Acute Pharyngitis

Pharyngitis, or acute pharyngitis, colloquially sometimes called cobblestone throat, is an inflammation of the back of the throat, otherwise known as the pharynx. The condition generally causes pain and a sensation of scratchiness in the region of the throat, as well as difficulty swallowing. 1 The condition is typically referred to as a sore throat.

Pharyngitis is a very common complaint, usually caused by a viral infection, or, more rarely, a bacterial infection. In the majority of cases, it will disappear within a week, though can last longer. Treatment will usually focus on managing the symptoms. However, antibiotics may be prescribed to treat the bacterial form of the condition. Generally, it is a non-serious condition, though in some instances it can cause severe symptoms or a serious infection.

Pharyngitis is usually a temporary condition, lasting for roughly one week. In a small number of cases, however, a sore throat can be recurring, becoming a condition known as chronic pharyngitis. The chronic form of the condition has a variety of possible causes, including persistent infection and stomach acid reflux. If pharyngitis lasts for weeks, it is probably chronic rather than acute pharyngitis. Smoking, vaping and exposure to other forms of smoke, such as industrial or woodsmoke, can all cause a chronic sore throat.

A variety of symptoms are associated with pharyngitis, with some of the most common including: 2

• Sore throat
• Pain or difficulty when swallowing or talking
• Swollen, sore glands in the neck or throat
• Red throat and red, swollen tonsils
• A hoarse voice
• White or grey patches on the back of the throat

A sore throat is the characteristic symptom of pharyngitis and – in some cases – may be the only symptom. A cobblestone appearance at the back of the throat, colloquially known as “cobblestone throat”, is in some cases present. This is a distinctive lumpy, irritated appearance of the back of the throat, caused by enlarged lymphatic tissue. It is visible on visual inspection. It can also be caused by a post-nasal drip, in which mucus that accumulates in the back of the nose and throat drips downward from the back of the nose.

Commonly, pharyngitis is caused by an underlying condition such as a common cold or flu. If this is the case, it may be accompanied by symptoms of these conditions, such as fever, coughing or a runny nose.

Pharyngitis is usually caused by the viruses that also cause a common cold or flu. In rare cases, the condition can be caused by bacteria. It is difficult to determine whether a case of pharyngitis has a viral or bacterial cause, since the symptoms are similar. 3 Smoking, vaping and exposure to airborne irritants can also cause a sore throat.

Viral conditions that can lead to pharyngitis include:

• Flu
• Common cold (adenovirus infection)
• Measles
• Chickenpox
• Mononucleosis (mono, caused by the Epstein-Barr virus)
• Croup (a childhood illness)
• Herpes simplex infection
• Enterovirus infection

The viruses that cause the condition are contagious, normally spread by discharge from the nose or mouth. A virus can also survive on objects or clothing and be spread in this way.

A sore, scratchy throat is a major symptom of mononucleosis, also known as mono or glandular fever, which is caused by the Epstein-Barr virus. Mononucleosis of this kind is most common among teenagers and younger adults. Other symptoms include: 4 1

• Severe fatigue
• Appetite loss
• Fever
• Muscle pain
• Swollen lymph nodes

Some people may also develop a rash. Tonsillitis can often occur in mononucleosis.

In acute HIV infection, pharyngitis is a common symptom. The symptoms of pharyngitis associated with HIV infection are the same as those of mononucleosis-related pharyngitis (see above), and also often present with tonsillitis. Symptoms that may occur in people affected by pharyngitis accompanying HIV infection are: 4

• Fever
• Sweats
• Malaise and lethargy
• Lack of appetite
• Swollen lymph glands.

A number of bacterial infections can also cause pharyngitis, most commonly Streptococcal bacteria, otherwise known as Group A streptococcus. In these cases, the condition is known as strep throat. Other bacteria that far less frequently cause pharyngitis include: 1

• Neisseria gonorrhoeae
• Corynebacterium
• Chlamydia pneumoniae
• Mycoplasma pneumoniae
• Group C, G or F Streptococcus

Group A streptococcus is the most common cause of tonsillitis (15-30% of cases).

Good to know: Group B streptococcus is not usually associated with strep throat or other upper respiratory tract infections. However, group B strep can cause pharyngitis, with tonsillitis and swollen lymph glands in the neck.

Strep throat is typically spread through person-to-person contact, commonly through bacteria in saliva or nasal discharge. Symptoms and signs of strep throat include: 5

• A sore throat and pain when swallowing which is more severe than with a normal sore throat.
• Fever, weakness and headache.
• Nausea, vomiting and abdominal pain, especially in children.
• White or grey patches visible on the back of the throat.
• Swollen, sore glands in the neck (lymph nodes).
• A widespread red rash.

If the strep throat symptoms occur after several days of coughing and a runny nose, it’s more likely that they are the result of a viral infection rather than Group A streptococcus. 3

Read more about COVID-19 vs. strep throat symptoms >>

If you’re concerned that you may have strep throat or tonsillitis rather than pharyngitis, you can do a free Ada symptom assessment now.

A doctor will usually diagnose the condition through a physical examination that may include:

• A close look at the throat, ears and nasal passageway
• Checking for swollen glands
• Listening to a person’s breathing using a stethoscope

If bacterial pharyngitis is suspected, a doctor may also take a swab from the throat and have it tested for the presence of bacteria.

Pharyngitis is a common symptom in tonsillitis, so much so that the condition is sometimes known as tonsillopharyngitis. Tonsillitis is a condition in which the tonsils in the throat become inflamed. It can be caused by viruses, such as the Epstein-Barr virus, or bacteria, such as Group A beta-hemolytic streptococcus or Staphylococcus aureus. Most cases of acute tonsillitis are viral, but chronic or recurring tonsillitis is usually bacterial in origin. 6

The symptoms of bacterial tonsillitis usually develop suddenly. They include: 6

• A red and swollen throat that is painful
• Fever
• Difficulty swallowing or painful swallowing
• Foul breath
• Painful lymph nodes in the neck

In viral tonsillitis, the affected person may also have:

• A headache
• An earache
• Nasal congestion or stuffiness
• A cough

Very swollen tonsils may cause airway obstruction. The symptoms of airway obstruction include: 6

• Breathing through the mouth
• Snoring
• Disordered breathing during sleep
• Lethargy and a general feeling of unwellness

If the affected person has difficulty opening their mouth, or their voice takes on a muffled quality as if they are speaking with a hot potato in their mouth, they may have peritonsillar abscess. This is an abscess around the region of the tonsils, and is a medical emergency, because it can cause sepsis and airway obstruction.

For more information on the symptoms and treatment of this painful throat condition, see this resource on tonsillitis. If you’re concerned that you may have strep throat or tonsillitis rather than pharyngitis, why not do a free Ada symptom assessment now?

Laryngitis is a condition where the larynx, or voice box, becomes inflamed due to overuse or a viral infection. The most common cause is a viral infection of the upper respiratory tract; bacterial laryngitis is rare. 7 It is often found in conjunction with a sore throat, or pharyngitis.

Coughing is linked to laryngitis, and therefore it often occurs in conjunction with diseases such as bronchitis, pneumonia, influenza, measles, whooping cough or diphtheria.

Symptoms of laryngitis include: 7

• Hoarseness or other changes in voice
• Tickling sensations in the throat
• A raw throat
• An urge to clear the throat

If a severe viral infection is present, the affected person may also have: 7

• Fever
• Malaise
• Difficulty swallowing
• Sore throat.

In some cases, a sore throat and voice changes might be caused by laryngeal cancer. This cancer is, however, quite rare. Important risk factors include smoking and excessive alcohol consumption. Human papillomavirus infection and gastroesophageal reflux disease can also increase a person’s risk of laryngeal cancer.

Most cases of pharyngitis will go away without treatment in a week or less. Antibiotics are not helpful in cases of pharyngitis caused by viral infections, and are only used in cases where a bacterial infection is lingering. Most treatment for pharyngitis can be carried out at home, using over-the-counter products.

There are a number of ways to help manage the symptoms of the condition: 8

• Drinking plenty of fluids is key to avoiding dehydration, which can make the symptoms of pharyngitis worse.
• Taking over the counter painkillers, such as ibuprofen or paracetamol, is a good way of managing pain, headaches and fever. These medicines should be taken according to the instructions on the packet.
• Lozenges can be useful in easing pain.
• Other over-the-counter products, such as anesthetic sprays, which can be bought from pharmacies and stores, can also help alleviate certain symptoms.

Antibiotics are ineffective against viral pharyngitis, though, they may be prescribed for those with a bacterial infection.

Doctors are often reluctant to prescribe antibiotics for bacterial pharyngitis due to the fact that they are not always effective and may cause side-effects. To decide if an individual should be prescribed antibiotics, doctors will sometimes use a test known as the Centor score. They will look for: 8

• Pus on the tonsils
• Painful or tender glands on the neck
• The absence of a cough
• Fever

If three or more of these features are present, a doctor will often prescribe a delayed prescription, whereby antibiotics will be prescribed for two or three days in the future, to be used if symptoms have not disappeared or have gotten worse.

Pharyngitis is contagious, meaning there are a number of ways to reduce the risk of contracting the condition. These include: 1

• Avoiding sharing utensils, food and drink
• Avoiding contact with people experiencing the condition
• Thorough and frequent washing of the hands, especially after coughing or sneezing and before eating

In the vast majority of cases, pharyngitis is a relatively harmless condition that will clear quickly without complications. Very rarely, however, the condition can progress and cause complications. It can also be a warning sign for a range of more serious conditions. 8

Possible complications include the infection spreading from the throat to nearby locations, causing, for example, an ear infection, sinus infection or less frequently pneumonia. However, this is unlikely to happen if the pharyngitis is appropriately managed. If symptoms persist or are particularly severe, a doctor’s diagnosis should be sought.

• Acute throat infection

Q: What is the difference between pharyngitis and laryngitis?
A: Pharyngitis is an inflammation of the pharynx, whereas laryngitis is an inflammation of the larynx, or the voice box. The main symptom of laryngitis is hoarseness or complete loss of the voice. Usually, treatment for both conditions is similar. 9

Q: What is the difference between pharyngitis and tonsillitis?
A: Pharyngitis is an inflammation of the pharynx, whereas tonsillitis is an inflammation of the tonsils, a pair of tissue masses at the rear of the throat. Symptoms of tonsillitis include soreness in the lower throat and hoarseness of the voice. 10 Pharyngitis and tonsillitis can occur at the same time – when this occurs, the condition is referred to as pharyngotonsillitis. 11

Q: What is strep throat?
A: Strep throat is a bacterial sore throat caused by Streptococcal bacteria, otherwise known as group A streptococcus. The pain and difficulty swallowing experienced as a result of strep throat are typically more severe than in cases of a viral sore throat. Moreover, symptoms not associated with a viral sore throat may also be experienced. These include:

• Fever, weakness and headache.
• White or grey patches visible on the back of the throat.
• Swollen, sore glands in the neck (lymph nodes).
• A widespread red rash.
• Nausea, vomiting and abdominal pain.

Feeling unwell? Get a free symptom assessment with the Ada app.