October 23, 2017

Sometimes, you can let a sore throat run its course, but here’s when to get it checked out.


A sore throat can be a mild condition to let run its course or the sign of a bigger problem. James Mosley, M.D., of the Vanderbilt Health Walk-In Clinic in Belle Meade answers questions about when to seek medical attention and what form sore throat treatment can take.

Question: When should someone go to a walk-in clinic for a sore throat?
Answer: That depends on the severity. If it’s just a minor irritation, then usually you can just let that run its course. If you have severe pain, difficulty swallowing, difficulty breathing or swollen lymph nodes, or if you see white patches in your throat or swollen tonsils, that’s usually a sign that you should be seen by a medical professional. If you have a fever of about 100.4 or higher, you should be seen. That’s a good sign that it could potentially be a strep infection. Also, if you notice any ear pain, rash, swollen joints, severe headaches or nausea, those are sometimes signs of strep.

Question: How long should you let a sore throat go on before you see a doctor?
Answer: Again, if it’s just minor mild soreness, you can let it go a week. If it goes beyond a week, then you should be seen in a clinic. If you have severe pain and especially difficulty swallowing or talking, then you should go right away. Or if you have the high fevers, any other symptoms mentioned above, go right away. A cough and runny nose are generally not associated with strep. That’s usually more of a sign of a head cold or potentially allergies, which are common this time of the year. But if you have those other symptoms I mentioned, then you should be seen.

Question: How common is strep? Are sore throats that last longer than seven days usually a sign of strep?
Answer: A lot of that depends on the age. Younger people — especially children over the age of 3, teenagers and young adults — are more prone to having strep infections than people over the age of 45. It’s just much less common in that age group. A lot of it depends also on exposure to people who have had strep. If you’ve been around somebody who has strep, then that increases your risk that you may have that. Also, some of it depends on your underlying health problems. People with underlying immune deficiency problems, diabetes, heart disease, asthma or lung problems may be a little more prone to getting infections. It would be more of a concern that you be checked sooner rather than later.

Question: What about over-the-counter treatments, at-home sore throat remedies? If you have a sore throat that you’re letting run its course, what can you do to get sore throat relief?
Answer: If you’re trying to soothe a sore throat, I recommend using either ibuprofen or Aleve since they have anti-inflammatory effects. They’re more likely to be help a sore throat than Tylenol. Ice chips, popsicles and cold liquids seem to help sometimes. Resting your voice helps, as do throat spray, lozenges or cough drops. In general, stay well hydrated and get plenty of rest.

Question: If you do come to a walk-in clinic and you have a sore throat, what is the treatment generally going to be?
Answer: We do a thorough history and exam. Based on the history, if the patient doesn’t have swollen lymph nodes, swollen tonsils, fever or a cough, then it’s much less likely to be strep. We may not do any testing other than just a good physical exam. If the patient does have swollen glands in the throat, tonsils, swollen glands in the neck or a fever above 100.4, then we’re going to be more inclined to recommend a quick strep test on the spot. The test of secretions from the throat takes about eight to 10 minutes and is about 96 percent accurate. If we still have some question after looking in the throat, getting the history and getting back a negative strep test, then we will send off a second swab for a culture. That takes about 48 hours. That’s really the gold standard to tell us for sure whether somebody has strep or not. We can also do testing for mononucleosis and blood work to check for elevated white blood cell count.

Question: Is there anything else you think people should know related to sore throats?
Answer: If somebody has a change in voice — especially if he sounds like she’s talking with something in his mouth — that can sometimes be a sign of what we call a peritonsillar abscess. That’s more of an emergent issue. We can usually see that easily here in the office, but it’s not something we would treat here. We would refer them on to an ear, nose and throat specialist or send the patient to the emergency room. Also, if someone is drooling from the mouth, that can indicate epiglottitis, which occurs when the tissue that protects the windpipe becomes inflamed. That can be a severe throat issue, and we send those people to the emergency room. Mono is fairly common. We see that sometimes concurrently with strep. The flu also can give you a sore throat. We can do flu testing here, as well.

There are other things that can potentially be signs of a serious problem that we may pick up on during an exam that you wouldn’t necessarily be able to tell just over the telephone. In recent years, we’ve found that teens and young adults may be prone to an unusual bacteria called fusobacterium necrophorum — big words for a potentially serious infection. Unfortunately, there’s not a really good test for that; it’s really hard to culture. A fairly large recent study found that a lot of young adults and college-age students have this. The hard part is you just can’t tell for sure without examining the patient, but the good news is that it’s something that is easily treated with antibiotics.

Question: So it’s just important to come in?
Answer: Come in to be seen if there’s any question whatsoever.

Vanderbilt Health operates a variety of walk-in clinics in Middle Tennessee, including some with Williamson Medical Center, to take care of everything from sprains and sport injuries to flu shots, fevers, coughs and rashes. Search locations and learn more about the conditions treated there.