Sore Throat

For further detail about risk assessment where there are related symptoms, please see the RefHelp page on Neck Lump and Throat Cancer Risk Assessment.

Acute Sore Throat

Most acute sore throats are due to viral infection, requiring advice and reassurance in Primary Care. Throat swabs or rapid antigen testing are not routinely recommended (SIGN). Use of antibiotics for streptococcal sore throat decrease symptom duration by less than 1 day (NICE 2018).

CKS has a useful summary of the management of acute sore throat, which emphasises that there is no evidence that sore throats caused by bacterial infection are more severe, or have significantly longer symptom duration, than those caused by viral infection. The CKS also gives advice on prescribing.

Scenarios or complications to consider include:

• Immunosuppression (consider FBC and same day specialist assessment)
• Drugs with the potential for leucopoenia (particularly DMARDs and carbimazole)
• Red flag symptoms or signs (epiglottitis, stridor, peritonsillar or other abscess)
• Systemic sepsis or clinically significant dehydration
• Other causes (glandular fever, candidiasis, or the rarities such as diphtheria or Kawasaki Disease).

For more detail please see: Scenario: Management | Management | Sore throat – acute | CKS | NICE gives more detail.

For emergency referral – please telephone St John’s and ask for on call ENT:

• Sore throat associated with stridor or respiratory difficulty is an absolute indication for inpatient admission
• If patient is unable to swallow fluids
• Suspected quinsy.

Persistent Sore Throat

It is common for sore throats due to infection to take some time to settle. Where there is a clear explanation for symptoms (persistent or post infection), and particularly when the person is otherwise low risk (<40, non-smoking) then it is appropriate to make a clinical judgement about duration of symptoms before referring. Please see also see specific advice about any accompanying hoarseness and indications for tonsillectomy.

Consider glandular fever (infectious mononucleosis) if sore throat persists or patient is debilitated and not responding to antibiotics.

Sore throat and suspected cancer.

The Scottish Referral Guidelines for Suspected Cancer include a head, neck and thyroid cancer section:

• Please refer as a USC anyone with unexplained constant unilateral throat pain (not simply a feeling of something stuck in the throat – FOSSIT), lasting three weeks or more.
• Check for any pain on swallowing which radiates to the ear (in the absence of any infection) as this can be a sign of malignancy.

Other related symptoms, if unexplained and lasting 3 or more weeks also require USC referral:

• Constant hoarseness (voice is never normal) in those aged 35 years or over
• Pain on swallowing (odynophagia)
• Red or mixed red and white patches of the oral mucosa (not oral thrush)
• Ulceration or swelling/induration of the oral mucosa
• Neck or parotid lump.

Consider whether there are associated risk factors – drug use as well as smoking and alcohol. There is further detail on the Neck Lump and Throat Cancer Risk Assessment page.

C.M. & I.N. – 2/2/26