Severe sore throat no fever
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Severe Sore Throat Without Fever: Causes and Management
Common Causes of Severe Sore Throat Without Fever
Viral Pharyngitis
One of the most common causes of a severe sore throat without fever is viral pharyngitis. This condition often presents with symptoms such as throat soreness, mild erythema, and tenderness of the anterior neck, but without the presence of fever1. Viral infections typically resolve on their own and do not require antibiotic treatment.
Bacterial Infections
While bacterial infections like streptococcal pharyngitis often present with fever, there are cases where a sore throat can be severe without accompanying fever. For instance, a clinical diagnosis of streptococcal pharyngitis can sometimes be made based on symptoms alone, even if fever is not present2. Rapid antigen detection tests (RADTs) and clinical scoring systems like FeverPAIN can help in diagnosing and managing such cases5.
Diagnostic Approaches
Clinical Scoring and Rapid Tests
Clinical scoring systems such as FeverPAIN, which consider factors like recent fever, purulence, rapid attendance, inflamed tonsils, and absence of cough, can be effective in diagnosing streptococcal infections and guiding antibiotic use5. Rapid antigen detection tests (RADTs) can further confirm the presence of group A streptococcus, aiding in targeted antibiotic therapy5.
Treatment Options
Antibiotics
Antibiotics are commonly prescribed for bacterial sore throats, even though the absolute benefits are modest. They can reduce the duration of symptoms and prevent complications such as acute otitis media, sinusitis, and quinsy4 7 8. However, the necessity of antibiotics should be carefully evaluated, especially in high-income countries where the risk of complications is lower4 7 8.
Symptomatic Relief
For viral pharyngitis and other non-bacterial causes, symptomatic relief is the primary treatment approach. Over-the-counter pain relievers, throat lozenges, and adequate hydration can help alleviate symptoms. In some cases, steroids may be used for severe symptoms, although their efficacy and safety are not well-established10.
Conclusion
A severe sore throat without fever can be caused by various factors, including viral and bacterial infections. Accurate diagnosis using clinical scoring systems and rapid tests is crucial for effective management. While antibiotics can be beneficial in bacterial cases, their use should be judicious to avoid unnecessary treatment. Symptomatic relief remains the cornerstone of managing viral pharyngitis and other non-bacterial causes.
Sources and full results
Most relevant research papers on this topic
A Case of Sore Throat and Fever
A previously healthy 41-year-old man developed a sore throat, headache, fever, and fatigue, but was initially diagnosed with pharyngitis, then consulted for internal medicine after his symptoms worsened.
Case ReportCASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 22-2015. A 20-Year-Old Man with Sore Throat, Fever, Myalgias, and a Pericardial Effusion.
A 20-year-old man with persistent myalgias and fever was initially diagnosed with streptococcal pharyngitis, but later developed a pericardial effusion and needed hospitalization for treatment.
Case Report
Rigorous JournalSore throat in COVID‐19: Comment on “Clinical characteristics of hospitalized patients with SARS‐CoV‐2 infection: A single arm meta‐analysis”
COVID-19 patients often experience fever, cough, muscle soreness, and fatigue, but rarely experience diarrhea, hemoptysis, headache, sore throat, shock, and other rare symptoms.
Meta-AnalysisAntibiotics for sore throat.
Antibiotics provide relative benefits in treating sore throat symptoms, but their absolute benefits are modest.
Very Rigorous Journal
Highly CitedClinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management)
The FeverPAIN clinical score and rapid antigen test effectively reduce symptom severity and antibiotic use in patients aged 3 years with acute sore throat, but not in those with delayed antibiotic prescribing.
RCT
Large Human TrialVery Rigorous JournalWorldwide comparison of treatment guidelines for sore throat
This review reveals that global treatment guidelines for sore throat are generally similar, with some variations in diagnostic and therapeutic approaches.
Systematic ReviewRigorous JournalAntibiotics for sore throat.
Antibiotics can reduce sore throat symptoms by about half and may protect against complications, but their absolute benefits are modest and require treating many patients for one to benefit.
Meta-AnalysisHighly CitedAntibiotics for sore throat.
Antibiotics effectively reduce symptoms of headache, throat soreness, and fever, and may prevent suppurative complications of sore throat.
Highly CitedA persistent sore throat
Secondary syphilis was diagnosed in a 30-year-old man with a persistent sore throat, after having condomless sex with a sex worker three months prior.
Case ReportSteroids for symptom control in infectious mononucleosis.
Steroid treatment for symptom control in glandular fever is insufficiently evidenced and lacks long-term research on side effects and complications.
Meta-AnalysisHighly Cited