Throat ulcers: cause, symptoms and treatment

Throat ulcers or ulcerations are open wounds or injuries in the throat area, that is, the back of the oral and nasal cavity. They often develop due to infections, including sexually transmitted infections, injuries, chemical irritants, or acid reflux. Typical symptoms include burning pain, difficulty swallowing, and bad breath; treatment depends on the underlying cause.

In this article, we explain the various symptoms, causes, and treatment options for throat ulcers. We also inform you about how to better prevent them in the future and when it is advisable to see a doctor.

Table of Contents

• What are throat ulcers?

• What causes throat ulcers?

• What are the typical symptoms of throat ulcers?

• How are throat ulcers diagnosed?

• How are throat ulcers treated?

• Summary

What are throat ulcers?

Throat ulcers, also referred to as ulcerations, are painful, open wounds that occur in the mucous membrane of the throat—meaning the soft palate, palatine arches, back wall of the throat, or side walls of the pharynx. The pharynx connects the oral cavity to the esophagus and nose. The mucous membrane that lines both the mouth and throat is sensitive tissue that forms a protective barrier against the penetration of foreign substances. Ulcers in this area appear as inflamed, reddish patches with a white or yellow coating and can vary in size (usually around 1 cm) and shape. They are often surrounded by a red border and cause severe pain, especially when eating, drinking, or speaking (Cleveland Clinic, 2023).

Are throat ulcers contagious?

Throat ulcers are not directly contagious, as they are often caused by non-infectious factors such as injuries or irritation. However, they can be contagious if caused by infectious agents such as viruses or bacteria, for example herpes simplex or bacterial sexually transmitted infections like chlamydia. The mode of transmission depends on the cause: ulcers caused by viruses or bacteria can be transmitted through direct contact with the mucous membranes of infected individuals—for example, through oral sex, sharing utensils, or droplets from coughing or sneezing (Cleveland Clinic, 2022).

What causes throat ulcers?

Ulcers in the throat area can be caused by a variety of factors. Infections, including sexually transmitted infections like chlamydia, gonorrhoea, or herpes, are common culprits. Injuries or sharp foods, chemical irritants such as tobacco and alcohol, autoimmune diseases like Behçet's disease, vitamin deficiencies (particularly B12 and iron), as well as stress and hormonal changes also play an important role in the development of such ulcers.

• Infections: Infections caused by viruses, bacteria, or fungi can promote throat ulcers, as these pathogens attack and damage the mucous membranes, leading to inflammation and wounds. Common pathogens include herpes simplex virus (HSV), Epstein-Barr virus (EBV), streptococci, Candida fungi, and sexually transmitted infections such as chlamydia and gonorrhoea.

• Injuries: Injuries leading to throat ulcers result from mechanical stimuli that damage the mucosa. These include swallowing foreign bodies or surgical procedures that irritate the sensitive mucosa.

• Chemical irritants: Chemical irritants such as aggressive mouthwashes, alcoholic beverages, and tobacco smoke, as well as acid reflux and vomiting (due to stomach acid), can damage the throat mucosa and promote inflammation and ulcers.

• Vitamin deficiency: A deficiency in essential vitamins, particularly B12, folic acid, and iron, can impair mucosal regeneration and increase susceptibility to injury and infection.

• Stress: Prolonged stress can weaken the immune system, increasing the risk of infections and inflammation. This can promote the development of throat ulcers, especially when additional risk factors are present and the body is less able to cope with harmful influences.

• Medications: Certain medications, especially chemotherapeutic agents, can damage the mucous membranes as a side effect and promote ulcer formation. Other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may also irritate the mucosa.

• Other causes: Can throat ulcers indicate a serious condition?

Source: Smith, 2023

Throat ulcers can indicate serious conditions. For example, they may occur in Crohn’s disease or ulcerative colitis as part of inflammatory changes in the digestive tract or be associated with other autoimmune diseases like Behçet’s disease. Throat ulcers can also occur in HIV, which is associated with immunodeficiency. In rare cases, they may also indicate certain types of cancer. If the ulcers in the throat last unusually long, occur repeatedly, or are accompanied by other symptoms, a doctor should be consulted promptly.

What are the typical symptoms of throat ulcers?

The symptoms that occur alongside throat ulcers can vary depending on the cause, but common symptoms include:

• Pain and burning, especially when swallowing or speaking

• White or red sore spots

• Swelling

• Dry feeling in the mouth

• Bad breath

• Increased saliva production

• Swollen lymph nodes

Infections are more likely to cause fever and swollen lymph nodes, while injuries cause more localized pain. Autoimmune diseases often trigger recurring, large ulcers, and chemical irritants are particularly associated with burning and redness of the mucosa (NHS, 2024).

What are the symptoms of oral sexually transmitted infections (STIs)?

Oral sexually transmitted infections (STIs) often initially cause no or only very mild symptoms, which is why they frequently go unnoticed. The classic symptoms vary depending on the pathogen:

• Herpes simplex, which commonly affects the lips and mouth, can also cause painful blisters or ulcers as well as burning in the throat.

• Syphilis appears as painless, hard ulcers (chancres).

• Gonorrhoea and chlamydia, as bacterial infections, can cause sore throat, redness, and swollen lymph nodes.

How long does it take for a throat ulcer to heal?

Ulcers in the throat usually heal within 1 to 4 weeks. However, the healing time varies depending on the cause: non-infectious, small ulcers heal more quickly, while larger or infectious wounds take longer. General health and the location of the ulcer—for example, whether it is in an area exposed to frequent irritation—also affect healing time.

When should I see a doctor?

A doctor's visit is necessary if a throat ulcer lasts longer than two weeks, is very painful, causes difficulty swallowing or breathing, recurs frequently, or is accompanied by other symptoms such as fever, swollen lymph nodes, or unexplained weight loss.

Want to assess your symptoms yourself?

In addition to the Chlamydia and Gonorrhoea Test, Homed-IQ also offers the option of checking your vitamin status with the Vitamin Deficiency Test, including B12 and folic acid. These tests are particularly helpful in the context of throat complaints and potential ulcers, as a deficiency in these vitamins can contribute to the development of throat ulcers. By understanding your symptoms better and specifically checking for possible deficiencies, you can make informed decisions about your health.

How are throat ulcers diagnosed?

Diagnosis of throat ulcers occurs in several steps:

• Medical history: Questions about the onset, progression, accompanying symptoms, medical history, risk factors, diet, and lifestyle habits.

• Examination: Visual inspection of the mouth and throat; assessment of size, shape, color, and characteristic features.

• Additional tests: Swabs, blood tests, biopsies to determine the exact cause.

• Imaging techniques: X-rays, ultrasound, CT, or MRI if deeper causes are suspected.

If symptoms are unclear or persistent, a doctor should always be consulted to establish an accurate diagnosis and determine the underlying causes.

How are throat ulcers treated?

Infections are treated with antiviral medications, antibiotics for underlying bacterial infections, or antifungals for fungal infections. Painkillers and anti-inflammatory medications are also used to relieve symptoms. For acid reflux, proton pump inhibitors such as omeprazole are used to reduce stomach acid production and protect the throat mucosa. In general, good oral hygiene and avoiding irritants such as smoking or spicy foods are helpful (Watson, 2019).

What home remedies help with throat ulcers?

Home remedies for throat ulcers include various natural approaches to relieve pain and inflammation. Gargling with salt water or chamomile tea can have anti-inflammatory effects, while applying honey offers antibacterial benefits. Cold drinks or ice cubes relieve pain, and spicy, acidic, or hot foods should be avoided to protect the mucosa.

How can throat ulcers be prevented?

Preventive measures are essentially aimed at promoting a strong immune system, maintaining the health of the mucosa, and minimizing any kind of irritation:

• Avoid tobacco, excessive alcohol consumption, and very spicy or strongly seasoned foods.

• Follow a healthy diet rich in important vitamins such as B12, folic acid, and iron. Vitamin B12 is found in animal products such as meat, fish, eggs, and dairy, while folic acid is present in foods such as leafy greens, legumes, nuts, and fortified grains.

• Use stress management techniques such as relaxation exercises or engaging in hobbies to strengthen the immune system.

• Use gentle mouthwashes and maintain good oral hygiene.

• Treat underlying conditions such as reflux and heartburn to reduce the risk of throat ulcers.

• Get tested regularly for sexually transmitted infections to detect potential health risks early and avoid spreading infections.

• Drink plenty of fluids.
  
  Source: NHS, 2024

Summary

Throat ulcers or ulcerations are painful, open wounds in the throat area that often develop due to infections, injuries, chemical irritants, or acid reflux. Typical symptoms include burning, difficulty swallowing, and bad breath. To prevent throat ulcers, risk factors such as tobacco use, excessive alcohol consumption, and spicy foods should be avoided. Good oral hygiene and a healthy diet rich in vitamins can also contribute to maintaining mucosal health.