Sore throat: causes, home care and when to see a doctor

In short

• Most sore throats are caused by viruses, often with a cold or flu, and get better on their own within about a week.
• Rest, fluids, soft or cool foods, lozenges and over-the-counter pain relievers used as the label directs can ease the pain.
• Strep throat is a bacterial infection that needs a test and a prescription. Cough, runny nose and hoarseness point toward a virus instead.
• Antibiotics do not help viral infections, and using them when they are not needed adds to antibiotic resistance.
• Trouble breathing or swallowing, drooling or a rapidly worsening illness is an emergency.

What causes a sore throat

Sore throat (pharyngitis) is most often caused by a virus, such as the ones behind colds and flu. Other causes include allergies, smoking, tonsillitis, mononucleosis and, less often, bacteria. The best-known bacterial cause is group A strep.

The CDC notes that viruses cause most sore throats at all ages, and group A strep accounts for roughly 20% to 30% of cases in children and 5% to 15% in adults. Strep, tonsillitis and a viral sore throat can be hard to tell apart without a test.

Viral or strep: clues

• Pointing to a virus: cough, runny nose, hoarseness, mouth sores or red, itchy eyes.
• More typical of strep: sudden onset, fever and pain on swallowing, swollen neck glands, and a red, swollen throat or tonsils, sometimes with pus.
• A scarlet-colored rash can signal scarlet fever, which goes with strep.
• Children with strep may also have a stomachache, headache, nausea or vomiting.
• Children under 3 rarely get strep throat.

These are clues, not proof. When cough, runny nose or hoarseness are clearly present, clinicians can often diagnose a viral sore throat from the history and exam. Otherwise a test is the way to tell.

What helps at home

1. Rest and drink plentyFluids keep you hydrated and the throat moist. Cool or soft foods can be easier to swallow.
2. Soothe the throatSucking on lozenges, or on ice or hard sweets for older children and adults, may ease the pain. Gargling with warm salty water can help, but not for children.
3. Use pain relievers carefullyOver-the-counter pain relievers can help. Read the label, check with a pharmacist if you are pregnant or take other medicines, and never give aspirin to a child.
4. Avoid smokeTobacco smoke irritates the throat. If you smoke, a sore throat is another reason to cut back.
5. Watch for changeIf it is not improving after a week, or you are getting worse, get checked.

Throat sprays have little proof of benefit when used alone. Small hard sweets and ice are a choking risk for young children.

Why antibiotics are not the default

Antibiotics are usually not needed for a sore throat, because they rarely ease symptoms or speed recovery when a virus is the cause. They are prescribed when a bacterial infection such as strep throat is likely or confirmed. In strep, treatment shortens symptoms, reduces spread to close contacts and lowers the risk of complications, including rare ones such as rheumatic fever and abscesses around the tonsils.

The WHO identifies misuse and overuse of antibiotics, such as taking them when they are not needed, as one of the main drivers of antimicrobial resistance. If you are prescribed an antibiotic, take it exactly as prescribed, and do not save leftovers or use someone else's.

When to see a doctor, and red flags

Make an appointment with your primary care provider if a sore throat has not improved after a week, if you get them often, if a lump in your mouth or neck or a mouth ulcer lasts more than 3 weeks, or if a child under 5 has a sore throat. Get same-day care if you have a very high temperature or feel hot, cold and shivery, show signs of dehydration such as passing less urine that is dark and strong-smelling, or have a weakened immune system.

Call 911 or go to an emergency room if you or your child has trouble breathing, cannot swallow, is drooling, makes a high-pitched sound when breathing in, or has severe symptoms that are getting worse quickly. Do not drive yourself, and take your medicines with you.

How a doctor checks

Your provider will ask about symptoms and look at the throat, tonsils and neck glands. If strep is possible, a throat swab can be tested with a rapid antigen test, which is quick but can miss some cases, or with a throat culture, which is the standard for confirmation. In children older than 3, a negative rapid test is usually followed by a culture. A positive test confirms strep.

1. Is this likely viral or strep, and do I need a test?
2. What can I use to ease the pain, given my other medicines?
3. How long should I expect it to last?
4. What signs mean I should come back?

Children

Symptoms are similar to those in adults, though a child may also have a high temperature and seem less active. Children under 5 with a sore throat should be seen by a provider. Avoid salt-water gargles for children, avoid hard sweets and ice for young children because of choking, and never use aspirin for a child's sore throat.

Questions and answers

Sources

1. NHS — Sore throat
2. MedlinePlus — Sore Throat
3. CDC — Group A Strep: Clinical guidance for pharyngitis
4. WHO — Antimicrobial resistance

Sources checked on 29 October 2026.