Strep throat? Just a cold? Here's how to figure out why your throat hurts so much—and how to get rid of it.
By Anisa Arsenault, Prevention
When your throat is sore and you can barely speak, you might not really care about what’s causing it, as long as you can get some relief. But types of sore throat are not created equal, which means treatment isn’t, either.
“The common causes of sore throat can be divided into infectious and non-infectious cases,” says Stephen Parodi, MD, infectious disease expert at Kaiser Permanente. Think of infectious cases of sore throat as something you contract, whether that’s a virus like the common cold or a bacterial infection like strep throat. Non-infectious cases, on the other hand, come from other factors that trigger inflammation, irritation, or damage in the throat, like allergies, smoking, or GERD.
“Infectious and non-infectious causes can all cause pharyngitis, the medical term for sore throat,” Dr. Parodi says, referring to inflammation in the back of the throat, which is most common. “There are other tissues in the throat where specific infections can occur such as the tonsils or vocal cords, and those are called tonsillitis and laryngitis, respectively.”
A closer look at the difference between infectious and non-infectious causes of sore throat can help you figure out how to soothe a sore throat as quickly as possible.
“The common causes of sore throat can be divided into infectious and non-infectious cases,” says Stephen Parodi, MD, infectious disease expert at Kaiser Permanente. Think of infectious cases of sore throat as something you contract, whether that’s a virus like the common cold or a bacterial infection like strep throat. Non-infectious cases, on the other hand, come from other factors that trigger inflammation, irritation, or damage in the throat, like allergies, smoking, or GERD.
“Infectious and non-infectious causes can all cause pharyngitis, the medical term for sore throat,” Dr. Parodi says, referring to inflammation in the back of the throat, which is most common. “There are other tissues in the throat where specific infections can occur such as the tonsils or vocal cords, and those are called tonsillitis and laryngitis, respectively.”
A closer look at the difference between infectious and non-infectious causes of sore throat can help you figure out how to soothe a sore throat as quickly as possible.
Viral infections
A number of viral infections, especially upper respiratory infections, can contribute to sore throat. High on the list is the common cold, or rhinovirus. Much lower on the list is a virus caused by a sexually transmitted disease, like herpes simplex virus.
“These viruses have a tendency to stick to cells in the throat because they’ve adapted to find targets in those areas that allow them to invade the immune system,” says Benjamin Tweel, MD, an Otolaryngologist at Mount Sinai Hospital in New York City. “This causes localized damage of some type, or inflammation—both of which could be painful.”
Examples of viral infections include:
“These viruses have a tendency to stick to cells in the throat because they’ve adapted to find targets in those areas that allow them to invade the immune system,” says Benjamin Tweel, MD, an Otolaryngologist at Mount Sinai Hospital in New York City. “This causes localized damage of some type, or inflammation—both of which could be painful.”
Examples of viral infections include:
- Rhinovirus
- Influenza virus (the flu)
- Mononucleosis
- Coxsackievirus (responsible for hand, foot, and mouth disease)
- Varicella virus (responsible for chickenpox and shingles)
- Herpes simplex virus
Viral infections don’t respond to antibiotics. Over the counter pain relievers like acetaminophen and NSAIDs can help soothe your symptoms, as well as these other home remedies for sore throat.
Bacterial infections
“Bacterial infections are less common than viruses but are important to diagnose because antibiotic treatment can prevent complications, particularly for strep throat,” Dr. Parodi says.
Just like viral infections, bacterial infections trigger an immune response, like inflammation, which is responsible for your sore throat. Unlike viral infections, bacterial infections are treated with antibiotics.
Examples of bacterial infections include:
Just like viral infections, bacterial infections trigger an immune response, like inflammation, which is responsible for your sore throat. Unlike viral infections, bacterial infections are treated with antibiotics.
Examples of bacterial infections include:
- Streptococcal pharyngitis (strep throat)
- Staphylococcus infection
- STDs like gonorrhea and chlamydia
- Allergies
According to Dr. Tweel, allergies shouldn’t be inherently painful. But there’s a few reasons they may cause pain in your throat.
“If someone has a lot of allergy symptoms happening and irritation in the throat is happening at the same time, the treatment of one can make the other better,” he says. “Plus, swallowing mucus caused by allergies may cause irritation. It's possible that if your allergies are making you sniffle and sneeze and cough, it may cause irritation in the throat.”
“If someone has a lot of allergy symptoms happening and irritation in the throat is happening at the same time, the treatment of one can make the other better,” he says. “Plus, swallowing mucus caused by allergies may cause irritation. It's possible that if your allergies are making you sniffle and sneeze and cough, it may cause irritation in the throat.”
Smoking and secondhand smoke
Dr. Parodi says the coughing triggered by smoking can lead to a sore throat.
Dry air
Like smoking, dry air can cause coughing, contributing to sore throat.
Gastroesophageal reflux disease (GERD)
Unlike the above non-infectious causes of sore throat, GERD can cause direct inflammation to the tissue and lining of the throat.
“When GERD and heartburn affect the throat, it’s called reflux laryngitis,” says Dr. Tweel. “When stomach contents—acids and enzymes—go up the esophagus, the first place they reach in the back of the throat is the larynx, or voice box, which is more sensitive to them than the esophagus. This causes inflammation in the voice box.”
“When GERD and heartburn affect the throat, it’s called reflux laryngitis,” says Dr. Tweel. “When stomach contents—acids and enzymes—go up the esophagus, the first place they reach in the back of the throat is the larynx, or voice box, which is more sensitive to them than the esophagus. This causes inflammation in the voice box.”
When to see a doctor about your sore throat
Since 90 percent of pharyngitis cases are viral and can’t be treated with antibiotics, you typically don’t need medical treatment other than OTC pain relief, if you choose. Still, you might not know if your sore throat is infectious or non-infectious, let alone viral or bacterial. Parodi explains specific instances when a sore throat necessitates a doctor’s visit:
- You have a fever of 101 degrees or higher
- Your throat pain is extremely severe in the first day or two
- Your throat pain lasts five to seven days
In the event of these more serious symptoms, you should head to the emergency room or call 911:
- You have trouble swallowing or are drooling because you can’t swallow your saliva
- You have swelling of the neck or tongue
- You can’t move your neck or have trouble opening your mouth
