingly benign as most of the causes for sore throat may be, there are signs and symptoms that you really don’t want to ignore. Here’s when you should be seen, and sometimes right away:

  • Fever lasting more than seven days
  • Sore throat lasting more than seven days
  • Trouble breathing
  • Drooling
  • Difficulty speaking or opening the mouth
  • Enlarged or swollen throat or tongue
  • Stiff neck
  • Rash
  • If the sore throat becomes chronic or comes and goes
  • And of course, as always, if the sore throat is particularly worrisome to you in any way.

Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.


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