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1. Viral pharyngitis
Most cases of sore throat are self limiting viral infections.
Presentation:
sore throat, mild pyrexia, often associated with upper tract infections, usually improves after 48 hours.
Management:
simple analgesia and rehydration

2. Bacterial pharyngitis
More prolonged than viral infections.
Presentation:
sore throat, pyrexia, systemically unwell
Management:
- Antibiotics = streptococcal infections are the commonest cause. Although most respond to penicillin there is an increasing incidence of streptococcal resistance. Antibiotics with B-lactamase inhibitor properties are a suitable alternative.
- Analgesia

3. Tonsillitis
Presentation:
severe pain on swallowing, fever, toxic
Aetiology:
Streptococcus pogenes, Staphylococcus aureus, Haemophilus influenzae
Management:
- Oral broad spectrum antibiotics may be effective, but in the event that there is no improvement then intravenous antibiotics are required.
- Rehydration
- Analgesia

4. Glandular fever
There is often confusion with patients who present with infectious mononucleosis. These patients often have a whitish grey exudates over their tonsils and a Monospot test is necessary to confirm the diagnosis. If the diagnosis is confirmed then abdominal examination and liver function tests are performed to exclude any hepatic or splenic involvement. Recovery in these patients can be prolonged. The are treated with antibiotics as in tonsillitis with the rationale that there may be a secondary infection.
(Note: ampicillin + glandular fever = rash. This may also occur with amoxicillin but it is unusual). Those patients, in whom recovery is prolonged, may be prescribed steroids which usually results in a dramatic improvement.

5. Peritonsillar abscess (Quinsy)
Presentation:
If the pain is more localised to one side and examination demonstrates displacement of that tonsil to the midline, then the diagnosis is likely to be a peritonsillar abscess or quinsy. These patients also have a muffled ‘hot potato’ voice.
Management:
Intravenous antibiotics with or without drainage of the abscess. Drainage may be performed by incision or needle aspiration. Broad spectrum antibiotics with anaerobic cover is usually necessary.

Patients who have had two quinsy’s will almost certainly develop another one at some stage and therefore tonsillectomy is indicated.

Note
Epiglottitis in an adult also presents with a sore throat and this should not be missed. These patients also find it painful to speak and often have a hoarse voice. The sore throat is more localised to the laryngeal area and the tonsils do not appear inflamed. Nasendoscopy will demonstrate oedema and inflammation of the epiglottis and supraglottic structures.