Sore throat: diagnostic and therapeutic dilemmas

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Anna Graham, special lecturer (a.graham@bristol.ac.uk),
Tom Fahey, senior lecturer (a.graham@bristol.ac.uk)

Division of Primary Health Care, University of Bristol, Canynge Hall, Bristol BS8 2PR

Correspondence to: Dr Graham

Accepted 4 May 1999

Sore throat is a common condition in general practice. The following cases presented us with diagnostic and therapeutic dilemmas

The patients

Case 1

Ms H, a 21 year old woman, consulted with a one day history of sore throat. She did not complain of cough or of any other associated respiratory symptom. On examination she was feverish (38°C), with exudate on her tonsils and tender cervical lymph nodes. A textbook of diagnostic strategies suggests that this collection of symptoms and signs increases the likelihood of her having group A β haemolytic streptococcus infection to over 40%.1 She was treated with a seven day course of penicillin, and a throat swab was taken to confirm infection with group A β haemolytic streptococcus. Four days later the swab result confirmed the presence of group A β haemolytic streptococcus which was sensitive to penicillin. Nine days after the initial consultation Ms H returned complaining of continuing symptoms of sore throat and requesting further antibiotics. She still had inflamed tonsils but with no exudate; her cervical lymphadenopathy had persisted. In view of her positive throat swab she was given a further course of penicillin. Serology for infectious mononucleosis was negative. A subsequent consultation confirmed that her sore throat had settled two days after the second consultation.

Case 2

Ms D, a 17 year old woman, consulted with a two day history of sore throat and blocked nose Examination revealed an inflamed pharynx with some exudate, but the patient was otherwise well. She had been treated with two consecutive courses of antibiotics for …