What is acute pharyngitis?

The back of your throat is called the pharynx. When this area gets inflamed this is known as pharyngitis. Sore throat is the term most commonly used to name this condition. This can cause variable degrees of discomfort particularly upon swallowing.

Acute pharyngitis is one of the most common causes for medical visits and occurs most commonly during the colder months. It can be caused by bacteria (group A Streptococcus) or viruses (common colds). Most of them resolve on their own without any particular intervention. However, it is important to know the cause in order to know what the best treatment is.

Causes of acute pharyngitis

Several microorganisms can result in pharyngitis. Among those, viruses are the most common cause of the disease. These viruses include:

• Rhinovirus
• Coronavirus
• Parainfluenza
• Adenovirus
• Influenza
• Epstein-Barr virus

Less commonly, bacteria can be the cause of pharyngitis. The most common one is group A streptococcus.

Besides microorganisms, there are other known causes of sore throat including:

• Air pollution and irritants: smoke from cigarettes and fumes can irritate your throat resulting in inflammation.
• Allergies: pet fur, dust and pollen also cause irritation of the mucosal membranes found at the back of your throat.

• Dry air and breathing through your mouth
• Gastroesophageal reflux disease (GERD): in this condition, there is a back flow of stomach acid into your pharynx. This acid irritates your throat causing a sore throat.
• Frequent exposures to cold and flu

Who are at risk?

You are at increased risk of having pharyngitis if you:

• are young (3-15 years old)
• are a smoker or are exposed to second hand smoke
• have allergies (particularly to dust, mold and pet fur)
• are exposed to chemical irritants
• have a weak immune system
• live in overcrowded areas

Transmission of pharyngitis

Pharyngitis is a contagious disease. This is because the microorganisms that cause it, both viruses and bacteria, are present in the nose and mouth of the infected individual. Whenever this particular person coughs or sneezes, the bacteria and virus travels in tiny liquid droplets towards other people or surfaces. If another person breathes in these infected droplets, he/she will end up having pharyngitis.

It can also happen if a person touches a surface contaminated with infected droplets, and then touch his/her face and mouth. It is recommended that you wash your hand thoroughly before touching your face. It is also advised that a person with pharyngitis shouldn’t share their beverages or food after having contaminated it.

Once you have contracted the pathogens, it will take you about two to five days to show up symptoms. This is known as the incubation period. During this time, even if you have no symptoms at all, you are still contagious. The Centers for Disease Control and Prevention (CDC) recommends that an infected person should avoid going in public until he/she no longer has fever and has taken antibiotics for at least 24 hours.

Signs and symptoms of Pharyngitis

The signs and symptoms present in pharyngitis depend on the underlying cause of the condition. These may include:

• itchy sensation in the throat
• painful and difficulty swallowing
• swollen and red tonsils
• coughing and/or sneezing
• fever
• body aches
• headache
• running nose
• swollen lymph nodes
• lack of energy
• general malaise
• loss of appetite
• white spots on your tonsils or throat
• hoarseness of voice

It is strongly advised to seek immediate medical help if you have the following symptoms:

• Not being able to swallow because of pain. This can also be accompanied by drooling
• Difficulty to breathe
• Difficulty to open your mouth
• Very high fever
• Severe sore throat lasting for more than 1 week
• Hoarseness of voice lasting for more than 2 weeks

The symptoms mentioned above can also be present in a variety of conditions other than pharyngitis. It is therefore important for you to give a clear history about your symptoms and course of the disease.

Making a diagnosis

With the help of a thorough history and a good physical examination, your doctor can most of the time already figure out the underlying cause of your pharyngitis and tailor your treatment accordingly.

The physical examination will include:

• Looking at your throat for redness, swelling and white spots
• Looking in your ears and nose using special apparatuses
• Palpating your neck to look for lymph nodes

If your doctor is not sure and thinks that there may be something else, he/she can order some other tests to confirm the diagnosis. These include:

• Throat culture: in this procedure, a cotton swab is used to collect a sample of the secretions found in your throat. This is then sent for analysis to check for the presence of suspected organisms. A rapid strep test is also available and the results can be obtained within minutes.
• Blood tests: a sample of blood is drawn from your bloodstream and is sent for analysis. This can indicate the presence of an infection.

Treatment of pharyngitis

If caused by a viral infection, pharyngitis is usually self-limiting and does not require any medication. There are some simple measures that you can take to alleviate your symptoms at home and these include:

• Making sure to stay hydrated by drinking plenty of fluids
• Warm soups can help in alleviating your symptoms and making you feel better. Avoid spicy foods for some time
• Homemade gargles using warm water mixed with salt: 1 teaspoon of salt in 8 ounces of water
• Using a humidifier can also be helpful to decrease the irritation caused by dry air
• Bed rest: get plenty of sleep and do not overuse your voice either
• Avoid cigarette smoke and other irritants

Some over the counter drugs can be used for pain relief such as acetaminophen or ibuprofen. Throat lozenges are also available over the counter for a soothing effect in your throat.

Some cases may however need medical treatment to show improvement. If your pharyngitis is caused by bacteria, antibiotics are the drugs needed to clear the infection and make you feel better. Your doctor will know best which antibiotic to prescribe. Do not try to buy antibiotics on your own. It is also important to take the full course of your treatment even if you started to feel better as failure to do so will lead to antibiotic resistance (this is when the antibiotic used will no longer have any effect on the bacteria)

Prevention

Simple steps can help you decrease your risk of having pharyngitis namely:

• Wash your hands frequently and thorough, especially before touching your face or mouth. You can also use a hand sanitizer containing alcohol
• Avoid being close to people who have pharyngitis or other bacterial infections
• Avoid smoking or being exposed to cigarette smoke

You can also prevent transmitting pharyngitis if you have it by simply avoiding crowds and covering your mouth and nose when you cough or sneeze.

Prognosis

Pharyngitis is most of the time a benign condition which can be easily managed at home itself. However, if you start having serious symptoms which are being persistent and worsening, immediately visit a doctor for further investigations.

J. Alastair, I. and Simon, M., 2016. Davidson’s Essentials of Medicine. 2nd ed. London: ELSEVIER.

Parveen, K. and Michael, C., 2017. Kumar & Clarks Clinical Medicine. 9th ed. The Netherlands: ELSEVIER.

Accera, J., 2019. Pharyngitis.