Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. Most often, it's a symptom of another illness - usually a viral infection such as a cold or the flu (influenza). In many cases, it's the first indication that you're getting sick.

• Cold
• flu
• influenza

Sore throats are so common they're one of the main reasons see a doctor. But all those visits may not be necessary. The great majority of sore throats are caused by a virus and usually go away on their own in about a week. Only about 10 percent are bacterial infections that may require medical care.

Most sore throat germs are transmitted through direct contact. Someone who is sick touches a doorknob, phone or other object. You handle the same object, picking up the germs, which are eventually transferred from your hands to your mouth or nose.

Bacterial infections are sometimes treated with antibiotics, although drugs don't always speed healing or prevent infections from recurring. And antibiotics aren't effective against viruses, which respond best to self-care measures such as resting and drinking plenty of fluids. Until you're feeling better, salt-water gargles, throat lozenges or hot water with honey and lemon can help make having a sore throat easier to swallow.

Signs and symptoms

A sore throat usually occurs in combination with other signs and symptoms. These can vary greatly, depending on the type of infection you have. For example, in addition to an itchy or sore throat, a cold is likely to cause:

• Sneezing

• Watery eyes

• Cough

• A low fever — less than 38.8 C

• Nasal congestion

• Slight body aches or mild headache

On the other hand, influenza, which is also caused by a virus, is marked by severe fatigue, body aches, chills, sweats and a fever over 38.8 C.

• Cold

• fatigue

• Headache

• influenza

Mononucleosis is a much longer-lived viral illness associated with a severe sore throat. Although signs and symptoms of the disease typically last about 10 days, it can take weeks to recover your strength after a bout of mono. In addition to a sore throat, the disease may cause:

• Swollen lymph nodes in your neck and armpits

• Swollen tonsils

• Headache

• Skin rash

• Loss of appetite

• Soft, swollen spleen

• Liver inflammation

Other viral illnesses, including measles, chickenpox and croup, also usually occur with a sore throat.

Bacterial infections associated with a sore throat include strep throat, tonsillitis and diphtheria — a serious respiratory illness characterized by a thick, gray covering in your nose, throat or airway that causes breathing difficulties and painful swallowing. Although vaccinations have greatly reduced the number of cases of diphtheria, it remains a potentially life-threatening illness.

• Diphtheria

Even more serious is epiglottitis, an uncommon bacterial infection in which the "lid" just above the voice box (larynx) swells, closing the airway. Epiglottitis is a medical emergency and requires immediate care. In addition to a severe sore throat, signs and symptoms may include:

• Extremely painful and difficult swallowing

• Muffled voice

• Drooling or spitting because of painful swallowing

• Fever

• Stridor — a sound that occurs when your airways are blocked

• Severe pain when the voice box is touched

Causes

Most sore throats are caused by viruses — the same germs that cause colds and flu. A smaller percentage are due to bacterial infections. Both types of sore throats occur throughout the winter, when the incidence of respiratory disease is highest. Strep throat peaks in the fall and spring.

Viruses and bacteria enter your body through your mouth or nose — either because you breathe in particles that are released into the air when someone coughs or sneezes, or because you have hand-to-hand contact with an infected person or use shared objects such as utensils, towels, toys, doorknobs or a telephone. Touch your eyes or nose after such contact and you're likely to become sick yourself. For that reason, hand washing is a key part of prevention.

Still, not all sore throats result from viral or bacterial infections. Other common causes of sore throat include:

• Allergies. The same pet dander, molds and pollens that trigger allergic reactions such as red, swollen eyes and a runny nose can also cause a sore throat.

• Dryness. Dry indoor air, especially in winter when rooms tend to be overheated, can make your throat feel rough and scratchy, particularly in the morning when you first wake up. Breathing through your mouth — often because of chronic nasal congestion — can also cause a dry, sore throat.

• Pollution and other irritants. Outdoor air pollution can cause ongoing throat irritation. But indoor pollution — especially tobacco smoke — is an even greater cause of chronic sore throat. What's more, inhaling secondhand smoke is often just as damaging as smoking itself. Smokeless tobacco, alcohol and spicy foods can also inflame your throat.

• Muscle strain. You can strain muscles in your throat just as you can strain them in your arms or legs. If you've ever gotten a sore throat after yelling at a concert or sporting event, you've likely strained your throat muscles.

• Acid (gastroesophageal) reflux. This occurs when stomach acid backs up into your food pipe (esophagus). Normally, a circular band of muscle (lower esophageal sphincter) blocks acid from coming up into the esophagus. But if the sphincter relaxes abnormally or weakens, stomach acid can back up, irritating your throat as well as your esophagus. In many cases, you can prevent or reduce acid reflux with simple lifestyle changes — losing weight, avoiding foods that cause you discomfort and not eating right before bed, for example. When these aren't effective, over-the-counter or prescription medications may offer some relief.

• HIV infection. HIV-positive people with CD4 cell counts below 500 sometimes develop a chronic sore throat. This isn't due to HIV itself but to a secondary infection such as oral thrush or cytomegalovirus, a common viral infection that can be extremely serious in immunocompromised people.

• Tumors. If you smoke or abuse alcohol, you're at high risk of tumors of the throat, tongue and voice box. In some people these tumors cause few, if any, signs and symptoms. In others, they can lead to hoarseness, difficulty swallowing and sore throat.

• Nicotine dependence

Risk factors

Although anyone can get a sore throat, some factors make you more susceptible to throat problems. These factors include:

• Age. Children and teens are most likely to develop sore throats. Children between ages 5 and 18 may have as many as five sore throats a year whereas adults have less than half that number. Strep throat — the most common bacterial infection associated with a sore throat — also occurs far more frequently in children. Less than one in 10 adult sore throats are strep-related, whereas up to 40 percent of sore throats in children may be caused by strep bacteria.

• Smoking or exposure to secondhand smoke. Tobacco smoke, whether primary or secondary, contains hundreds of toxic chemicals that can irritate the sensitive lining of your throat.

• Allergies. If you have seasonal allergies or ongoing allergic reactions to dust, molds or pet dander, you're more likely to develop a sore throat than people who don't have allergies.

• Exposure to chemical irritants. Particulate matter in the air from the burning of fossil fuels as well as common household chemicals can cause throat irritation. In general, try to avoid biking, walking or jogging on busy roads or exercising outdoors on high-pollution days. At home, use lemon juice and vinegar instead of commercial cleaning products.

• Chronic or frequent sinus infections. Drainage from nose or sinus infections can cause throat infections as well.

• Living or working in close quarters. Viral and bacterial infections spread easily anywhere people gather — childcare centers, classrooms, offices, prisons and military installations.

• Lowered immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include diseases such as HIV and diabetes, treatment with steroids or chemotherapy drugs — even fatigue and poor diet.

• chemotherapy

• fatigue

When to seek medical advice

Although uncomfortable, most sore throats aren't harmful and go away on their own in five to seven days. But sometimes they can signal a more serious condition. See your doctor if you or a child has any of the following:

• A sore throat that is severe or that lasts longer than a week

• Severe difficulty swallowing or breathing

• Excessive drooling in a young child

• A temperature higher than 38.3 C in babies under age 6 months and 39.4 C in older children

• Tender or swollen lymph glands in the neck

• Pus at the back of the throat

• Rash

• Hoarseness that lasts longer than two weeks

• Blood in saliva or phlegm

• Symptoms of dehydration, such as sunken eyes, severe weakness and decreased urine output

• Contact with someone who has been diagnosed with strep throat

• Recurring sore throats

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