Acute pharyngitis

Last reviewed: 2 Sep 2023
Last updated: 02 Aug 2023



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


all patients



Jeffrey R. Donowitz, MD


Pediatric Infectious Diseases

Children’s Hospital of Richmond

Virginia Commonwealth University




JRD declares that he has no competing interests.


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


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




RR declares that he has no competing interests.

Remco de Bree, MD, PhD


Head and Neck Surgeon

VU University Medical Center


The Netherlands


RdB declares that he has no competing interests.

  • Acute pharyngitis images
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  • Guidelines

    • Pharyngitis (strep throat)
    • Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
    More Guidelines
  • Patient leaflets

    Sore throat

    More Patient leaflets
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