What is acute pharyngitis?

DEAR DOCTOR K:

I saw my doctor last week, who said I had acute pharyngitis but didn’t say what that was. It sounds serious. What is it?

DEAR READER:

Good news: It’s rarely serious. I know the word “acute” in front of any medical term makes it sound serious. And I know that Latin-based words like “pharyngitis” sound alien. But acute pharyngitis simply means that your throat has become inflamed by something, usually an infection.

Acute pharyngitis causes a sore throat, one of the most common medical problems for which people seek medical care. The most common causes of acute pharyngitis are infections with bacteria or viruses.

When I was in medical school, we were taught that a patient with a sore throat had either an infection with a type of bacteria called Group A streptococcus (“strep”) or with any of multiple viruses. Group A strep was diagnosed with a throat culture and was treated with antibiotics, particularly penicillin. Since antibiotics do not work against viral infections, antibiotics were not to be prescribed except when the throat culture showed Group A strep.

So, I was taught that what a doctor did for a patient with acute pharyngitis was simple: You got a throat culture, and if it showed Group A strep, you prescribed antibiotics.

It did seem simple. The problem was that it wasn’t that simple in practice.

One reason why was that the results of a culture took one to two days to come back. You had to track down the patient when the culture came back showing Group A strep, and then start treatment. To avoid the time those steps took, many doctors just prescribed antibiotics when they were pretty sure the patient had a strep throat.

The problem was that doctors weren’t terribly good at making that judgment. As a result, antibiotics often were prescribed in people with sore throat caused by viruses. Overuse of antibiotics, in turn, led to bacteria becoming resistant to antibiotics — which has now become an important problem.

The way a doctor today diagnoses and treats a patient with acute pharyngitis is not very different from the way it was decades ago. From my perspective (with which not all my colleagues agree), it should be different today.

One thing that has changed is that 70 years ago, an unrecognized and untreated throat infection with Group A strep could cause one of two serious diseases: acute rheumatic fever or acute glomerulonephritis. The first is a condition that can damage the heart valves, and the second can damage the kidneys. Early diagnosis and treatment greatly reduced the chance that these diseases would develop. Today, however, the Group A strep that are circulating in the United States are much less likely to cause these diseases.

In tomorrow’s column, I’ll talk about what else has changed in how a doctor should diagnose and treat a patient with acute pharyngitis. It turns out that the “simple” sore throat is not simple at all.