Table of Contents
Overview – Pharyngitis
Pharyngitis refers to inflammation of the oropharynx, most commonly presenting as a sore throat. It is a frequent cause of primary care consultations, particularly in children and young adults. The majority of cases are viral and self-limiting, but bacterial causes such as Group A Streptococcus (GABHS) are clinically significant due to their potential for serious complications, including rheumatic fever and glomerulonephritis. This page outlines the key aetiologies, clinical features, complications, investigations, and management strategies relevant to both general practice and hospital settings.
Definition
Pharyngitis is defined as inflammation of the oropharynx without tonsillar involvement.
Aetiology
Viral Causes (40–60%)
- Adenovirus
- Coxsackie virus
- Herpes Simplex Virus (HSV)
- Epstein–Barr Virus (EBV)
- Influenza virus (Orthomyxovirus)
Bacterial Causes
- Group A β-haemolytic Streptococcus (GABHS)
- Neisseria gonorrhoea
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Corynebacterium diphtheriae
Morphology
- Red, inflamed oropharyngeal mucosa
- May display white lesions or purulent exudate
Clinical Features
Viral Pharyngitis
- Coryzal symptoms: cough, rhinorrhoea
- Mild to moderate sore throat
- May include conjunctivitis or diarrhoea
Bacterial Pharyngitis (GABHS)
- Sudden onset sore throat
- Fever
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy
- Absence of cough
- More common in children <15 years
EBV Pharyngitis (Infectious Mononucleosis)
- Prominent fatigue
- Generalised lymphadenopathy
- Maculopapular rash
- Sore throat resistant to standard therapy
Complications
- Rheumatic fever – Post-GABHS; affects heart, joints, and skin
- Glomerulonephritis – Immune-mediated renal involvement
- Meningitis – Rare but serious bacterial progression
Investigations
For GABHS Suspicion
- Rapid streptococcal antigen detection test (RADT)
- Throat swab culture (gold standard but time-consuming)
- Anti-streptolysin O titres (ASOT) – supports recent infection
For Suspected EBV
- Monospot test (heterophile antibody)
- Full blood count – shows atypical lymphocytes
- EBV serology (VCA-IgM, EBNA)
Management
General Supportive Measures
- Analgesia: Paracetamol or NSAIDs
- Ensure hydration
- Decongestants (e.g., phenylephrine) if needed
If Bacterial (GABHS)
- First-line: Penicillin V or G for 10 days
- If allergic: Erythromycin or Azithromycin
If EBV (Mononucleosis)
- Avoid penicillin (may cause a characteristic rash)
- Rest and supportive care
- Advise against contact sports if splenomegaly present
Differential Diagnosis
- Acute tonsillitis
- Viral tonsillitis
- Diphtheria (pseudomembrane and airway risk)
- Peritonsillar abscess (quinsy)
Summary – Pharyngitis
Pharyngitis is a common condition primarily caused by viral pathogens, but bacterial forms—especially GABHS—require careful diagnosis to prevent complications like rheumatic fever or glomerulonephritis. EBV should be considered in adolescents with fatigue and diffuse lymphadenopathy. Management is mainly supportive, with targeted antibiotics indicated only in confirmed bacterial cases. For a broader context on related illnesses, visit our Respiratory Overview page.