Throat Ulcers: 7 Causes, Treatment & When to Worry

Updated in November 2023

Generally, a throat ulcer can emerge during periods of stress or intense emotions, but it can also be a result of a wound in the mouth that is healing, infection (like herpes) or medication use (like anti-inflammatories).  When throat ulcers are very big and take a long time to heal, they can be a sign of a more serious disease such as AIDS or cancer.

A throat ulcer is a small, round sore that is whitish in the middle and reddish on the outside. It causes pain and discomfort, especially when swallowing or speaking. In some cases, it can be accompanied by other symptoms such as fever, general malaise and swollen lymph nodes in the neck area.

You should see a doctor if your frequently experience throat ulcer, if they take long to heal, or if they are accompanied by other symptoms like fever and weight loss. The doctor may prescribe ointments for to treat a throat ulcer and suggest the elimination of acidic foods from your diet. Another common recommendation is gargling warm water with salt to help relieve discomfort.

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What causes throat ulcers?

Throat ulcers can happen for many reasons, like:

1. Aphthous stomatitis

Throat ulcers from aphtous stomatitis are not linked to a specific cause, and are generally associated with pain. They tend to emerge following small mouth wounds, periods of stress and menstruation. 

Furthermore, an iron or B12 deficiency, allergies to oral products (like tooth paste) and foods (like citric fruit and cinnamon) can cause aphthous stomatitis.

What to do: Throat ulcers from this condition usually resolve on their own within 3 weeks, without any specific interventions. However, You should see a doctor if you have intense pain or have difficulty breathing. The doctor may prescribe ointments with anesthetic and corticosteroid properties to relieve pain. 

2. Herpes

The virus that causes oral herpes can also cause painful ulcers on the throat, tongue or top of the mouth in addition to the usual blisters around the lips. 

These symptoms may be accompanied by fever and general malaise when the infection occurs for the first time. Recurrences will usually cause more mild symptoms. 

What to do: Throat ulcers caused by herpes tend to improve within 2 weeks without any specific treatment. However, if symptoms like fever, malaise or intense pain occur, you should see a doctor to confirm a diagnosis. The doctor may prescribe medications like antivirals or analgesics to reduce symptoms and speed-up recovery. 

3. COVID-19

COVID-19 is a viral infection caused by the SARS-CoV-2 virus. It can cause throat ulcers due to factors like intense inflammation and the virus’ direct effect on the oral mucosa. 

Other more classic symptoms of this infection include coughing and fever. Check-out the other symptoms of COVID-19 and how it is transmitted.

What to do: It is important to consult a family doctor, lung specialist or infectious disease specialist if you suspect you may have COVID.19. The doctor may prescribe acetaminophen or antivirals, although more severe cases may require treatment in a hospital setting.

4. Medication use

The use of some medications, mainly non-steroidal anti-inflammatories (like naproxen), anti-hypertensives (like losartan) and chemotherapy medications may lead to throat ulcers as a side effect. 

What to do: You should avoid using these medications unless indicated by a doctor. If prescribed, they should be taken only as instructed. If you suspect your throat ulcers are related to medications, you should consult your prescriber to reevaluate dosing or consider an alternative medication.

5. Systemic lupus erythematosus

A throat ulcer caused by systemic lupus erythematosus can occur in areas like the throat, tongue, roof of the mouth or lips. It is also common to notice weight loss, decreased mood and joint pain with this condition. 

Learn more about the symptoms of lupus and what can cause this condition.

What to do: If you suspect you may have systemic lupus erythematosus, you should consult a rheumatologist. The throat ulcers tend to improve with treatment of the overall condition, which may involve oral corticosteroids and anti-malarials. 

6. HIV infection 

HIV can cause one or more throat ulcers that are large, painful and take a long time to cure. This is especially true for patients who are not receiving or adhering to adequate treatment. 

Although an HIV infection can cause minimal symptoms in the beginning, if left untreated, it significantly affect immunity and increase the risk for infections. 

What is it: It is important to consult a family doctor or infectious disease specialist if you think you may have HIV. If confirmed, the throat ulcers will typically improve with general HIV treatment, which may involve antiviral medications. 

7. Oral cancer

Oral cancer can cause throat ulcers or several throat wounds that are difficult to heal. Depending on the extent of the tumor, other symptoms can emerge, like difficulty swelling, hoarseness, weight loss and swollen lymph nodes along the neck. 

What to do: Oral cancer should be assessed by a doctor if suspected. Diagnosis is confirmed with a biopsy of the lesion. Treatment may include surgery to remove the tumor, radiation therapy and chemotherapy. 

If you get a throat ulcer more than once a month, or if two outbreaks of ulcers happen within less than a week of each other, you should see your family doctor for blood tests that can help identify what may be causing the problem. Once the diagnosis is made, appropriate treatment is started so as to prevent the sore from appearing again.

Other situations that may cause small sores in the throat are tonsil stones, tonsillitis, and aphthous stomatitis, which are more common in infants.

Treatment options

Treatment for throat ulcers can be completed with combination corticosteroid and anti-inflammatory ointments, or with topical anesthetics (e.g. xylocaine 5%). These are prescribed by a doctor and applied with a finger or with the help of a cotton swab.

Other drugs that can be used to relieve pain caused by throat ulcers are acetaminophen or ibuprofen, and should be used as recommended by a doctor. Laser treatments can be used if the throat sore is greater than 1 cm in diameter or if the sore is causing difficulty with eating or drinking.

Speed-up throat ulcer healing

To help heal throat ulcers, some precautions should be considered, such as:

  • Rinsing your mouth with mouthwash after brushing your teeth, as this can help to eliminate bacteria and cleanse the area
  • Avoiding acidic foods like lemon, pineapple, tomato, kiwi and orange, as the acidity can increase pain
  • Eating more foods rich in B complex vitamins, folic acid and iron such as banana, mango, low-fat yogurt or apple juice (vitamin deficiency can cause throat ulcers)
  • Gargling warm water with salt or gargling hydrogen peroxide diluted in water, as they are antiseptic and clean the area. To prepare the solution, simply add 1 tablespoon of salt into 1 cup of warm water or 2 tablespoons of hydrogen peroxide 10 volumes in 1 glass of water. Check out other gargle recipes you can use at home to relieve a sore throat.
  • Avoid worsening by not eating hard or crunchy foods such as toast, peanuts, nuts
  • Using a toothbrush with soft bristles;
  • Avoid oral hygiene products with irritating ingredients like sodium lauryl sulphate.

If you follow treatment as directed by your doctor while keeping these recommendations in mind, throat ulcers will likely disappear on their own within a few days.

If you are also experiencing mouth ulcers, check out natural ways to speed-up healing at home.

When to worry

When throat ulcers appear frequently (e.g. more than 6 times a year) you should see a doctor for assessment, especially if you have other symptoms. Testing that may be ordered includes:

  • Complete blood count
  • Iron, ferritin and iron uptake, vitamin B12 levels
  • HIV antibodies, viral cultures and biopsy.

However, there is usually no need to request these exams and they are generally done when the throat ulcers are difficult to control.