Infectious Causes of Sore Throat

If you ask anybody what is a common pathogen that causes a bad sore throat, strep is probably the answer you will get the majority of the times. However, strep due to GABHS for which a rapid strep test is performed only accounts for about 10-15% of all sore throats overall due to a bacteria. When taking into consideration ALL pathogens, viruses cause the majority of all sore throats. Indeed, viruses cause 85% to 95% of throat infections in adults and children younger than 5 years of age; for those aged 5 to 15 years, viruses cause about 70% of throat infections, with the other 30% due to bacterial infections. The real culprit that causes most of the bad non-viral sore throats at least in young adults (15-30 years) is Fusobacterium necrophorum. This germ accounts for about 20% of all sore throats and is treated slightly differently from strep. 

However, strep throat is common in school-age children between 5 and 15 years old though still accounts for less than 30% of sore throats in this age group.

These facts should be taken into consideration when a patient has a bad sore throat. Often, too much weight is given to a negative strep test and therefore no antibiotics are given even though clinically, a bacterial throat infection is present. 

Take home point is that if a patient appears to have an acute tonsillitis/pharyngitis, antibiotics should be prescribed even if strep test negative. 

Check out the table below from JUCM.

Unfortunately, there is no quick or easy test to detect these other organisms at this time. Regardless of the culprit germ, tonsillectomy and/or adenoidectomy can be considered if enough infections occur. Watch a video showing how a tonsillectomy is performed here!