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Diagnosed with tonsillitis and post-nasal drip. What is causing soar throat? Looking for treatment

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ENT Specialist
Practicing since : 1991
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Dear ENT Doctor,

Hi! I have recently been diagnosed with tonsillitis and post-nasal drip. I'm trying to determine the cause and further treatment options.

I'm a 31-year-old XXXXXXX male. I have had a mild, persistent soar throat that is worst from bed time until morning for over a month now. The soar throat began about four days after I performed unprotected oral sex on a XXXXXXX man and is my only symptom.

I have been treated for possible gonorrhea and chlamydia in my throat. Neither of the single-dose antibiotics (azithryomycin or rocephin) helped. My gonorrhea throat swab also came back negative.

I was also given the antibiotic doxycycline for 14 days but this did not help, and I received a negative result on a throat culture looking for abnormal bacteria.

Most recently, I was prescribed the nasal spray steroid Fluticasone for 1 or 2 weeks. This has not been helping. My GP said the next step was to see an ENT.

She said my tonsils were red and there was some pus. She also found some post-nasal mucus in my throat. Step test came back negative.

I have been trying Cold-Eeze and hot water with lemon/lime, honey, and salt but soar throat persists.

My questions are:

1. What could be causing the soar throat and tonsillitis? Antibiotics haven't worked. A cold would have gone away by now. I have already had mono. The doctor didn't see signs of fungal infection. I have no reason to believe I have a new allergy or something in my environment leading to the symptoms.

2. Does tonsillitis ever go away on its own after a month? If so, how long does it take?

3. What further treatment options would you suggest as an ENT?

Posted Tue, 27 Nov 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 7 hours later

Thank you for your query.

1. The sore throat may be due to:
a. Viral infection (no response to antibiotics)
b. Acid reflux (symptoms worse at night through to the morning)
c. Post nasal drip (PND observed on examination)
d. Allergy (has any anti-allergic medication been prescribed?)

2. Tonsillitis may persist as chronic tonsillitis. Sins and symptoms include frequent sore throat, anterior pillar congestion, palpable non-tender Jugulo Digastric (JD) Nodes and enlarged tonsils.

3. A repeat swab is recommended with an added PCR (Polymerase Chain Reaction) test. Is is possible to check your contact / partner? Lymphogranuloma Venereum should be ruled out. Shigellosis may be a cause as you had abdominal symptoms. HPV (Human Papilloma Virus), Hepatitis B & C, HIV among others should be ruled out. Use a medicated OTC mouthwash such as Peridex / Periogard (chlorhexidine) to gargle. You have already taken most antibiotics normally given.

4. You may share the close-up images of your throat and test results for further advice.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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