Dr Cathy Stephenson
Winter is a time when GP surgeries and after-hours clinics are full of coughs, colds and sore throats. In recent years, a lot of time and resource has been spent encouraging people to stay at home, and treat their symptoms themselves, in a very appropriate attempt to reduce the burden on a very stretched health service, but also the over-prescribing of antibiotics for what is usually a viral illness. However, this advice does create something of a conundrum when it comes to sore throats.
Most sore throats are still viral in origin – in fact we think about 90 per cent of adult sore throats and 60-80 per cent of childhood ones are caused by one of the common cold viruses.
The remainder however can be bacterial, and can cause significant problems in some individuals. So how do you tell if your sore throat is something worth worrying about, and if it is, what should you do?
Firstly, it depends on your general health and any previous illnesses you may have had. If you are ‘‘frail’’ for any reason, either because of advanced age or poor health, have a medical condition or you’re on medication that compromises your immune system, you need to take any infection more seriously and seek medical advice.
This includes very young infants, as well as people with conditions such as diabetes, cancer, heart disease or who are on immune-suppressing medications.
Anyone who has ever had rheumatic fever, or lives in a household where someone else has been affected, should also book an appointment to be seen by a doctor or nurse.
They will do a swab of your throat, looking for the bacteria streptococcus. This bacteria, known as GABS, is responsible for most bacterial throat infections, including tonsillitis, and in some cases can lead to rheumatic fever and damage to the heart valves if left untreated.
The risk of rheumatic fever is higher in areas of increased deprivation, overcrowded living conditions, Ma¯ ori and Pacifica peoples, and those in the 3-35 year age range. If you fall into two or more of those ‘‘at risk’’ groups and have a sore throat, go to your doctor so a swab can be taken and antibiotics started if needed.
If you don’t fall into any of the categories mentioned above, you need to be guided by how you feel. If you have the classic symptoms of a cold, with a runny nose, dry cough and malaise, the sore throat is very likely to be a part of a viral ‘‘respiratory tract infection’’ and almost certainly doesn’t need any medical input.
However, if you have a high fever, sudden onset of severe sore throat, swollen glands in your neck, headaches and don’t have the other symptoms, it is more likely (though not certain) that you have a bacterial infection or perhaps glandular fever, and should see a doctor to be assessed.
If you feel like having a look in your throat, or your child’s throat, you should do this with a good light, and try to push the tongue down a little with the back of a teaspoon to get a good view. Tonsillitis, strep throat, or glandular fever will usually cause big, red, inflamed tonsils, with ‘‘exudate’’ or white stuff on them – if the tonsils look like that, a visit to the doctor is a good idea.
If there is any history of dribbling or drooling from the mouth, or you can’t swallow, don’t do this – you could have something more serious such as a tonsillar abscess or a rare condition known as epiglottitis.
Both of these need immediate medical attention,