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Why do I have sore throat?

Q: I am a 30 years old man who had a Streptococcal infection in the throat last month and the culture showed beta-haemolytic Streptococci. I took Gatifloxacin for 10 days. But now I feel something stuck in my throat all the time. The doctor advised me to take Pentid 400 twice daily and checked my ASO titre, which was 250. What should I do now? Is it necessary to remove the tonsils?

A:Inflammation of the throat (commonly called and manifested as “sore throat”) may be due to soreness of various parts of the throat such as pharynx, larynx, or tonsils (medically referred to as pharyngitis, laryngitis or tonsillitis). This soreness may be due to infectious causes (viral, bacterial) or might be due to non-infectious reasons (mechanical injury or environmental irritants). Streptococcal infection of the throat is a common condition in children and adults. The disease is usually manifested as pain in the throat, along with fever, enlargement of tonsils, transient enlargement of some neck nodes, and transient pain during swallowing for a few days. Most cases resolve spontaneously or with antibiotic treatment. Antibiotics in streptococcal sore throat, usually of the penicillin group are usually given to prevent complications, prevent the spread of infections to others, and reduce the duration of symptoms in the affected person. The condition is suspected clinically, and bacteriological culture using throat swabs, and blood tests (such as the anti-streptolysin O or ASO titres) are done to confirm clinical suspicion. In penicillin allergic patients, alternative antibiotics belonging to the cephalosporin group, macrolide group (such as erythromycin and azithromycin) are used depending on antibiotic susceptibility patterns and clinical discretion. Complications are uncommon, but if that occurs it may be either localised to abscess formation in and around the tonsils, or rarely due to immunological problems arising out of the infection and affecting either the heart (rheumatic fever) or the kidneys (post-streptococcal glomerulonephritis).

Tonsillectomy is rarely required after an ordinary attack of streptococcal sore throat, because most cases either resolve spontaneously or after a course of antibiotic therapy. If the problem persists it would be important to rule out if there are any localised complications (such as an abscess formation), and this is best achieved by consulting an ENT (Ear, Nose, Throat) specialist (also called oto-rhino-laryngologist). Surgery may be required if there is recurrent infection, or there are complications which cannot be corrected by medical treatment alone. The benefits of surgery must be weighed against possible risks of surgery, such as bleeding and post- operative infection, etc. The important facts to remember are: sore throat is a very common condition, it mostly resolves spontaneously with time or with a course of medical treatment, and complications are uncommon in most cases. Surgery if required is best assessed by an ENT specialist, and is a relatively simple procedure, with few complications. I wish you a speedy and uneventful recovery.

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