Sore throats - December 2025

[BELL RINGING] Welcome back to Coffee Break, the audio equivalent of a wall drink when your voice sounds like gravel. It's all throat, most of the time they're nothing serious, but they can really ruin your day. Do you really need those antibiotics? Should you gargle, rest, or just power through? And how do you know when it's something more serious, like strip or tonsilitis? We break down the signs, the myths, and what actually helps. That's this week on Coffee Break. I'm Dr. Jeff Hampe, and I'm Dr. Sam McGinley. And this is season one of Coffee Break. We are two general practitioners from beautiful dogs that are in the United Kingdom, and we are happy to have you here with us for another Coffee Break. In our show, we give you helpful and useful health and wellness information in short and easily digestible episodes. That's right, and hopefully in a fun and enjoyable way as well. In today's Vat Sea of Health information, we hope to be your trusty island of reliable and impartial independent, unbiased information. And we may even have some guests with us to help. So sit back and enjoy. Hey Coffee Break! Okay, so today we're talking about sore throats, which are incredibly common. Pretty much, I'm sure, that we've all had a sore throat at some point. Oh, I agree. And so yeah, and they reckon that about a third of adults will have a sore throat that they classes severe in nature in the last 12 months. Yeah. And perhaps we all realise as well that it's much more common in the winter months, where in fact, we see a peak usually in children. Definitely. And that's a really good point to say now we are in the winter months that if you will not listen to our vitamin D episode, you need to listen to that and after you listen to this one, vitamin D is very important in winter. And if you're listening to us in the UK, then it's time to start taking those vitamin D supplements. If you've not started taking them already. Absolutely. Yeah. So what are the causes of sore throats? Well, what usually happens is an acute or so sudden onset, upper respiratory tract infection. So infections sort of in the nose, throat, mouth area, upper airways, will cause swelling of the mucosal lining and that will cause pain. Usually as a result of either something called pharyngeitis or essentially a infection at the back of the throat or tonsillitis where there's inflammation or infection of the tonsill. That's right. And what are the things that cause it? Well, the most common causes viral, as far infections. But bacteria can also cause it and the bacteria that tend to this harm, we call streptococcus. Specifically group A streptococcus. But streptoccus, which is why sometimes you'll hear it refer to as strept throat. But the commonest form is viral. And within the viral group, there are numerous causes which is why the illness may vary as to where you get symptoms in other places. Absolutely. Yeah. So you might have a sore throat on a long side. Funny gut symptom or something. And that's because it's the type of virus that happens to be causing that. Exactly. So streptococcus is the most common bacterial cause of a sore throat. But actually it's really common to find this bacteria streptococcus in the throats. It's just that sometimes the body's immune system has lost the ability to control the amounts of that. Yeah. That bacteria, which then needs it to be able to get in and under the protective barrier of our throat and then it therefore causes the symptoms, doesn't it? Yeah, that's right. So the natural equilibrium of things living in our body, the ecosystem, how things live, just gets a bit disrupted and the streptococcus live there. Suddenly they take control of a bit more dominant than usual and that causes symptoms. The important thing to say though is that sore throat, whether it's called by viral or bank, tear relief infection is usually self limiting. Normally it results within two weeks. So actually quite a long time to be suffering with quite a nasty symptom, isn't it? And if we look at the time of resolution, then 40% of people will see their sore throat improve within about three days, 85% are symptom free by a week. And the majority of everybody else is symptom free after those two weeks. Yeah, absolutely. There are some complications to infection with the throat. So we may all have heard about scarlet fever. This is a condition that affects more parts of the body as a result of certain strains of streptococcus that actually produce a toxin when they infect us and that results in classic symptoms such as a rash. And it is recommended that this is treated to prevent rapid spread amongst communities. Another important complication is some of the Quincy, which is increasingly rare these days, but very very serious isn't it? A Quincy essentially is when your tonsules are affected, the tons of the tissue is affected. Such a degree that it swells up, it becomes inflamed, that it can actually close off the back of your throat and it can't hurt. It is really quite serious, but thankfully we don't tend to see quite as much of that. Anymore, once we might have used to. Absolutely. And then sometimes along side of sore throat you may have symptoms relating to an ear or a sinus infection and again they may or be viral in cause but sometimes it can be a bacterial cause that may require additional treatment. So what do we look for to help us determine whether the sore throat, where the infection is a viral sore throat, which is the most common or bacterial sore throat? Well we can look at some of the symptoms and there are specific symptoms with intensity with viruses. Things like a runny or a block nose or a cough they're often associated with viral illnesses aren't they? What do you say is blood pressure, which is a tract infection? And then we might have other symptoms and signs such as flu symptoms, Covid symptoms over the last five, six years as well and that points us in a sort of direction. But is there anything else that we can do as clinicians who help point us in the direction of his viral, his bacteria? What's the best treatment for us to help? Yeah, we do use a very helpful score system called the fever pain score and that looks at five areas to do a symptom for signs that essentially each part of the score scores one or zero so that we look at fever. How long you've had a symptom for if you have a very inflamed throat or tonsils, if there's what we call exidate or sort of a discharge or a pulse on the tonsils and then whether or not you have a cough and in particular if you do have a cough it's your much more likely to have a virus affecting your throat than the bacteria. And if you've ever seen your doctor, if you ever see your GP with a sore throat, you may notice that they suddenly are on their computer a little bit more and it's not because they're googling your symptoms, they're probably doing a flu pain score aren't they? The background to try to come up with an answer to reassure you or to tell you what she would you need. Importantly though, very few cases of sore throat end up needing to be seen in the hospital, be referred to a hospital, but there are some times that we might say or you may need to be in a hospital on them. Absolutely, so if we suspect you developed an abscess or the quinzied we will talk about if you have breathing difficulties associated with your sore throat, maybe due to the level of swelling for example, or if we are concerned that you may have symptoms or signs consistent with sepsis then we will be arranging for you to be transferred urgently to the hospital. Yeah, definitely and we will be doing an episode on sepsis in the not-to-distant future, so do keep listening for that. There may be other specific reasons for us to change the plan, medications, other conditions, if children don't have their vaccines, where immunizations up to date, then we may need to change how we treat. But what sort of things can you do if you have got a sore throat yourself? Well, there is loads here, isn't there? If you develop a sore throat, firstly we would encourage you to think about what other symptoms you have got, or symptoms you might not have. If you have got lots and lots of other cold symptoms like a really blocked nose, running nose and a cough for example, then it is most likely to be viral. So we would encourage you to expect your throat pain to improve over the next three days up to seven that you were saying before. But just be wary that if your other cold symptoms do settle but you have a worsening sore throat or new fever, then it's not unheard of a viral illness to leave you with a tonsillitis that may be bacterial for example. Yeah. You could do your own fever pain school. They're easily available online. You could fill in the boxes and the online school systems will give you some basic guidance of what you could do. And then your first step should really be thinking about seeing a pharmacist first because they can provide symptomatic treatment and actually under the new NHS guidance, pharmacists are able to access specific further treatments for sore throat. Exactly. So symptom treatment is really simple, analogies, it's really simple, painkillers, they're paracetamol, ibuprofen, if you're able to, of course obviously if there's a reason you can't take those things and don't throat sprays. So throat sprays were just off to lower the count to throat sprays. These are often medicated. They contain a low gland aesthetic, which is how they work, your spraying or low plant aesthetic onto the bit of the throat. hurts. You do need to be really, really careful with those, I don't you, because they can numb the rest of your mouth. Certainly, we'll numb the bathroom your throat, and if you therefore drink something hot, and it's scalded, you won't know that you're burning yourself, so you have to be really careful. Honey in lemon drinks, hot drinks, all the traditional cure for sore throat, it's very helpful. I do sometimes recommend gargling, clorexidine mouthwash, that's quite soothing and antiseptic. And old fashioned salt water gargles can be quite helpful as well, but definitely don't swallow higher of those. Absolutely. If you've seen your pharmacist first, or if you've seen your doctor, and you've had an assessment and decisions made to this may well be more likely bacterial, they may then decide that you need an antibiotic, and we have some unusual ones that we go to. So normal first line treatment for sore throats, if you need antibiotics, tends to be a penicillin, oxenethyl penicillin, or an alternative for chirologic, and it's usually a five day course. So the guidance historically has said seven to ten days to prescribe, hasn't it? For different variations of sore throat, but there is plenty of literature out there that now suggests that five days are sufficient for most people, but you may have specific circumstances where you need to go. Definitely any chair of the country has to have an end of the guidelines, isn't it? So Sam, when might you need to get further help? Well, there is a list here that we'll go through, but we'd encourage you to think about getting extra help. If you feel like, if you've been given treatment and things are not going how to expect, or you feel increasingly well, please do get yourself reviewed, but a list of things to think about. So these are difficult to describe in an audio setting like this, but the list that you will see on various pieces of information will include very very cold skin, or that it's gone strange colour, so mottled really come about. Or if you've developed an unusual rash, particularly a non-blanching rash. Definitely. And if you've got feelings of confusion or drowsiness or slurred speed, what wins a photo is decreased conscious level. Yeah, absolutely. Which you may not pick up yourself. Exactly. That might be somebody else who's picking that up on you because they're worried that you're no longer your normal self. Yeah. Difficulty breathing. This might be that you just feel like you can't get your breath, or that you're breathing quickly, or you might notice that you're turning blue around the lips, or that in a child you may see the skin around the ribcage sucking in, so what we call recessions, sub-costal or intercostal recessions around the ribcage. Certainly if you develop severe headaches or you're getting sickness and vomiting with it, if you're getting chest pain with it. Yeah, absolutely. Difficulty swallowing, particularly if you're drooling and you can't even get your saliva to go down, you would want to be assessing you. Yeah, and then if you're coughing up blood, and then that's also some you do need to see somebody about signs of dehydration might include little or no urine being passed. And if you're just feeling a lot worse, then you should probably just be getting yourself seen too. Yeah, most definitely. And there are a few things that maybe not quite the word, you probably do need you to seek medical assistance and medical advice, or necessarily as an emergency, but maybe as soon as a appointment, but for instance, if you're not starting to prove a little by the time you were given, as part of your safety, that you're by your clinician, children who are mid-lear infections, if fluids start to come out of the ears, or actually the hearing is starting to deteriorate, or they're developing deafness. Absolutely. And finally, it is important to know that if you have an illness and infection, you may have other symptoms in various systems of your body, the most common is probably a gut symptoms, abdominal symptoms. And that might include diarrhea, which may be due to the illness itself, or maybe due to the antibiotics. Really common, but if it's contributing to you feeling worse and it's worth getting some further advice. Okay, brilliant, Jeff, so any take-home points for you? So, yeah, I think it's really important to realize the duration of symptoms. So most people are going to get the symptoms resolved within a week, pretty much every but about two weeks. If you are three weeks down the line and you've still bought us all throats, and you probably don't have any other symptoms, no other viral type symptoms, no other infection type symptoms, then actually that's a really good time to come and see us, isn't it? Because actually, this probably isn't due to an infection anymore, we need to know what's going on. We need to check, we need to infer the tests. So I think I would say knowing how long your symptoms are going to last up to a couple of weeks, if you've got ongoing symptoms, there could be other things and we need to see, so definitely your doctor. It's not that you've got a lingering infection that just hasn't gone yet. Yeah, that's really neat. My take-home point is that we are in a world where we are trying to be more cautious with antibiotics, hence why we're using things like the fever, pain, and scones. So we'd encourage, we've all got access to online things, we've told you about it here, we'd encourage you to think about using it, and that may help guide you and reassure you before you make your first contact with the healthcare question. However, the caveat is always make sure that you get yourself seen in people unsure, and do speak to your pharmacists, they are, they have been empowered by the NHS to be able to help people with sore throats in a broad way than they used to be able to. This has been an episode of Coffee Break. We hope you have enjoyed it, and if you have, then we hope you will join us again for another Coffee Break soon. Remember, if you do want to get in touch with us, or if you have any ideas or suggestions, then please feel free to email us at the show at [email protected]. You can listen to us and subscribe to the show on any of the podcast platforms and via your computer, smartphone and home smart devices. We have used a variety of resources for the information in the show to try and ensure that it is up to date and the most applicable. We have also put any important links we've discussed in the show notes. Coffee Break is a coffee-break production and is created, written and hosted by me, Dr Sam McGinnley and me, Dr Jeff Hamm, the editor and producer is Dr Jeff Hamm. All the content we provide in the show is for general informational purposes only. The content does not constitute medical or healthcare advice. The content is valid in England at the time of recording. The content should not be relied upon as a substitute for professional medical or healthcare advice applicable to your specific circumstances. We advise that you always consult a qualified medical professional for any medical matters.