Pharyngitis

Introduction

Pharyngitis is an inflammation of the pharynx, which is the back wall of the throat. It manifests as a sore throat, difficulty swallowing, and sometimes a fever. When it extends to the tonsils, it is called tonsillitis or strep throat. Highly common, pharyngitis is of viral origin in 70-80% of cases and resolves spontaneously within a few days. The main challenge is to identify the rare bacterial forms, particularly those caused by group A streptococcus, which require antibiotic treatment.

If you have a severe sore throat, a high fever, or difficulty swallowing, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our app available on the App Store and Google Play.

Who is at risk?

Pharyngitis mainly affects children and adolescents, particularly in group settings (daycare, school). Strep throat is predominantly observed between the ages of 3 and 15. Adults can also be affected, but bacterial forms are rarer. Smoking, exposure to irritants, recurrent viral respiratory infections, allergies, gastroesophageal reflux and mouth breathing are contributing factors. Immunocompromised patients are at risk for more severe infections.

Symptoms of Pharyngitis

Main Symptoms

• Sore throat: pain of varying intensity, sometimes radiating to the ear.

• Odynophagia: pain when swallowing.

• Moderate to high fever depending on the cause.

• Redness of the pharynx upon examination, sometimes with whitish or pultaceous coatings.

• Associated symptoms depending on the etiology: cold, cough, runny nose, conjunctivitis (viral origin); absence of cough and cervical lymphadenopathy (streptococcal origin).

• Tender cervical lymphadenopathy.

• In children: high fever, abdominal pain, vomiting, sometimes a scarlatiniform rash (scarlet fever).

When to seek emergency care?

An emergency consultation is necessary in the following situations:

• A very severe sore throat making it impossible to eat or drink.

• Difficulty breathing or a "hot potato" voice (suspicion of peritonsillar abscess, epiglottitis).

• Stridor or respiratory distress — call 144.

• Persistent high fever with deterioration of general health.

• Unilateral sore throat with asymmetric swelling (peritonsillar abscess).

• Appearance of a purpura, a stiff neck, or neurological disorders.

• Sore throat persisting beyond one week, or recurring in adults (suspicion of mononucleosis, occasionally ENT cancer).

What to do before calling Docadom? Stay hydrated, take a painkiller (paracetamol), rest, and contact your primary care physician first. If they cannot be reached or if you need a doctor at home outside of operating hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone app (App Store and Google Play). In case of signs of severity (respiratory distress, inability to swallow saliva, neck deformity, fever with purpura), dial 144 immediately.

Causes of Pharyngitis

Viral Pharyngitis

The most common form (70-80% of pharyngitis cases). The viruses involved are rhinoviruses, adenoviruses, influenza viruses, coronaviruses, parainfluenza, Epstein-Barr virus (EBV), herpes virus, RSV, COVID-19. Viral pharyngitis is often associated with a cold, a cough, or conjunctivitis and resolves spontaneously in 3 to 7 days.

Bacterial Pharyngitis

The main bacterium is group A streptococcus. More rarely: streptococci of other groups, Fusobacterium, Mycoplasma, Chlamydia, Neisseria gonorrhoeae. The presentation typically combines high fever, a very red throat with whitish coatings, cervical lymph nodes, and an absence of cough and rhinitis. Strep throat poses a risk of post-infectious complications (acute rheumatic fever, glomerulonephritis) and warrants antibiotic treatment.

Other Causes

• Infectious mononucleosis (EBV): adolescents, major fatigue, pseudomembranous tonsillitis, diffuse lymphadenopathy, splenomegaly.

• Gonococcal pharyngitis or related to an STI.

• Gastroesophageal reflux and chronic irritative causes.

• Allergies and exposure to irritants (tobacco, pollution, dry air).

• More rarely, ENT cancers in smokers over 50 years old.

Diagnosis of Pharyngitis

Diagnostic Methods

• Anamnesis: age, duration of symptoms, associated signs (cough, fever, rhinitis, contact with a case).

• Clinical examination: inspection of the throat, palpation of cervical lymph nodes, examination of other mucous membranes.

• Mac Isaac clinical score (in children > 3 years and adults): helps evaluate the risk of streptococcal pharyngitis.

• Rapid antigen detection test (RADT) for Strep A: recommended in case of a high clinical score. Confirms or rules out strep throat.

• Throat culture in case of doubt or a negative RADT with high suspicion.

• CBC, Monospot test if mononucleosis is suspected.

• STI screening in case of suspicious pharyngitis in a sexually active adult.

Alternative Diagnoses

• Tonsillitis (acute tonsillitis).

• Sinusitis with post-nasal drip irritating the throat.

• Infectious mononucleosis.

• Peritonsillar abscess, retropharyngeal abscess.

• Epiglottitis (life-threatening emergency, exceptionally rare since Hib vaccination).

• Gastroesophageal reflux disease.

• Irritative pharyngitis (tobacco, allergy).

• ENT cancer in elderly smokers.

Treatment of Pharyngitis

Viral Pharyngitis

Treatment is essentially symptomatic:

• Paracetamol: first-line pain reliever and fever reducer.

• NSAIDs occasionally for pain (to be avoided in case of severe signs of infection or suspicion of secondary infection).

• Throat lozenges, saltwater gargles.

• Abundant hydration, rest, warm and soft diet.

• No antibiotics: useless and encourages bacterial resistance.

Streptococcal Pharyngitis (Strep Throat)

• Amoxicillin: gold standard treatment for 6 days.

• Cephalosporins or macrolides in case of penicillin allergy.

• Associated painkillers.

• Antibiotic treatment reduces the duration of symptoms, contagiousness, and prevents complications (ARF, glomerulonephritis).

Associated Measures

• Rest, hydration.

• Avoid irritants (tobacco, alcohol).

• Adapted diet (cool drinks, ice cream, soft foods).

• School or work exclusion during the first 48 hours of antibiotic therapy or until clear improvement.

Prevention of Pharyngitis

• Regular handwashing.

• Respiratory hygiene (covering mouth and nose when coughing, disposable tissues).

• Avoid close contact with sick individuals.

• Recommended vaccinations: influenza, COVID-19.

• Smoking cessation.

• Limit exposure to pollution and irritants.

• Treatment of potential GERD or chronic sinusitis.

• Sufficient hydration, especially in winter (heating).

Possible Complications

Complications are rare. Untreated strep throat can lead to complications like acute rheumatic fever, post-streptococcal glomerulonephritis, scarlet fever, less commonly Sydenham's chorea or toxic shock syndrome. Locally, suppurative complications can occur: peritonsillar abscess, retropharyngeal abscess, cervical cellulitis, Lemierre's syndrome (jugular thrombosis). An otitis media or sinusitis can complicate pharyngitis. Chronic pharyngitis is often linked to irritants or GERD.

When to Contact a Doctor for Pharyngitis

Any severe or prolonged pharyngitis warrants medical advice:

• First line of action: contact your primary care physician, who can perform a rapid strep test and prescribe an appropriate treatment.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.

• In case of severe signs (respiratory distress, inability to swallow saliva, neck deformity, drooling, lost or altered voice), dial 144 without delay.

Conclusion: Differentiating Viral from Bacterial Origin

Pharyngitis is a common and usually benign condition. It is characterized by a sore throat, difficulty swallowing, and sometimes fever, which can lead to complications like acute rheumatic fever, glomerulonephritis, peritonsillar abscess, or otitis. The distinction between a viral cause (majority, symptomatic treatment) and a bacterial cause (streptococcus, antibiotic treatment) relies on the rapid diagnostic test. Good respiratory hygiene and appropriate follow-up limit complications.

If in doubt, consult your primary care physician first. If they are not available, Docadom provides you with an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.