Common Causes of Cobblestone (Sore) Throat Symptoms

Cobblestone throat is a symptom rather than a diagnosis. There are many forms of sore throats, including those caused by viral and bacterial infections. With any of these infections, you can develop lumps and redness at the back of your throat, making the tissues look like a cobblestone road.

In this article, you will learn the causes of cobblestone throat and how it's treated.

Sore throat of a women. isolated on white background.

Tharakorn / Getty Images

What Is Cobblestone Throat (Pharyngitis)?

"Pharyngitis" is the medical term for a sore throat that is inflamed or swollen. Various illnesses, infections, and injuries can cause a sore throat. One way to tell the difference among the types of sore throat is the length of symptoms.

Acute Pharyngitis

With acute pharyngitis, pain and inflammation develop quickly and can occur with or without drainage. In many cases, inflammation and sore throat are stand-alone symptoms that can last for up to two weeks. Acute pharyngitis is often caused by viral or bacterial infections.

Chronic Pharyngitis

Chronic pharyngitis is a sore throat that lasts longer than a few weeks. The discomfort associated with a chronic sore throat can also come and go over time. Viral and bacterial infections can cause chronic pharyngitis, but allergies, acid reflux (when stomach acid flows back up into your esophagus), or other chronic diseases are more often to blame.

Other Causes of Sore Throat

Some less common but sometimes more serious causes of sore throat include:


Pharyngitis can occur on its own or with other symptoms. When your throat takes on a red, swollen cobblestone appearance or becomes inflamed without symptoms like cough or nasal discharge, the cause is likely a bacterial rather than viral infection.

In severe cases of pharyngitis, you may experience symptoms like:


Bacterial or viral infections cause most cases of pharyngitis. A stuffy nose with postnasal drip, a leaking of nasal drainage down the back of your throat, can cause a cobblestone effect.

Bacterial infections are more common in the winter and spring, while viral infections are more common in the summer and fall. Strep throat, a bacterial infection, is a common cause of acute pharyngitis.

You can also develop redness and inflammation in your throat from allergies or other irritants like smoke, hot liquids, or other trauma.

Could It Be COVID-19?

Sore throat is a symptom of some varieties of COVID-19, although each variant of the illness has unique symptoms, and not all include a sore throat. The same variant can cause different symptoms in each infected person.

Redness and inflammation of the throat can occur with the COVID-19 illness or from coughing brought on by the illness. It's important to rule out other causes too. Your healthcare provider may test you for COVID-19 and influenza (the flu), strep throat, or respiratory syncytial virus (RSV) when making a diagnosis.

When to See a Healthcare Provider

An acute sore throat can last up to two weeks, while chronic infections last longer. If your sore throat lingers for more than a few weeks or worsens over time, you should make an appointment to see a healthcare provider.

Seek immediate medical attention if your sore throat develops with severe symptoms like:

A sore throat that doesn't go away or includes unusual symptoms could be a sign of more serious problems like throat cancer or GERD.

Treatment and Home Remedies

Not all cases of pharyngitis require treatment. A viral infection usually clears on its own, although healing may take a few weeks. If a bacterial infection like strep throat causes inflammation and swelling, your provider will likely prescribe antibiotics to resolve the infection.

Whether your sore throat is caused by a viral or bacterial infection, or something else, there are several home remedies you can try to ease your discomfort. Examples include:

  • Drink plenty of fluids.
  • Drink tea or warm liquids with honey.
  • Suck on hard candy or lozenges.
  • Use a humidifier to add moisture to the air.
  • Gargle with salt water.

Over-the-counter (OTC) pain-relief medications like Tylenol (acetaminophen) or Advil or Motrin (ibuprofen) may be used to treat pain and swelling.

Prevention Tips 

You can't avoid every infection, but there are a number of things you can do to reduce your risk of developing pharyngitis. This includes:

  • Staying current with vaccinations (such as for the flu and COVID-19)
  • Practicing good hand hygiene
  • Staying away from people who are sick
  • Avoiding contact with your mouth or face with unwashed hands


A sore throat can take on a cobblestone appearance, with redness and swelling. Sore throats can be caused by bacterial or viral infections or result from other illnesses or irritations. Talk to your healthcare provider if your sore throat isn't getting better after two to three weeks.

A Word From Verywell

Sore throats usually aren't anything to be alarmed about, but a sore throat with swelling and redness may be more concerning. The COVID-19 pandemic has raised awareness of various respiratory symptoms, including sore throat. See your healthcare provider for additional testing if you have a sore, red, or inflamed throat that isn't getting better after a few weeks or is getting worse despite treatments at home.

Frequently Asked Questions

  • How long does cobblestone throat last?

    Pharyngitis, which can give your throat a cobblestone appearance, can last for two weeks, but in some cases it may linger for longer. Your healthcare provider can help you identify a cause and find proper treatment.

  • What’s a healthy throat color?

    Most throats are pink and smooth, but bacteria and viruses can cause redness, bumps, or irritation. Talk to your healthcare provider if you notice drainage, swelling, or lumps in the back of your throat.

  • Can you treat cobblestone throat with just OTC medication?

    Depending on the cause of your symptoms, OTC medications and home remedies may be enough to resolve a cobblestone throat. If the cause is viral, there is no real cure and the illness will have to run its course, and bacterial infections usually require antibiotics.

  • Is cobblestone throat contagious?

    Some forms of pharyngitis are contagious. Bacterial infections like strep and viral infections like SARS-CoV-2 that causes COVID-19 can all be passed from person to person. A sore throat caused by allergies or postnasal drip isn't as likely to be contagious.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. MedlinePlus. Pharyngitis.

  2. BMJ Best Practice. Acute pharyngitis.

  3. Wolford RW, et al. Pharyngitis. StatPearls.

  4. Centers for Disease Control and Prevention. Pharyngitis (strep throat).

  5. El-Anwar MW, Elzayat S, Fouad YA. ENT manifestation in COVID-19 patientsAuris Nasus Larynx. 2020;47(4):559-564. doi:10.1016/j.anl.2020.06.003

By Rachael Zimlich, BSN, RN
Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.