Sore throat and tonsillitis: what causes them and when to see a doctor

A sore throat is one of the most common reasons people look for medical advice. In most cases it settles on its own within a few days. In some cases it needs assessment, and the central question is almost always the same: is this a virus or a bacterial infection?

What causes a sore throat

In the large majority of cases a sore throat is caused by a virus. The same viruses responsible for common colds and respiratory infections are the most frequent cause.

There are other causes as well. A sore throat can result from a bacterial infection, from dry air, from smoke, from allergic rhinitis draining into the throat, from straining your voice, or from acid reflux.

The cause matters, because it determines what helps. A sore throat caused by a virus does not need an antibiotic, however severe it feels.

What tonsillitis is

Tonsillitis is inflammation of the tonsils, the two lymphatic tissues at the back of the mouth. It presents with throat pain, difficulty swallowing, swollen tonsils and often a fever.

The tonsils may look red and enlarged, sometimes with white or yellowish patches. The lymph nodes in the neck may also be swollen and tender.

Tonsillitis is caused by both viruses and bacteria. The appearance of the tonsils on its own does not reliably distinguish between the two, which surprises many people. White patches do not automatically mean an antibiotic is needed.

Viral or bacterial

This is the question that determines treatment, and it is not answered by any single finding.

The doctor weighs several things together: how abruptly it started, whether there is a fever and how high, whether a cough and runny nose are present, the appearance of the tonsils, the state of the lymph nodes, your age, and what is circulating at the time.

Broadly, a prominent cough and runny nose point more towards a virus. Their absence, combined with a high fever and marked inflammation, raises the likelihood of a bacterial infection. None of these findings is decisive on its own, which is why the assessment is made as a whole.

When the distinction is not clear, the test involves taking a sample from the throat, either as a rapid test or a culture. This requires being physically present and cannot be done remotely. The doctor will tell you if they consider it necessary and where you can have it done.

How long it lasts

A viral sore throat usually peaks on the second or third day and settles gradually over three to seven days.

Tonsillitis can last a little longer, particularly when accompanied by a high fever. Mild discomfort on swallowing may remain for a few days after the other symptoms have gone.

If a sore throat persists beyond a week without any improvement, it is worth having it assessed.

When it is worth speaking to a doctor

Not every sore throat needs a medical assessment. It is worth speaking to a doctor when:

• The pain is severe, or swallowing has become significantly difficult
• There is a high fever, particularly without a cough or runny nose
• Symptoms persist beyond a week, or are getting worse
• You felt better and then became worse again
• The lymph nodes in your neck are markedly swollen and painful
• You have a long-term condition or a weakened immune system
• You need documentation for work
• Sore throats keep coming back

Most of these can be assessed well over a video call. The assessment rests largely on what you describe, while the camera allows the doctor to look at your throat. If you need to be seen the same day, you can book with a doctor who is available at that moment.

If the doctor decides that examination by hand, a throat swab or other laboratory tests are needed, they will explain this and direct you accordingly.

When you need urgent help

Call 112 immediately, or 166 for an ambulance in Greece, or go to the emergency department of the nearest hospital, if any of the following appear:

• Difficulty breathing, or noisy breathing
• Being unable to swallow even fluids, or drooling
• Difficulty opening your mouth
• Marked swelling of the neck or face
• Pain strongly on one side, with a changed voice
• A high fever with severe exhaustion and confusion

These cannot be assessed remotely. They need immediate physical examination.

Antibiotics and sore throats

Antibiotics act on bacteria and have no effect on viral infections. Because a sore throat is caused by a virus in the large majority of cases, an antibiotic usually offers nothing.

This is not a technicality. Taking antibiotics unnecessarily contributes to antimicrobial resistance, an issue closely monitored by health authorities, and can cause side effects without any benefit.

When an infection genuinely is bacterial, an antibiotic has a clear role. If the doctor decides one is needed, they can issue an electronic prescription through Greece's national ΣΗΣ system during the consultation, or a private prescription if you do not have an AMKA number. That decision belongs solely to the doctor, based on your overall picture, and the consultation fee covers the medical assessment itself, whatever its conclusion.

If you have been given an antibiotic, complete the course as prescribed and do not keep leftovers for another time.

What helps at home

Whatever the cause, there are things that ease the symptoms:

• Fluids, at regular intervals. Warm drinks help many people.
• Pain and fever medication, following the instructions on the packet or your pharmacist's advice.
• Gargling with warm salt water, which gives temporary relief.
• Humid air, particularly in heated rooms.
• Avoiding smoke and resting your voice.
• Soft foods if swallowing is painful.

If you already take medication for something else, ask before adding anything.

Sore throat and tonsillitis in children

Sore throats are very common in children and most cases are viral. Younger children do not always describe the pain, but they may eat less, be more irritable, or refuse fluids.

Seek help immediately if the child:

• Is breathing with difficulty, or noisily
• Is not swallowing fluids, or is drooling
• Is unusually drowsy or hard to wake
• Has not had a wet nappy for many hours
• Has a fever together with a rash
• Is under three months old and has any fever

For everything else, a conversation with a doctor helps separate what is expected from what needs watching. A parent or guardian books the appointment and stays with the child throughout the consultation.

When sore throats keep returning

Some people get tonsillitis repeatedly within the same year. When that happens the question changes: it is no longer about the individual episode but about the pattern.

In these cases it is worth writing down how many episodes you have had, when, how long each lasted and what was given each time. That picture is what guides the discussion.

The doctor will explain whether your case needs assessment by an ear, nose and throat specialist, and what would be evaluated there.

Frequently asked questions

Do I always need an antibiotic for tonsillitis? No. Tonsillitis is often caused by a virus, in which case an antibiotic offers no benefit. Whether one is needed is decided by the doctor based on the overall picture, and if it is, a prescription can be issued during the consultation.

Do white patches on the tonsils mean bacteria? Not necessarily. They appear in viral infections too, which is why the appearance of the tonsils alone is not enough.

How long does a sore throat last? Usually three to seven days. If it persists beyond a week without improvement, it is worth having assessed.

Can a strep test be done remotely? No. It requires a sample taken from the throat and physical presence. The doctor will tell you if they consider it necessary.

Can the doctor see my throat on a video call? In many cases yes, with good lighting. It is one part of the assessment rather than the whole of it.

Can the doctor give me a sick note for work? The doctor can issue a sick note where they consider it clinically appropriate, based on the assessment.

If you have a sore throat and are not sure whether you need to see a doctor, you can talk it through without leaving the house. See how telemedicine in Greece works, or download the DocNow app, choose an available doctor and book your appointment. Each consultation is scheduled for 15 minutes and costs a flat €20. The doctor will assess your case and explain the appropriate next steps, at their clinical discretion.

Appointment availability depends on doctor availability at the time of booking.

The information above is provided exclusively for educational purposes and does not replace medical advice. Please consult your treating doctor to determine the most appropriate treatment plan for your individual needs.