Sore Throat

TABLE   —  CAUSES OF PHARYNGITIS

1-3 Days Duration Viral URI Strep Throat Other [uncommon] Bacteria DON’T MISS Deep Tissue Infection Peritonsillar Abscess Consider Primary HIV Diphtheria Neutropenia

>4-5 Days Duration Strep Throat [unlikely if >3 days] Mononucleosis Primary HIV Gonorrhea Herpes simplex ? Mycoplasma ? Syphilis (secondary) Tularemia DON’T MISS (see 1st Column) Rabies Long-Standing Duration Allergic Rhinopharyngitis Gastroesophageal Reflux

What to Order for Pharyngitis >4-5 Days’ Duration:

Strep throat screen, of one form or another, if not yet done.

 

CBC with manual differential

• Atypical Lymphocytes suggest mono or Primary HIV
• Absolute Neutrophils <500-1,000 = Neutropenia

Monospot for Mono (may need to repeat weekly)

 

Liver Function Tests

• slight elevation of transaminases ALT / AST suggests Mono
• also may be elevated in Primary HIV

Consider GC probe or culture, if very recent oral sex on a new partner

 

??? Herpes Simplex detection test

• Only if Hx of recurrent sore throats, & visible vesicles to swab

Review risks for Primary HIV

• If suspicious:  HIV Antibody and esp.  HIV RNA (Viral Load)