Acute pharyngitis

Last reviewed: 28 Aug 2022
Last updated: 29 Jun 2022

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, and cough (in viral infection)
  • sore throat
  • pharyngeal exudate
  • cervical adenopathy
  • fever
  • headache
  • nausea, vomiting, and abdominal pain
  • conjunctivitis (in measles)
  • maculopapular rash (in measles)
  • Koplik spots (in measles)
  • scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)
More key diagnostic factors

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)
Other diagnostic factors

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
  • irradiation
More risk factors

Diagnostic investigations

1st investigations to order

  • rapid antigen test for group A Streptococcus (GAS)
  • nucleic acid amplification (via polymerase chain reaction) for group A Streptococcus (GAS)
More 1st investigations to order

Investigations to consider

  • culture of throat swab for group A Streptococcus (GAS)
  • culture of throat swab for gonococcus or chlamydia
  • serum monospot for Epstein-Barr virus infection
More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Jeffrey R. Donowitz, MD

Pediatrician

Pediatric Infectious Diseases

Children’s Hospital of Richmond

Virginia Commonwealth University

Richmond

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

    • Sexually transmitted infections treatment guidelines, 2021: gonococcal infections
    • Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
    More Guidelines
  • Patient leaflets

    Sore throat

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

Use of this content is subject to our disclaimer