Patient history: key information

Age: Streptococcal (bacterial) throat infections are more likely in children of school age.

Duration: Most sore throats will get better within seven days. If present for longer and not resolving, then the patient should be referred to the GP surgery for further advice.

Associated symptoms:

• Cold, catarrh and cough may be associated with a sore throat. There may also be a fever and general aches and pains. These are in keeping with a minor self-limiting viral infection
• Hoarseness of longer than three weeks’ duration is an indication for referral
• Difficulty swallowing (dysphagia) is sometimes seen with tonsillitis or peritonsillar abscess (quinsy) and is a sign usually requiring urgent referral
• Loss of taste or smell (or alteration in these) is a recognised feature of Covid-19, which can also cause sore throat. If this is suspected the patient should do a Covid test.

Previous history: Recurrent bouts of throat infection, such as several episodes of ‘tonsillitis’ in the past year, would mean that referral is indicated.

Smoking habit: Smoking will exacerbate a sore throat. If the patient smokes, then it can be a good time to offer advice and information about quitting.

Present medication:

• Steroid inhalers can cause hoarseness and candidal infections of the throat and mouth. Generally this happens at high doses and can be prevented by rinsing the mouth with water after using the inhaler. Poor inhaler technique can lead to large amounts of the inhaled drug deposited at the back of the throat
• Any patient taking carbimazole and presenting with a sore throat should be referred immediately.
  A rare side-effect of carbimazole is agranulocytosis (suppression of white cell production in the bone marrow)
• The same principle applies to other drugs associated with agranulocytosis, including methotrexate and azathioprine
• A patient receiving chemotherapy for cancer should be referred as a sore throat can be the first sign of a life-threatening infection.