Sore throat lasting weeks: causes, red flags and when to get it checked

A throat that stays sore for weeks has usually moved beyond a simple viral infection. It tends to be driven by a persistent irritant, an inflammatory problem or a chronic infection of the tonsils. A small proportion reflect something structural, which is why persistent one-sided pain is examined.

• Laryngopharyngeal reflux and postnasal drip, with throat clearing, a sensation of mucus and morning hoarseness.

• Smoking, vaping, alcohol, dry air, mouth breathing at night and voice overuse.

• Recurrent or chronic tonsillitis and tonsil stones with a bad taste and sore, swollen tonsils.

• Allergic rhinitis and chronic sinusitis causing postnasal drip.

• Glandular fever (infectious mononucleosis) in young adults, with marked fatigue and swollen glands that can last weeks.

• Oral thrush, especially after inhaled steroids or antibiotics.

• Quinsy (peritonsillar abscess), with severe one-sided pain, difficulty opening the mouth and a muffled voice.

• Throat cancer, which usually presents with a persistent one-sided sore throat, ear pain, hoarseness, a neck lump or difficulty swallowing.

One-sided pain lasting more than three weeks, referred ear pain, a lump in the neck, a persistently hoarse voice, difficulty swallowing, unexplained weight loss, coughing blood, and a long history of tobacco and alcohol use are the main warning signs.

• Call 999 or go to A&E: difficulty breathing, noisy breathing, drooling, or being unable to swallow saliva or open the mouth.

• Same-day GP or NHS 111: severe one-sided throat pain with fever and muffled voice (possible quinsy).

• Urgent GP referral: sore throat or hoarseness persisting over three weeks, a neck lump or ear pain with throat symptoms in a smoker.

• Routine GP: a sore throat lasting two to three weeks with reflux or postnasal drip.

Questions include duration, one or both sides, fever, voice change, ear pain, swallowing, reflux, smoking, alcohol, allergies, and exposure to infection. The throat, tonsils, mouth, ears, nose and neck glands are examined, and a throat swab may be taken.

• Throat swab: for bacterial infection if tonsillitis is suspected.

• Blood tests: glandular fever screen and full blood count in suspected mononucleosis.

• Flexible nasendoscopy: to examine the back of the throat and voice box if symptoms persist.

• Neck ultrasound or CT: for lumps or suspected abscess.

• Biopsy: only if a suspicious area is seen.

Stay hydrated, use simple painkillers and throat lozenges, humidify the bedroom, and stop smoking. Treat reflux with lifestyle changes, such as avoiding late meals. Saline nasal rinses help postnasal drip. Antibiotics only help when bacterial infection is confirmed and are not needed for most sore throats.

On the NHS a GP examines and refers to ENT when needed. Privately, ENT consultation with nasendoscopy can be booked directly, although red-flag symptoms should go through the urgent cancer pathway.