Persistent sore throat
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Persistent Sore Throat: Causes, Diagnosis, and Treatment
Common Causes of Persistent Sore Throat
A persistent sore throat can be caused by a variety of factors, ranging from infections to more serious conditions. The most common causes include viral and bacterial infections, allergies, and sinus infections 23. Viral infections, such as those caused by the common cold or flu, typically resolve on their own, while bacterial infections, like those caused by group A streptococcus, may require antibiotic treatment to prevent complications such as rheumatic fever 23.
Uncommon and Serious Causes
Secondary Syphilis
In some cases, a persistent sore throat may be indicative of secondary syphilis. This was observed in a man who had a sore throat for two months, accompanied by fever and enlarged cervical lymph nodes. Positive results from Treponema pallidum haemagglutination and rapid plasma reagin tests confirmed the diagnosis .
Laryngeal Cancer
Persistent sore throat can also be a warning sign for laryngeal cancer, especially when combined with other symptoms such as hoarseness or difficulty swallowing. A UK study highlighted the importance of considering laryngeal cancer in patients with chronic sore throat symptoms .
Lemierre's Syndrome
Lemierre's syndrome, a rare but serious condition, can present with a persistent sore throat. It is characterized by a severe sore throat, septicaemia, multiple abscesses, and jugular vein thrombosis, often caused by Fusobacterium necrophorum 67. This condition underscores the need for thorough investigation when a sore throat does not improve with standard treatment.
Diagnostic Approaches
Thorough History and Physical Examination
A detailed history and physical examination are crucial for diagnosing the cause of a persistent sore throat. Routine testing may include pharyngeal cultures and rapid streptococcal antigen testing, especially in severe cases . For chronic cases, additional tests such as biopsies, blood cultures, and imaging studies may be necessary to rule out more serious conditions 157.
Eosinophilic Oesophagitis
Eosinophilic oesophagitis (EO) is another potential cause of chronic sore throat. This condition may require serial oesophageal biopsies and food allergy testing for diagnosis. EO can lead to oesophageal stricturing if left untreated .
Treatment Options
Antibiotics and Antiviral Medications
For bacterial infections, antibiotics such as penicillin are commonly prescribed. In cases of viral infections, treatment is usually supportive, focusing on symptom relief 23.
Proton Pump Inhibitors
Persistent throat symptoms may sometimes be related to gastro-oesophageal reflux disease (GORD). Proton pump inhibitors (PPIs) are often prescribed to manage these symptoms, although their effectiveness remains a topic of debate .
Specialized Treatments
In cases of secondary syphilis, appropriate antibiotic therapy is essential. For conditions like Lemierre's syndrome, aggressive treatment with antibiotics and possibly surgical intervention may be required 17.
Conclusion
A persistent sore throat can be a symptom of various underlying conditions, ranging from common infections to serious diseases like laryngeal cancer and Lemierre's syndrome. Accurate diagnosis through thorough history-taking, physical examination, and appropriate testing is essential for effective treatment. Awareness of less common causes, such as secondary syphilis and eosinophilic oesophagitis, can aid in timely and accurate diagnosis, ensuring better patient outcomes.
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