4 Causes of a Sore Throat, and When to Worry

It's winter time, and infection is certainly a cause of a sore throat. But what else can cause throat discomfort? What signs and symptoms should you be worried about? And when should you see your doctor?

Sanaz Majd, MD
5-minute read
Episode #250

The winter season has certainly arrived—with snot dripping, cough droplets swarming, temperatures spiking, and sick people moaning. Germs are spreading faster than wildfire as I write. And a sore throat is often where the story all begins.

The winter season seems to also trigger allergies, asthma, and holiday dietary indiscretions. Therefore, many of you reading this may be wondering why you seem to have developed a sore throat. Is it a bug? And if so, what does it mean? And what if it comes and goes, or remains persistent for days or weeks? How do you know if your sore throat is something serious and when should you see your doctor?

To answer these questions and more, let's review some of the top causes of a sore throat.

Causes of a Sore Throat

  1. Viruses
  2. Strep Throat
  3. Allergies
  4. Acid Reflux

Let's review each cause a bit further.

1. Viruses

Okay, so in the winter time, there’s no doubt that viral illnesses are the very top cause of an acute sore throat. What do I mean by acute? Well…not chronic. Something that develops rather suddenly, and often resolves rather quickly.

Viruses, like in the common cold, often begin by attacking the throat. Some people feel it more than others, but it has the potential to be quite distressing and downright dreadful. The viral sore throat that often signals the beginning of a viral illness often lasts only several days, and then begins to dissipate once the runny, stuffy, snotty nose symptoms appear. But those first few days are often the worst. The typical viral course worsens each day from onset, peak somewhere between day three to day five, and then gradually improves each day after. Most people feel much better somewhere between day seven and day ten.

No one said that viruses are not nasty—sometimes they’re even more of a nuisance than bacteria. But unfortunately they don’t have a cure like bacteria do, and once plagued with it, it must simply play out its course. Kuddos to the next upcoming millionaire who will develop a cure for a virus.

Be sure to review tips on how to treat the common cold and flu viruses.

2. Strep Throat

The most common bacteria invading the throat are by Streptococcus Pyogenes, otherwise known as “strep throat.” Strep throat is not nearly as common as viruses when infecting the throat, and is more commonly found in children and adolescents rather than adults.

It is, however, another acute cause of sore throat. So what's the difference between strep throat and a viral illness, you may be wondering? Here are some other features more commonly seen in strep:

  • Fever
  • Lymph node enlargements around the neck and throat
  • Pustules on the tonsils in the back of the throat

Here’s a dead giveaway that the culprit is unlikely to be strep: there’s no nasal symptoms or cough with strep. It’s simply a sore throat with fever, very unlike the common cold.

A simple swab of the throat will often reveal strep, but there are two types. One is referred to as a “rapid strep” test that not all doctor’s offices will carry, but most urgent cares do. It can give an estimate of whether or not it’s strep, and provides a result right away. However, it’s not the gold standard, and can produce false positives. The best test for strep is a throat culture swab, but it can take a few days to provide a result. Most doctors will run that throat culture anyway if the rapid strep test is positive.

Penicillin or Amoxicillin can eradicate strep more quickly, but strep throat typically also resolves on its own within two to five days even without treatment, believe it or not. Our immune system carries some tough soldiers to combat many infections. But we do recommend antibiotics if strep is discovered.


Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

About the Author

Sanaz Majd, MD

Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women's health and patient education.