What should you know about really bad sore throat?

A severe sore throat may occur with a viral illness such as a common cold, influenza or COVID-19. Tonsillitis, strep throat, glandular fever, allergic rhinitis and acid reflux are other possibilities. The presence of a sore throat does not establish which condition is responsible. Cough, runny nose or hoarseness can fit a viral illness; fever, tender neck glands, inflamed tonsils or a lack of cough may lead a clinician to consider other causes, but symptoms can overlap.

Assessment may include looking at the throat, checking hydration and breathing, feeling the neck, and deciding whether testing is useful.

Sip fluids often, choose cool or warm drinks according to comfort, rest your voice, and use soft foods. Gargling with warm salt water may soothe some adults. Follow label directions for suitable pain relief and check with a pharmacist if you are pregnant, have a chronic condition, or take other medicines. Avoid smoking and do not share antibiotics or use leftover medicine.

Get urgent help if you cannot swallow saliva, are drooling, have noisy or difficult breathing, a muffled voice, severe one-sided swelling, neck swelling, or trouble opening your mouth. Seek prompt medical review for dehydration, a persistent high fever, a rash, worsening pain, marked weakness, or symptoms that are not settling. A rapidly worsening throat needs assessment even when the cause is unclear.

Ask whether your examination suggests a viral or bacterial cause, whether a throat test is needed, and which pain-relief options suit you. Mention fever, cough, exposure to illness, reflux, allergies, medicines and your ability to drink.