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Sore throat (pharyngitis) is one of the top 10 reasons that patients visit doctors. Most of these patients are concerned about having developed strep throat. 70% of these patients get antibiotics. However, not all sore throats are strep throat. In fact only 5-15% of sore throats in adults are due to streptococcus pharyngitis.

The most common cause of sore throats are viruses especially the rhinovirus. Other viruses include coronavirus, influenza, adenovirus, herpes simples virus and less commonly the Epstein-Barr-virus associated mononucleosis. Antibiotics are not effective for viral pharyngitis.
Other causes include allergies, smoking, coughing or yelling excessively, gastroesophogeal reflux (heartburn), or low humidity.

However, it is important to detect the presence of strep pharyngitis because untreated strep may lead to complications such as rheumatic fever, acute glomerulonephritis (a type of kidney disease), peritonsillar abscess, and meningitis. It has even been associated in children with development of obsessive compulsive disorder or Tourette syndrome.

The gold standard of detecting strep group A is the throat culture. To avoid the 24-48 hour delay that occurs with standard throat cultures, a rapid strep test may be done. The sensitivity of this test is slightly lower than the throat culture.

Other clinical criteria besides the throat culture which may be used to determine if you have strep throat and therefore need treatment is the presence of 2 or more of the following:

• tonsillar exudates (pus or white film) in the back of the throat
• tender, enlarged, anterior, cervical nodes (glands in the neck)
• absence of cough
• fever
• positive rapid strep antigen test

If none or only one of these criteria is present, then antibiotics are not recommended. Over the counter medications which may help soothe the sore throat include lozenges or cough drops, acetominophen (Tylenol) or ibuprofen (Advil/Motrin) , decongestants and antihistamines for congestion, and of course rest and fluids and minimizing talking.