Sore Throat
Sore throat (pharyngitis) is usually viral, but the key clinical question is whether it's group A streptococcus, which is treated differently. The IDSA published a 2025-2026 guideline update on clinical scoring specifically for this question.
Symptoms
Throat pain, difficulty swallowing, and sometimes fever, swollen glands, or white patches on the tonsils.
Causes and risk
Most sore throats are viral. Group A strep is more likely in school-age children and in the presence of Centor criteria (fever, tonsillar exudate, tender anterior neck nodes, absence of cough).
How it is evaluated
The Centor/modified Centor score, endorsed by IDSA, ACP/CDC, and AAFP, stratifies strep risk before testing -- it's most useful for identifying low-probability patients who can skip testing altogether. A rapid antigen test, with confirmatory culture in children if negative, is standard when testing is indicated.
Treatment
Confirmed strep is treated with penicillin or amoxicillin for 10 days per IDSA/AHA/AAP guidance in the AAP Red Book; antibiotics are given only for a positive test, not empirically. Everyone benefits from symptomatic care regardless of cause.
When to seek care
Drooling, muffled voice, difficulty breathing or swallowing, or severe one-sided throat swelling can signal a peritonsillar or deep-neck abscess or airway compromise and need same-day evaluation.