GPAtlas🧭 When to suspect
Acute sore throat is among the commonest reasons for a primary care or community-pharmacy consultation. The great majority are self-limiting viral infections that settle within about a week regardless of treatment, and withholding antibiotics rarely leads to complications.
The clinical task is threefold: rationalise antibiotics using a validated score (FeverPAIN or Centor), recognise the few time-critical causes (airway compromise, quinsy, sepsis), and never dismiss a sore throat in a vulnerable patient – especially anyone immunosuppressed or taking carbimazole, propylthiouracil, or a disease-modifying antirheumatic drug (DMARD), in whom it may herald neutropenia.
| Cause / differential | Pointers |
|---|---|
| Viral pharyngitis (commonest) | Coryza, cough, hoarseness; systemically well; low FeverPAIN/Centor. |
| Group A streptococcus (GAS, “strep throat”) | Tonsillar exudate, tender anterior cervical nodes, fever, no cough; higher FeverPAIN/Centor. |
| Scarlet fever | GAS plus a fine sandpaper rash, flushed cheeks with circumoral pallor, and strawberry tongue; notifiable. |
| Glandular fever (Epstein–Barr virus, EBV) | Adolescents/young adults; prolonged (> 1 week), marked posterior cervical nodes, fatigue, ± splenomegaly. |
| Quinsy (peritonsillar abscess) | Severe unilateral pain, trismus, uvular deviation, “hot-potato” voice, drooling. |
| Serious / rare | Epiglottitis/supraglottitis (rapid airway compromise); Lemierre’s syndrome (persistent unilateral symptoms with sepsis). |
Source: NICE NG84
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