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Sore throat in adults | Mate korokoro

Also called pharyngitis

Key points about sore throats

Having a sore throat is very common, especially in children (see our other page on sore throat in children). The discomfort can range from a scratchy feeling to severe pain.
A sore throat can be caused by a viral infection, eg, a cold, the flu or COVID.
It can also be caused by a bacterial infection – most commonly Streptococcus (often known as 'strep throat').
If you're at higher risk of rheumatic fever, you need to have any sore throat checked by a healthcare provider. If it's not treated it can cause rheumatic fever and heart damage. If it's strep throat you will need antibiotics.

Young woman grimacing and holding sore throat

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Causes of a sore throat

About 90% of sore throats are caused by viral infections, eg, the common cold, flu or COVID. Viral sore throats usually get better by themselves within a week. Antibiotics don't fix viral sore throats.

Some sore throats are caused by bacteria, most commonly Streptococcus (often known as 'strep throat'). Children and young people at risk of rheumatic fever require treatment with antibiotics for 10 days to prevent rheumatic fever. Read more about strep throat.

Other conditions that can cause a sore throat include:

Māori tamariki and Pasifika children are most at risk of developing rheumatic fever and should see a doctor or nurse if they show ANY sign of sore throat.

Video: Rheumatic fever

(Stop Sore Throats Hurting Hearts, NZ, 2016)

When to get help if you are at higher risk of rheumatic fever

For people at higher risk of rheumatic fever, it is very important that a sore throat is always checked early by a nurse or GP. This is because untreated strep throat can cause rheumatic fever and heart damage for life.

You are at higher risk of rheumatic fever if:

you have had rheumatic fever before
someone in your family or household has had rheumatic fever.

You are also at higher risk if you have 2 or more of the following:

Māori or Pasifika ethnicity
You're 3–35 years of age
You live in poorer or crowded living conditions.

When to get help if you're not at higher risk of rheumatic fever

If you're not high risk for rheumatic fever, you should see your healthcare provider if your symptoms aren't improving after 48 hours, or if you:

have neck stiffness or ear pain
have swollen glands (feel for tender lumps in your neck) that are getting bigger
have any other symptoms you are concerned about.

Seek immediate medical help if you:

have difficulty breathing, eg, struggling for each breath or making a grunting noise with each breath
have great difficulty swallowing
develop a skin rash
are not able to drink much or shows signs of dehydration (very dry mouth, no urine for more than 8 hours, confused and drowsy)
develop a fever (high temperature)
have severe pain at the back of your throat
have any other symptoms that appear life threatening.

Call Healthline 0800 611 116 if you're not sure what to do.

The main symptoms of a sore throat are:

a painful or scratchy throat, especially when you swallow
difficulty swallowing
redness at the back of your mouth
bad breath
cold and flu symptoms, eg, a cough, hoarseness, red eyes and runny nose (usually not seen with strep throat).
swollen glands in your neck
your tonsils are large and covered in white stuff.

The image below shows a normal throat and a red throat with white spots on a swollen tonsil.

Image credit: Medical gallery of Blausen Medical 2014 via Wikimedia Commons(external link)

It's not possible to be sure from symptoms whether a sore throat is caused by a virus or bacteria. This is why people at higher risk of rheumatic fever should always get a throat swab done. See diagnosis and treatment of strep throat.

Your healthcare provider will ask questions about your symptoms and look in your mouth. They may take a throat swab to test for Streptococcus if you are at high risk of rheumatic fever or are at risk of spreading a strep throat infection. For example, if you are a:

healthcare worker
residential care worker
food handler
teacher
childcare worker
student.

If glandular fever is suspected you may need to have a blood test.

Self-care

The treatment of a sore throat depends on the cause. A sore throat that's caused by a viral infection is usually treated by self-care measures such as:

pain relief medicines
drinking more fluids
eating soft foods
trying ice blocks
honey and lemon juice.

Medicines for sore throat

A sore throat is often caused by a viral infection, and the pain and discomfort usually eases after a few days. It often doesn't need treatment with medicine. But if the pain is very uncomfortable you can use the following medicines to ease the symptoms.

Medicines	Description
Paracetamol or ibuprofen	Taking pain relief medicines such as paracetamol may ease your symptoms and may allow you to eat and drink more comfortably. Read more about paracetamol. You can also use ibuprofen, an anti-inflammatory medicine, to ease the pain but ibuprofen may not be suitable if you have some medical conditions. Read more about ibuprofen.
Throat products (lozenges, sprays and gargles)	Sore throat products are available as lozenges, sprays or gargles. Some contain anaesthetics (numbing agents) and may provide temporary relief from soreness. Most of these products can be used every 2–3 hours. Common examples include: Codral sore throat lozenges Difflam lozenges Difflam spray Difflam mouthwash Strepsils lozenges Strepfen intensive lozenge Cepacaine mouthwash. Talk to your pharmacist about the best pain relief for you or your child. Medicated throat lozenges are not suitable for children. Some lozenges have a high sugar content and may not be suitable for people with diabetes.
Cough suppressants	If your sore throat is because of an ongoing, continuous dry cough, a cough suppressant (eg, dextromethorphan) may be helpful. Most cough and cold medications are not suitable for tamariki. Read more about cough and cold medicines for children.

When are antibiotics used for sore throat?

Most people don't need antibiotics for a sore throat because most sore throats are caused by viruses and antibiotics are not effective at killing viruses. Antibiotics don't make much difference to symptoms – you have a 50% chance of being better in 3 days without antibiotics, and within 3 days with them. In either case, with or without antibiotics, you have a 90% chance of being better in 7 days.

Antibiotics are needed in some cases – although it's not considered worthwhile to routinely prescribe antibiotics for most children, Māori or Pasifika children or those coming from crowded homes may benefit from taking antibiotics. This is because the chances of them developing other health problems such as ear infections, rheumatic fever or glomerulonephritis (inflammation of the kidneys) are higher than for most children.

Antibiotics may also be given if you are at risk of spreading a strep throat infection, eg, if you are a:

healthcare worker
residential care worker
food handler
teacher
childcare worker
student.

The course of the antibiotics is usually for 10 days, and it is important that you or your child complete the full 10 days of antibiotics, even if you or your child start to feel better. This helps to stop strep throat from turning into rheumatic fever. Antibiotics can be given in a form of a capsule, liquid or as an injection.

To help soothe a sore throat you can do these things: