Viral Sore Throat

By Roland Larrabee, M.D.

A viral sore throat is an infection of the throat caused by a virus. A viral sore throat occurs when a virus attacks the throat area. Many different viruses can cause a sore throat, including:

• flu viruses
• common cold viruses
• coxsackie virus (a virus that causes a throat infection called herpangina)
• infectious mononucleosis ("mono") virus.

The symptoms will vary slightly depending on which type of virus you have. The symptoms of flu virus infections can include sore windpipe, cough, and fever. The symptoms of adenovirus infection can include severe throat pain, cold symptoms (runny nose, cough), white bumps on the tonsils, mild soreness and swelling of the lymph nodes in your neck. The symptoms of herpangina can include sore throat, fever, headache, poor appetite, pain in the stomach, neck, arms, and legs, and sores on the throat, tongue, or roof of the mouth. The symptoms of infectious mononucleosis can include fever, extreme, prolonged fatigue lasting 1 or more weeks, white coating on the throat or tonsils, red spots on the roof of the mouth, large swollen glands in the neck, and faint red rash on the chest or whole body.

It is often difficult to tell whether a sore throat is caused by a virus or by strep bacteria. In general, the main symptoms of strep throat are a severe sore throat with difficulty swallowing. Other possible symptoms of strep are fever, swollen lymph nodes in the neck, white spots on the tonsils, and sometimes headache, stomach pain, and rash. On the other hand, sneezing, a runny nose, and nasal congestion are common symptoms of infections by a virus, but not the strep bacteria. To diagnose a viral sore throat, your health care provider will review your symptoms and examine you. He or she may also take a throat swab to check for strep throat. Most doctors’ offices now have very accurate rapid throat swab tests that allow diagnosis of strep within a few minutes. If your physician suspects mononucleosis, a Monospot slide test or complete blood count may also be done.

The treatment is similar to that of the common cold. Antibiotics have no affect on viral infections. You can use analgesics to relieve minor pain. The treatment consists of gargling with warm water. Some people feel more relief with warm, salty water. Avoid contact with others until the symptoms are gone. Get plenty of bed rest or otherwise limit activity until the fever is gone. Mononucleosis is an illness that can affect the whole body. There is no specific treatment for it.

The effects will last as long as the virus affects the body. Most viral infections last from several days to 2 weeks. Mononucleosis may last longer. To help take care of yourself, take the full course of treatment your health care provider prescribes.

For a sore throat:

• Drink chicken soup, cold drinks, and other clear, nutritious liquids. If it is painful to eat, don't eat solid food. When you can eat, eat nutritious foods.
• Do not smoke cigarettes or breathe secondhand smoke.
• Gargle with warm salt water (1/2-teaspoon salt per cup of water) as often as is comfortable.
• Suck on hard lozenges or candy.
• Take acetaminophen, ibuprofen, or naproxen according to the directions on the container.
• Limit activities, especially those requiring talking.

If you have a fever:

• Take acetaminophen or ibuprofen to reduce the fever
• If under the age of 21, avoid taking aspirin because of the risk of Reye’s syndrome

• Drink clear liquids such as water, juice, tea, and bouillon frequently during the day.
• Reduce your normal activities until the diarrhea has stopped.
• If you are nauseated, suck on ice chips.
• Generally, you can eat foods of your choice as long as you tolerate them.
• Over-the-counter medications can help (e.g., loperamide), but only use it for 2 or 3 days.

• You have a severe sore throat for more than 48 hours.
• You have a fever, chills, or sweats.
• You have painful swollen neck glands (lymph nodes).
• You are unable to swallow or are not eating or drinking well.
• You have pus (white spots) on your tonsils.

If you've been diagnosed with viral sore throat:

• Avoid close contact with others for about 24 to 48 hours. However, with many viruses, you are most infectious before symptoms start.
• Use tissues when coughing or sneezing.
• Wash your hands before touching food or food-related items such as dishes, glasses, silverware, or napkins.
• Wash your hands after coughing, sneezing, or blowing your nose.
• Use paper cups and paper towels in bathrooms instead of common drinking cups or shared hand towels.
• Don't share food or eating utensils with others.