A sore throat is one of the most common reasons people see a doctor, and most of the time a virus is behind it. Antibiotics only help when the cause is a bacterium, in practice group A streptococcus. The doctor's job is to tell the two apart and to recognise the few situations where a sore throat needs urgent care.
A virus is the most common cause
A viral throat infection usually comes with a cold: a runny nose, cough, hoarseness and often a mild fever. The pain is at its worst for a couple of days and eases within a week. The throat can look very red, but redness says nothing about the cause. Antibiotics do not shorten a viral infection, and an unnecessary course exposes you to side effects and adds to bacterial resistance.
In teenagers and young adults, a sore throat that drags on with marked tiredness and swollen lymph nodes can point to glandular fever. That too is a viral illness, and antibiotics do nothing for it.
When strep is suspected
These features point to a streptococcal throat infection:
- fever above 38 °C
- white patches or pus on the tonsils
- tender, swollen lymph nodes in the neck
- no cough or runny nose
The more of these are present, the more likely a bacterium is. Even so, the cause cannot be reliably judged from symptoms alone, which is why Finnish Current Care guidelines base antibiotic treatment on a throat sample: a rapid strep test or a culture. If the symptoms clearly point to a virus, no test is needed. In children under three, strep throat is rare.
A rapid test needs a swab from the throat, so it cannot be done in a chat. The doctor can, however, judge whether a test is needed and direct you to have the sample taken. A positive test is treated with a course of penicillin, which shortens the symptoms, reduces infectiousness and prevents complications.
What to tell the doctor
- when the sore throat began and whether it is getting worse or easing
- whether you have a fever and how high it has been
- whether you have a cough, runny nose or hoarseness
- whether you can swallow food and drink normally
- whether your neck is swollen or tender, and whether on both sides or just one
- whether strep has been diagnosed in your family or close circle
- which medicines you take and whether you have drug allergies, especially to penicillin
Self-care
- Pain relief is the most effective help: paracetamol or an anti-inflammatory painkiller as the package leaflet directs.
- Drink enough. Cold or warm drinks, ice cream and lozenges make swallowing easier.
- Rest and stay home while you have a fever.
- Throat sprays and lozenges give momentary relief but do not speed up recovery.
- Wash your hands and cough into your sleeve.
A doctor's assessment is worthwhile if
- the pain is severe, you have a fever and no cough or runny nose at all
- the symptoms last more than a week or get worse after first easing
- the fever returns after a few better days
- tonsillitis keeps coming back several times a year
- you feel clearly unwell
- you are pregnant, or have an illness or medication that weakens your immune system
Go to the emergency department or call 112 immediately if
- breathing is difficult, your breathing is noisy or you cannot lie on your back
- you cannot swallow your saliva or it dribbles from your mouth
- you cannot open your mouth properly or your speech becomes muffled
- there is severe swelling on one side of the throat or neck
- the fever is high and comes with confusion, a stiff neck or spots on the skin that do not fade when pressed
- swelling or redness in the neck is spreading quickly
These can be signs of a throat abscess or inflammation of the epiglottis, which are treated in hospital. Do not start with a remote service.
How Treat can help
In Treat you describe your symptoms in your own words and the service asks the follow-up questions. A licensed doctor usually assesses the situation within minutes during service hours and tells you whether self-care is enough, whether a strep test is needed or whether you should be seen in person. If a sample has already been taken and the result is positive, the doctor can send the treatment straight to the national Prescription Centre (Reseptikeskus), so any pharmacy can dispense it. If needed, the doctor writes a sick leave certificate.
Treat is not an emergency service. In an emergency, call 112.
This article is general health information and does not replace an individual assessment by a doctor.