Is your sore throat something more serious?

By far the most common cause of sore throat is a viral infection. It's often accompanied by typical symptoms of a cold - coughing, sneezing, feeling tired and a bit achy. Your pharmacist can advise on over-the-counter remedies to help you feel better while your immune system fights it off.

These include painkillers like paracetamol or ibuprofen: there's not much evidence that gargling with soluble paracetamol before swallowing it is more effective, but some people swear by it. Interestingly, there is some evidence that regular gargling with water can cut your chance of getting colds and sore throats. It may be worth trying the popular option of gargling with salt water, but definitely try not to swallow it.

Do keep up your fluid intake with a sore throat. Fever makes you prone to dehydration, making headache and tiredness worse.

Tonsillitis

Tonsillitis, or inflammation of the tonsils at the back of the throat, is also most often down to infection with a virus. The sore throat is at its peak for two to three days, then gradually settles over the course of a week or so. However, it can be caused by a bacterial infection (usually one called streptococcus). It's most common in children, teenagers and young adults, although it can affect older adults too.

There are certain key features that can help you decide whether you need to see a doctor about antibiotics. You should see your GP or pharmacist (some pharmacists now offer a specialist 'test and treat' service, which allows them to issue antibiotics if needed) if you have at least three of these symptoms:

• Sore throat with no cough.

• High temperature.

• Swollen tender glands on the front of your neck.

• White pus on the back of your throat when you shine a torch into your mouth .

An abscess on the tonsils is more serious still. Watch out for difficulty in breathing; problems swallowing even saliva or opening your mouth properly; and very severe pain on one side of your throat.

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Epiglottitis

Epiglottitis is the term used to describe inflammation and swelling of the epiglottis which lies just behind the root of the tongue. It is usually caused by infection with a bacteria. The usual symptoms are a severe sore throat, pain or difficulty swallowing and a high temperature (fever). Breathing difficulties can occur. Prompt treatment is needed to ensure that enough oxygen can reach the lungs and usually includes antibiotics. If epiglottitis is treated quickly, the outlook is generally very good. Untreated, it can be life-threatening. Since immunisation against Hib was introduced, the number of children who develop epiglottitis in the UK has reduced dramatically.

by Dr Pippa Vincent, MRCGP

Glandular fever

Glandular fever is also more common in young adults and teenagers. Although you may have only a mild sore throat, it's likely to look very red and inflamed. It's usually accompanied by swollen, tender glands, especially in your neck, and can make you feel absolutely exhausted. It's caused by a virus but can leave you tired and washed out for weeks or even months. If your doctor suspects glandular fever, they'll send off a blood test to confirm.

Thrush

Most of us (well, certainly most women!) associate thrush with a vaginal fungal infection. But you can get thrush in your mouth and throat. Oral thrush is fairly common in babies but happens far less often in adults.

It's more likely if you're taking steroid inhalers (rinsing your mouth thoroughly after taking your medicine and using a spacer with your inhaler will cut the risk) or if your immune system is suppressed by conditions such as cancer, or by medicines which work by damping down your immune system.

Along with sore mouth and throat, thrush usually leads to small white patches in the mouth which don't rub off easily with your finger. The mouth lining underneath may look inflamed and redder than usual.

Could it be cancer?

Some non-infectious conditions can leave you with a sore throat. Hay fever is one of them, although sneezing, itchy watery eyes and blocked nose are usually a give-away. Throat cancer occasionally starts with pain in the throat that doesn't settle, although other causes are much more likely. If you've been a smoker and pain doesn't settle, see your doctor.

Persistent hoarseness should also always be checked out if it doesn't settle within three weeks. Laryngitis can cause sore throat and hoarseness, but symptoms usually settle within a week. If the hoarseness persists, you must see your GP so he or she can exclude throat cancer.

Acid reflux

You may think of stomach reflux as an unlikely culprit for sore throat. In reflux, acid from the stomach leaks backwards into your gullet, leading to burning pain behind your breastbone, known as heartburn. But it can also leave a nasty taste in your throat, as acid can rise right up into your mouth, especially when you lie down and it doesn't have to battle against gravity. This acid can lead to soreness and sometimes an irritating cough. So don't be surprised if your doctor asks you about indigestion if you go in with persistent sore throat.

Is your medication to blame?

An uncommon cause of sudden-onset, severe sore throat is low levels of white blood cells, which help you fight off infection. This is most likely if you're taking medicines which can interfere with your immune system: carbimazole (used for overactive thyroid gland), chemotherapy for cancer, or so-called 'disease modifying drugs' given in conditions like rheumatoid arthritis, psoriasis or Crohn's disease.

Steroid inhalers can lead to sore throat due to a thrush infection. Always rinse your mouth after taking your steroid inhaler.

There is no sure-fire way of avoiding sore throats, but there is strong evidence that eating a balanced diet and taking regular exercise can help strengthen your immune system. If you're unlucky enough to succumb despite a healthy lifestyle, make your pharmacist your first port of call.