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The most common cause (30% to 60%) of pharyngitis in adults is a self-limited viral infection that occurs as part of the common cold. Rhinovirus is the most common etiologic agent.

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Pharyngitis in adults is caused by a bacterial infection in approximately 5% to 10% of patients. This is different than in children, in whom bacterial pharyngitis accounts for 30% to 40% of cases.

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Group A beta hemolytic Streptococcus pyogenes (GABHS) is the pathogenic organism responsible for most cases of bacterial pharyngitis in adults.

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Prevention of rheumatic fever is possible if antibiotic therapy is started up to 10 days after the onset of symptoms, but antibiotic treatment does not appear to affect the incidence of acute poststreptococcal glomerulonephritis.

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Other more uncommon bacterial causes of acute pharyngitis include non–group A beta hemolytic streptococcus, Arcanobacterium haemolyticum, sexually transmitted organisms (gonorrhea, syphilis, and chlamydia), tuberculosis, tularemia, and diphtheria.

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Influenza continues to be a worldwide problem. Each year, influenza develops in 500 million people globally with approximately 150,000 people requiring hospitalization in the United States alone. In nonpandemic years, 20,000 to 40,000 deaths occur. In pandemic years, this number can reach 100,000 deaths annually. Influenza A rather than type B is responsible for most of the significant morbidity and mortality.

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Sore throat from Epstein-Barr virus is found in 82% of patients with infectious mononucleosis and is the most common complaint. Other symptoms may include abdominal discomfort, headache, stiff neck, and skin rash.

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Treatment for most patients with infectious mononucleosis consists of supportive care, rest, antipyretics, and analgesics. Patients should be advised to avoid contact sports until examination and abdominal ultrasonography confirms resolution of splenomegaly. Antivirals are not beneficial in uncomplicated infections. Antibiotics are indicated only for secondary bacterial infections. Steroids are indicated for complications related to impending upper airway obstruction, severe hemolytic anemia, severe thrombocytopenia, or persistent severe disease.

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Candida sp. can affect the oropharynx in the form of pseudomembranous candidiasis (thrush). The most common isolated organism is Candida albicans but other organisms (C. glabrata, C. Tropicalis, C. dubliniensis, C. rugosa, and C. krusei) are now emerging as causative agents, especially in immunocompromised patients and for those who have received previous radiotherapy.