Most sore throats are viral and settle within a week. A small proportion are bacterial (such as streptococcal infection) and benefit from antibiotic treatment. A few are something else that needs different management. Private same-day assessment with throat swab takes the guesswork out and lets us treat the right thing.
Educational information — not a substitute for clinical assessment
This page describes sore throat in general terms to help you decide whether assessment may be helpful. It is not a diagnostic tool. If you recognise yourself in what follows, please book a consultation.
Sore throat (pharyngitis) has many causes, but the picture is usually one of these:
By far the most common cause — around 80–85% of sore throats. Common viruses include rhinovirus (common cold), adenovirus, influenza, COVID-19, parainfluenza, enterovirus, and Epstein-Barr virus (glandular fever). Viral sore throats don’t benefit from antibiotics — they need symptomatic relief and time.
Around 5–15% of sore throats are bacterial, most commonly Group A Streptococcus ("strep throat"). Bacterial throat infections benefit from antibiotic treatment to reduce duration, prevent complications, and reduce transmission. Distinguishing bacterial from viral on clinical examination alone isn’t perfectly reliable, which is why we use a structured scoring system (FeverPAIN or Centor) and may use a throat swab.
Caused by Epstein-Barr virus. Particularly common in teenagers and young adults. Causes severe, prolonged sore throat with tonsil enlargement, fever, swollen lymph nodes, and profound fatigue. Often misdiagnosed initially as bacterial. Blood test confirms.
Two validated scoring systems help estimate the likelihood of bacterial (specifically streptococcal) infection:
Each item scores 1 point. Higher scores indicate higher likelihood of bacterial infection.
Similar tool, scoring tonsillar exudate, tender neck lymph nodes, absence of cough, and fever.
These scores guide whether antibiotics are appropriate and/or whether a throat swab is worth doing. Low scores: viral very likely, no antibiotics. High scores: bacterial more likely, antibiotics often justified.
Some symptoms with sore throat are emergencies. Call 999 or go to A&E if:
• Stridor — high-pitched harsh sound when breathing in
• Drooling and inability to swallow saliva
• Severe difficulty breathing or noisy breathing
• Cannot open mouth properly (trismus)
• Muffled voice ("hot potato" voice)
• Severe one-sided throat swelling
• Confusion or extreme drowsiness
These can indicate epiglottitis (rare but life-threatening), peritonsillar abscess, or severe airway compromise. Don’t wait.
Duration, fever, swallowing difficulty, breathing difficulty, voice change, recent contacts (school, family), travel history, smoking, alcohol, immunisation status, previous tonsillitis pattern, other symptoms.
FeverPAIN or Centor score to estimate likelihood of bacterial infection and guide treatment.
For intermediate scores, or where treatment decisions are difficult, a swab from the tonsils sent for laboratory culture (or rapid antigen test) identifies bacterial causes. Available same-day at MHW. Results from culture take 24–72 hours; rapid antigen testing gives same-visit results for strep.
Either symptomatic management alone, antibiotics if bacterial cause confirmed/likely, or escalation (referral) for severe or atypical presentations.
For confirmed or likely bacterial infection (high FeverPAIN/Centor score, positive swab, or specific clinical features), a short course of antibiotics typically reduces symptom duration by about a day and prevents the small risk of complications (rheumatic fever, kidney problems). We follow NICE NG84 for prescribing decisions and inform you of the rationale. UK law prevents naming specific medications on this website.
No antibiotics needed (and a specific class of antibiotic should be avoided as it commonly causes a rash in EBV infection). Rest, fluids, time. Avoid contact sports for several weeks because of risk of splenic injury.
For peritonsillar abscess, suspected epiglottitis, airway concerns, or severe systemic illness, we arrange urgent ENT or A&E referral as appropriate.
If you’re getting frequent severe sore throats — especially with confirmed tonsillitis — tonsillectomy may be worth considering. The threshold (per ENT UK / SIGN guidance):
With each episode severe enough to need a doctor and time off work/school. We can refer for private ENT assessment and tonsillectomy if appropriate.
Consider same-day booking if:
Call 999 or go to A&E for stridor, drooling, severe breathing difficulty, or extreme one-sided swelling (see red flags above).
No — not unless they’re indicated. Around 85% of sore throats are viral and antibiotics don’t help. Inappropriate antibiotic use contributes to resistance. We use validated scoring and swabs to make the right decision.
For most cases, we make the decision at the appointment based on examination and scoring. Throat swab results take 24–72 hours but rarely change immediate management for a clear clinical picture.
Yes — COVID is now a common cause of sore throat. We can test on site (PCR or rapid antigen) if you wish.
If symptoms are severe, prolonged, or you’re a teenager/young adult with marked fatigue and lymph node swelling, we test specifically for glandular fever. Blood tests take 1–3 days.
The rare complications of streptococcal throat infection (rheumatic fever, post-streptococcal kidney inflammation, scarlet fever) are reasons to treat confirmed bacterial throat infections. These are rare in the UK but worth being aware of, particularly with severe presentations.
Current prices are on our Fees page. Throat swab and blood tests are additional and quoted before being done.
Yes — we see children from any age. Children must attend with a parent or guardian. For very young children with severe symptoms, A&E or our urgent care service may be appropriate.
Worth a fuller assessment — checking for underlying cause (reflux, allergies, immune issues), pattern of recurrence, and whether tonsillectomy might help. Book a longer initial consultation rather than another same-day appointment.
Care at MHW Clinic is delivered by a small clinical team, with Dr Haydar Bolat as Clinical Director. The specific clinicians involved in your care depend on the plan agreed with you at consultation.
UK-registered GP and Clinical Director at MHW. Provides same-day sore throat assessment including history, examination, FeverPAIN/Centor scoring, throat swabs where indicated, and antibiotic prescribing aligned with NICE NG84.
View profileLanguages spoken across the team: English, Turkish, Bulgarian, Bengali, Hindi, Albanian, Azerbaijani, German, Romanian. We can also arrange professional telephone interpreters in most other languages at no extra cost. More on languages and interpreters →
This page was reviewed by Dr Haydar Bolat, Clinical Director at MHW Clinic. Content is based on NICE Guideline NG84 (Sore throat — acute: antimicrobial prescribing), NICE Clinical Knowledge Summaries, and current UK clinical practice and current UK clinical practice. It is updated when guidance changes. Educational information only — not a substitute for clinical assessment.
Don’t suffer wondering whether you need antibiotics. Book a same-day consultation and a swab if needed.