When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Acute pharyngitis

Last reviewed: 21 Oct 2024
Last updated: 18 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • child or adolescent age
  • winter or spring season (in bacterial pharyngitis)
  • summer/fall season (in enteroviral pharyngitis)
  • rhinorrhea, nasal congestion, hoarseness, oral ulcers, and cough (in viral infection)
  • sore throat
  • pharyngeal exudate
  • cervical adenopathy
  • fever
  • headache
  • nausea, vomiting, and abdominal pain
  • conjunctivitis
  • maculopapular rash (in measles)
  • Koplik spots (in measles)
  • scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)
Full details

Other diagnostic factors

  • sexual activity or abuse (in HIV, gonorrheal, or chlamydial infection)
  • treatment failure of penicillin
  • pharyngeal ulceration (in tularemia)
  • pharyngeal gray membrane (in diphtheria)
Full details

Risk factors

  • nasal colonization with group A Streptococcus (GAS)
  • GAS-infected contact
  • sexual activity or abuse
  • ingestion of nondomestic meats
  • immunocompromised host
  • use of inhaled corticosteroids
  • lack of immunization or vaccine failure
Full details

Diagnostic tests

1st tests to order

  • rapid antigen test for group A Streptococcus (GAS)
  • nucleic acid amplification (via polymerase chain reaction) for group A Streptococcus (GAS)
Full details

Tests to consider

  • culture of throat swab for group A Streptococcus (GAS)
  • culture or PCR of throat swab for gonococcus or chlamydia
  • serum monospot for Epstein-Barr virus infection
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Jeffrey R. Donowitz, MD

Pediatrician

Pediatric Infectious Diseases

University of Virginia

Charlottesville

VA

Disclosures

JRD declares that he has no competing interests.

Acknowledgements

Dr Jeffrey R. Donowitz would like to gratefully acknowledge Dr William A. Petri, Jr, a previous contributor to this topic.

Disclosures

WAP declares that he has no competing interests.

Peer reviewers

Richard Roberts, MD, JD, FAAFP, FCLM

Professor of Family Medicine

University of Wisconsin School of Medicine and Public Health

Madison

WI

Disclosures

RR declares that he has no competing interests.

Remco de Bree, MD, PhD

Otolaryngologist

Head and Neck Surgeon

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

RdB declares that he has no competing interests.

  • Acute pharyngitis images
  • Differentials

    • Epiglottitis
    • Retropharyngeal, peritonsillar, and lateral abscess
    • Infectious mononucleosis
    More Differentials
  • Guidelines

    • Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
    • Pharyngitis (strep throat)
    More Guidelines
  • Patient information

    Sore throat

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer