Persistent sore throat: when to worry

A persistent sore throat is a fairly common problem, often caused by viruses, bacteria, allergies, or even environmental irritants. In most cases, it tends to go away on its own within a few days. However, if the sore throat lasts for weeks or comes with other symptoms, it is essential to pay attention and see a doctor. 

When a sore throat lasts a long time, especially if it comes with other warning signs, it is important to be examined to find out what is causing it. Self-medication, particularly the use of antibiotics, is not recommended, because it could delay a correct diagnosis and appropriate treatment. Distinguishing between viral and bacterial infections is crucial in order to follow an effective treatment.

When to worry and see a doctor

• A sore throat that lasts more than a week.
• Difficulty swallowing or breathing.
• High fever (over 38°C).
• Swollen lymph nodes in the neck.
• Blood in saliva or sputum.
• Hoarseness.
• Unexplained weight loss.
• Lumps or masses in the neck.
• Pain that radiates to the ear.

The medical exam for a persistent sore throat

The doctor will perform a physical examination of the throat, neck, and ears. They may also order blood tests, a throat swab, or other diagnostic tests to identify the cause of the sore throat.

Treatment

Treatment of a persistent sore throat depends on the underlying cause. The doctor may prescribe antibiotics for bacterial infections, medications for acid reflux, antihistamines for allergies, or other specific treatments, and may give some useful advice, such as getting adequate rest, drinking plenty of fluids, gargling with warm salt water, using humidifiers to keep the air moist, and, finally, avoiding cigarette smoke and polluted environments.

All the causes of a persistent sore throat

Bacterial infections

• Group A beta-hemolytic streptococcus (Streptococcus pyogenes) 

One of the most common causes of bacterial pharyngitis, especially in children. Symptoms include an intense sore throat, difficulty swallowing, high fever, red and swollen tonsils with white or yellowish patches, and swollen lymph nodes in the neck. If left untreated, this condition can lead to serious complications such as rheumatic fever or glomerulonephritis. Diagnosis is made with a throat swab, while treatment involves the use of antibiotics.

• Other bacteria 

Infections such as Mycoplasma pneumoniae and Chlamydia pneumoniae can cause pharyngitis with a persistent sore throat, often accompanied by a dry cough. Neisseria gonorrhoeae infections can also lead to pharyngitis, particularly in sexually active people.

Viral infections

Turning to viral infections, infectious mononucleosis, caused by the Epstein-Barr virus (EBV), causes a prolonged sore throat, often associated with fever, fatigue, swollen lymph nodes (especially in the neck), and an enlarged spleen and liver. This condition can last several weeks, and diagnosis is made through blood tests.

HIV infection

Another virus to consider is HIV (human immunodeficiency virus), where a persistent sore throat can be one of the first symptoms of the infection, along with fever, fatigue, night sweats, and swollen lymph nodes. In the advanced stages of the infection, the sore throat can result from opportunistic infections, and diagnosis is made with specific HIV tests.

• Other viruses

Finally, other viruses such as rhinovirus, adenovirus, the influenza virus, and parainfluenza can cause a sore throat, often accompanied by a cold, cough, and other respiratory symptoms. The herpes simplex virus can also cause painful lesions in the throat.

Gastroesophageal reflux (GERD) 

Gastroesophageal reflux, also known as GERD, is a condition in which stomach acid flows back up into the esophagus, causing irritation and inflammation. Although the most common symptoms of GERD include heartburn and acid regurgitation, there are also less typical manifestations, such as a chronic sore throat. When the acid rises, it can reach the pharynx and larynx, irritating and damaging the delicate lining of these areas. Continued exposure to acid can cause chronic inflammation of the throat, leading to a persistent sore throat, hoarseness, and a cough that does not go away. In some cases, reflux can cause a specific inflammation of the larynx and pharynx, known as laryngopharyngeal reflux.

Here are some symptoms of a sore throat related to gastroesophageal reflux:

• Chronic sore throat, often described as a burning or irritated feeling.
• Hoarseness or changes in the voice.
• Persistent cough, especially at night.
• Feeling of a lump in the throat.
• Needing to clear the throat frequently.
• Difficulty swallowing.

Allergies

When an allergic person comes into contact with an allergen, such as pollen, dust, or pet dander, their immune system overreacts. This reaction leads to the release of histamine and other inflammatory chemicals. Histamine is responsible for the swelling and irritation of the mucous membranes, including those of the throat. If the inflammation becomes chronic, it can cause a persistent sore throat, hoarseness, and cough. In addition, the excess mucus produced because of the allergy can drip down the back of the throat, causing irritation. This phenomenon is known as postnasal drip.

Common allergens and symptoms

• Pollen. This allergen causes seasonal allergic rhinitis, with symptoms such as sneezing, a runny nose, itchy eyes, and a sore throat. Often, the sore throat is caused by postnasal drip.
• Dust mites. These tiny insects, commonly found in homes, can cause allergy symptoms all year round. Symptoms include nasal congestion, cough, and a chronic sore throat.
• Pet fur. The fur and saliva of pets can trigger allergic reactions. Symptoms can range from mild irritation to severe breathing difficulties.
• Mold. Mold spores, both outdoors and indoors, can trigger allergic reactions. Symptoms can include cough, sore throat, and nasal congestion.

Environmental factors

Environmental factors can play a key role in a sore throat that persists. This happens because prolonged exposure to environmental irritants can damage the delicate mucous membranes of the throat, making them more vulnerable to inflammation. When these membranes are damaged, their barrier function is compromised, allowing pathogens and allergens to enter more easily. Continuous irritation can lead to chronic inflammation of the throat, which results in a persistent sore throat, hoarseness, and cough. Moreover, chronic inflammation can cause an enlargement of the mucous glands, with greater mucus production. Among the most common environmental irritants are dry air, cigarette smoke (including secondhand smoke), air pollution, overuse of the voice, and exposure to irritating chemicals.

The rare cases in which there is a tumor

Although a sore throat that lasts a long time is rarely a sign of cancer, it is important not to overlook this possibility, especially if there are other risk factors or associated symptoms. 

Laryngeal cancer forms in the larynx, the organ that houses the vocal cords. The most common symptoms include persistent hoarseness, changes in the voice, difficulty swallowing, throat pain that can radiate to the ear, chronic cough, and the feeling of having a lump in the throat.

On the other hand, throat cancer (which includes the oropharynx and hypopharynx) develops in the back of the mouth, in the tonsils, at the base of the tongue, or in the lower part of the throat. Symptoms can include a persistent sore throat, difficulty swallowing, ear pain, lumps in the neck, changes in the voice, and unexplained weight loss.

In addition, if cancer affects the esophagus, the tube that connects the throat to the stomach, difficulty swallowing (dysphagia), chest pain, weight loss, hoarseness, and chronic cough can occur.

The main risk factors include cigarette smoking, excessive alcohol consumption, HPV (human papillomavirus) infection, chronic gastroesophageal reflux (GERD), exposure to chemicals, age, and family history.

When to suspect cancer

• A persistent sore throat that does not improve with conventional treatments.
• A sore throat accompanied by persistent hoarseness or changes in the voice.
• Difficulty swallowing that gets worse over time.
• Lumps or masses in the neck.
• Unexplained weight loss.
• Blood in saliva or sputum.
• Persistent ear pain.

Diagnosis

• Laryngoscopy. It allows the larynx and throat to be viewed.
• Biopsy. Removal of a tissue sample for examination under a microscope.
• Imaging tests. CT scan or MRI, to assess the extent of the tumor. They can be performed at the facilities of the group Nefrocenter with state-of-the-art equipment that ensures accurate results.