What is the best course of action for a patient who complains of a sudden sore throat that resolved within a day, followed by body pains without fever?

Clinical Assessment and Management

This presentation is consistent with a viral upper respiratory infection, and antibiotics are not indicated. The sudden onset sore throat that resolved within one day followed by body aches without fever strongly suggests a viral etiology rather than bacterial pharyngitis 1.

Why This is Viral, Not Bacterial

• The absence of fever is a key distinguishing feature that strongly suggests viral rather than streptococcal etiology 1
• Group A streptococcal pharyngitis typically presents with sudden onset sore throat accompanied by fever, pain on swallowing, and tender anterior cervical lymphadenopathy 1
• The rapid resolution of throat symptoms within one day is atypical for bacterial pharyngitis, which usually persists for several days 2
• Body pains (myalgias) without fever are characteristic of viral infections, particularly influenza and other respiratory viruses 1, 3

Recommended Management Approach

Provide symptomatic treatment only with ibuprofen or paracetamol for relief of body pains. 1

• No testing for Group A Streptococcus is warranted because the clinical presentation lacks features suggestive of bacterial pharyngitis 1, 4
• The combination of absent fever, rapidly resolved sore throat, and predominant myalgias makes the probability of streptococcal infection extremely low 1, 4
• Reassure the patient that viral pharyngitis typically resolves within 7 days, with most symptoms improving within 3-4 days 5, 2

When to Reconsider or Escalate

• If symptoms persist beyond 7 days or worsen significantly, consider alternative diagnoses including suppurative complications 5, 6
• Red flags requiring urgent evaluation include severe dysphagia, drooling, respiratory distress, trismus, or unilateral throat swelling (suggesting peritonsillar abscess or epiglottitis) 6, 7
• If fever develops along with severe throat pain, tonsillopharyngeal exudates, or tender anterior cervical lymphadenopathy, then testing for Group A Streptococcus would be appropriate 1, 4

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on the initial sore throat alone without laboratory confirmation and appropriate clinical features 1, 4
• Treating based on clinical symptoms without the characteristic features of streptococcal pharyngitis (fever, exudates, lymphadenopathy) leads to unnecessary antibiotic use in 60-70% of cases 4, 2
• The rapid resolution of throat symptoms within one day essentially rules out bacterial pharyngitis, which does not follow this pattern 2
• Body aches are a common viral symptom and do not indicate need for antibiotics 1, 3