White spots on tonsils no pain or fever

How to cure white spots in tonsils

A sore throat is caused by a reaction of the body to infections by viruses or bacteria that inflame the tonsils and pharynx, causing diseases like mononucleosis or bacterial tonsillitis. Therefore, usually the treatment is done with the use of anti-inflammatory drugs and, if necessary, antibiotics, prescribed by a general practitioner.

There are homemade methods that can speed recovery, such as gargling with salt and water.

The pus that appears in the throat should not be removed with your finger or swab as it will continue to form until the inflammation improves, and doing so may create wounds, as well as worsening the pain and swelling in that area. However, it is important to remember that the presence of yellow or whitish spots in the tonsils, without other symptoms, may be just a sign of white stones.

Remedies for sore throat with pus

Treatment should be done according to the cause of the infection, which can be diagnosed by a general practitioner or otorhinolaryngologist, thereby alleviating body pain and fever that may also be present, in addition to treating inflammation.

The main remedies used in treatment are:

  • Anti-inflammatory drugs, such as ibuprofen, nimesulide, ketoprofen: to improve inflammation, redness, difficulty swallowing and fever;
  • Corticosteroids, such as prednisone or dexamethasone: are used when anti-inflammatory drugs do not solve the problem or the sore throat is intense;
  • Antibiotics, such as benzarhine benzylpenicillin, amoxicillin or azithromycin: are used only in cases of bacterial infection, to eliminate the bacteria that caused the infection.

In some cases, the infection may form an abscess in the tonsils, and when this happens, the doctor can drain the accumulated pus.

What can cause white spots on the tonsils

The main causes of white spots in the tonsils are viral infections, such as Epstein-Barr, which causes mononucleosis, measles virus or cytomegalovirus, for example, or infections by bacteria that infect the respiratory tract, such as streptococci or pneumococcus.

Home Treatment Options

There are home remedy options that can help treat throat inflammation, and reduce the amount of pus such as:

  • Gargling with lukewarm water and salt, or lemon with water and honey;
  • Honey teas with ginger, eucalyptus, mauve, salvia or althea;
  • Drink grapefruit juice. Ideally, grapefruit juice should not be used if you are already taking medication prescribed by your doctor, as it may reduce the effectiveness of the medication.

This type of treatment can be done as soon as the throat begins to become swollen, to avoid it getting worse, or in conjunction with the medication to remove the pus from the throat prescribed by the doctor.

In addition, throughout the treatment, it is important to rest and drink plenty of fluids, to help the body recover.

‘I have a sore throat – I need antibiotics’

Debunking common patient myths and misconceptions

The myth

A painful sore throat means I have tonsillitis – particularly if there are white spots on my tonsils – and I need antibiotics.

The reality

Most sore throats are caused by a viral infection and don’t require antibiotics.

A sore throat is a common condition, with a third of adults reporting a sore throat and a third of those visiting the doctor each year.1 You should explain to patients that a sore throat is usually a self-limiting condition, with a 40% chance of recovery within three days and 85% chance within a week. Antibiotics will generally reduce the duration of symptoms by one day – but at the risk of side effects such as diarrhoea and thrush, as well as the risk of building up a resistance to the drug.

The NICE guidance says that ‘most people get better without antibiotics’ and ‘withholding antibiotics rarely leads to complications’,2 but it is still common for people to believe that a severe sore throat or flecks of white pus on the tonsils means that antibiotics are needed.

The severity of a sore throat can be assessed using either the Centor score or FeverPAIN (see box, right). NICE recommends using one or the other; in practice, they are essentially the same.

Even if a patient has a maximum score that doesn’t necessarily mean they require antibiotics. A maximum FeverPAIN score of 5 gives no more than a two-thirds chance that the streptococcus bacteria will be isolated from the throat. The Centor top score is even less, with 4 giving a 50-60% chance of a bacterial infection.

Most of the features of these score systems can be accessed without seeing the patient, which is useful for services that use phone triage. Over the phone, if a patient has no temperature or painful lumps in their neck and has a cough, they will not need antibiotics, even if they have white spots in their throat. Instead, they can be signposted to their local pharmacy, where they can combine over-the-counter analgesia, such as paracetamol or ibuprofen, with throat lozenges and analgesic throat sprays. There is little evidence for the use of these treatments but anecdotally they are useful.

However, there are cases when a sore throat can be more serious and does require antibiotics if indicated by the FeverPAIN/Centor scores. For example, patients taking drugs that suppress the immune system, such as methotrexate, ciclosporin, mycophenolate (usually given orally), and injectable biologic drugs that often end in ‘mab’, such as infliximab and adalimumab. These patients hopefully should be aware that they are immunocompromised and should tell you this information.

The same may apply to patients who are on chemotherapy or have HIV, which isn’t well-controlled with antiretroviral drugs. Any patients taking carbimazole for hyperthyroidism, which can sometimes suppress the bone marrow so that there aren’t enough white blood cells to fight infection, and presents with a sore throat should have a full blood count taken.3

Complications from a sore throat are rare and the SIGN guidance states that antibiotics should not be given to prevent complications, specifically because there is no evidence that they prevent rheumatic fever, glomerulonephritis, quinsy, or infection spreading in the community.4

We have a responsibility to manage antibiotics wisely, or they may not be available for future generations.5 It is rare that a sore throat needs antibiotics and we should take an evidence-based approach to only prescribe if absolutely necessary.

Methods to assess the severity of a sore throat

FeverPAIN score – one point for each, maximum 5

  • Fever (during the previous 24 hours)
  • Purulence (pus on tonsils)
  • Attend rapidly (within three days after onset of symptoms)
  • Severely inflamed tonsils
  • No cough or coryza (inflammation of mucus membranes in the nose)

Centor score – one point for each, maximum 4

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • History of a fever
  • Absence of a cough

  1. NICE CKS: Sore throat – acute. London;NICE:2018
  2. NICE. NG84: Sore throat (acute): antimicrobial prescribing. London;NICE:2018
  3. BNF. Carbimazole. London;NICE:2018
  4. SIGN 117. Management of sore throat and indications for tonsillectomy. Edinburgh;SIGN:2010
  5. Davies S, Sugden R. What if antibiotics were to stop working? London:The King’s Fund

Tonsillitis: Diagnosis and Tests

How is tonsillitis diagnosed?

To diagnosis tonsillitis, your doctor will:

  • Examine your throat for redness, swelling or white spots on the tonsils
  • Ask about other symptoms you’ve had, such as a fever, cough, runny nose, rash or stomachache
  • Look in your ears and your nose for other signs of infection
  • Feel the sides of your neck to see if the lymph nodes are swollen and tender

After confirming a tonsillitis diagnosis, your doctor will need to determine whether the infection results from a virus or bacteria (strep throat).

How is strep throat diagnosed?

Your doctor may order a throat culture — also known as a strep test — to determine if you have strep throat. A throat culture is a simple test that checks for the presence of specific bacteria in your throat. During a throat culture:

  1. Your doctor will swipe the back of your throat with a long cotton swab to gather saliva and cells. The test may feel uncomfortable, but it is not painful.
  2. While you wait, your doctor will test the cells to check for bacteria. This test is called a “rapid strep test.” The results are ready in about 10-15 minutes.
  3. If the results are positive and the test does detect bacteria, your doctor will prescribe an antibiotic to treat you for strep throat.
  4. If the results are negative and the rapid strep test does not detect bacteria, your doctor may send the sample away to a lab for more thorough testing. This longer lab test usually takes 2-3 days to get results.
  5. If the lab test results come back negative, you’ll know the tonsillitis is viral, not bacterial.

How do I know if I have tonsillitis?

If you have a sore throat, swollen tonsils and pain with swallowing, you may have tonsillitis. You should visit your doctor to determine whether bacteria or a virus is causing the tonsillitis. The treatment varies based on the type of infection.

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White spots on tonsils can be an alarming sight to see, but many of the causes are not a reason for you to fret. Tonsils are located at the back of the throat, and you can actually see them if you open your mouth wide and look into a mirror. Some individuals develop a condition that impacts their tonsils so they have to remove them, but the majority of people go their whole lives with them.

When you’re sick, your tonsils may become red, sore, or even swollen, and sometimes when this occurs you may notice white spots, which may be filled with pus. Finding out the underlying cause of the white spots on tonsils is important for you know how to properly treat them. In many cases, they will go away on their own, but other conditions do require medical intervention.

Here we will outline the many different causes of white spots on tonsils along with symptoms and treatment options.

What are causes and symptoms of white spots on tonsils?

Tonsil stones: Tonsil stones are hardened white deposits of fragments compiled of bacteria, food particles, dead cells, and mucus. Tonsils normally contain cells to fight off infection, but they can still become infected when the tonsil stones get trapped.

Common symptoms of tonsil stones include bad breath and ear aches. The good news is that tonsil stones don’t normally require treatment, but if they cause discomfort or distress your doctor may have to remove your tonsils.

Tonsillitis: Tonsillitis is the inflammation of the tonsils, accompanied by fever and swallowing difficulty. Pus inside the white spots on tonsils indicates either a bacterial or a viral infection. Other symptoms of tonsillitis include headache, stiff neck, and fever.

If the cause of the infection is bacterial, your doctor will prescribe antibiotics. If tonsillitis is recurring, then your doctor will remove your tonsils.

Strep throat/pharyngitis: Strep throat and pharyngitis are similar conditions that can cause white spots on tonsils. Strep throat is more serious than pharyngitis because it is brought on by the strep bacteria, which can cause extreme sore throat, fever, difficulty swallowing, chills, and in some causes nausea and vomiting.

To treat strep throat, your doctor will prescribe antibiotics. If strep throat is left untreated it can get progressively worse, and the bacteria may even enter the bloodstream making the condition deadly.

Pharyngitis is caused by a virus, so antibiotics cannot be prescribed. Treatment for pharyngitis usually involves gargling salt water.

Oral thrush: Oral thrush is a fungal infection in the mouth and throat area. The fungus responsible for oral thrush is candida albicans – yeast infection. We always have some level of candida albicans in our body, but when the levels rise and there is an imbalance that is when infection can occur. White spots will develop along the cheeks and tongue, so your taste will be altered.

Mononucleosis (kissing disease): Mononucleosis, also known as the kissing disease or mono, is a viral infection, which causes headache, fever, and persistent tiredness. Severe sore throat and pus-covered swollen tonsils are also characteristic of mono.

Diphtheria: Diphtheria is a respiratory infection that affects the nostrils and throat. It is caused by bacteria. Symptoms include inflamed lymph nodes, fever, and difficulty swallowing and breathing.

At first, the tonsil may appear to have a grey-white layer, and in other incidences it appears in white patches covering the tonsils. Children over the age of five are at highest risk for diphtheria. The good news is, there is a vaccination for this condition that can prevent it.

Vincent’s angina: This is an ulcer formation on the oral cavity, pharynx, and tonsils. The ulcers will begin on the gums and continue to spread. Eventually, they will bleed even with the slightest touch and white spots will develop on the tonsils. Antibiotics are the common mode of treatment for Vincent’s angina.

Viral pharyngitis: This is an infection of the pharynx causing the pharynx and tonsils to swell. Pus will form on the tonsils appearing as white spots. If the infection is bacterial you will be prescribed antibiotics. If it’s viral, it will clear up on its own.

STDs: Some sexually transmitted diseases (STDs) can cause white spots on tonsils. STDs that can cause white spots on tonsils include chlamydia, gonorrhea, herpes simplex virus, and HIV. Symptoms may include nausea, allover pain, fever, reduced appetite, sore throat, mouth sores, itchy mouth, swollen gums, swollen uvula, and swollen lymph nodes.

Smoking and leukoplakia: Smoking can increase the risk of oral cancer and leukoplakia, which is a precancerous condition. Early signs of leukoplakia include white patches on the mouth, tongue, and tonsils. Smoking cessation often resolves the white spots, but your doctor may need to scrape them off if they are cancerous.

Other miscellaneous conditions

White spots on tonsils – no fever: Sometimes, tonsillitis can occur without the presence of a fever and tonsil stones can also develop without any other symptoms except for notable white spots on tonsils. Even if you don’t have a fever but notice white spots, you may still want to go in and have your doctor confirm diagnosis of tonsil stones.

White spots on tonsils – no pain: White spots without the presence of pain could be a viral infection or a malignant growth. Generally, viral infections will clear up on their own, so there is no need to worry. Simply gargling with salt water can help clear up the white spots on tonsils.

White spots on tonsils – not strep: A negative test result for strep in the presence of white spots on tonsils could be a result of any other of the conditions listed above. Your doctor will have to run further testing to determine the cause.

White spots on tonsils – allergies: In some cases, seasonal allergies can cause white spots on tonsils as a result of a post-nasal drip. You may find that treating your allergies may resolve the white spots on tonsils.

How to get rid of white spots on tonsils?

If you have a specific cause for white spots on tonsils stemming from a bacteria or fungus, your doctor will prescribe antibiotics or antifungal medications as a treatment. If your condition is caused by a virus or something else non-threatening, there are some general tips you can use in order to get rid of the white spots on tonsils.

  • Get plenty of rest
  • Gargle salt water
  • Drink warm or cold fluids to ease throat pain
  • Eat smooth foods like ice cream or yogurt
  • Use a cool mist humidifier in your room
  • Suck on lozenges
  • Use over-the-counter pain relievers
  • Avoid irritating foods, like spicy food, chips, raw vegetables, highly acidic food, etc.
  • Avoid smoking
  • Use a cotton swab to dislodge tonsil stones
  • Limit alcohol consumption

By utilizing some of these tips you can help reduce or even get rid of the white spots on tonsils, as well as reduce the associated pain.

On this page:

  • What is mono?
  • Symptoms
  • Diagnosis
  • Treatment
  • Prevention
  • Further information

What is mono?

Infectious mononucleosis (also known as “mono” or the “kissing disease”) is a fairly common viral disease that usually affects adolescents and young adults, including college students. The infection is typically caused by the Epstein-Barr virus but may be caused by other related viruses.

Many college students have already developed immunity or resistance by the time they reach college age. Once you have had mono it is unlikely that you will ever get it again.

Symptoms:

Symptoms usually appear 20-50 days after infection. The severity of symptoms varies greatly between individuals. Symptoms may be so mild that one can have mono without knowing it. In other cases, symptoms may be severe enough to require hospitalization. Common symptoms include:

  • Severe sore throat, which is almost always present and lasts about 6-10 days. The throat may be very red, with white spots or pus on the tonsils. This can initially look similar to strep throat.
  • Fever of 100-103° F (37.8-39.4° C), which is usually worst during the first week and may worsen at night.
  • Swollen, tender glands (lymph nodes) in the neck, lasting up to one month after you are feeling well.
  • Fatigue
  • Headaches

Diagnosis:

If you have any symptoms and are concerned that you may have mono, you should visit a clinician. See How to Get Health Care.

  • The clinician will perform a physical exam, including of your throat and glands. Because mono symptoms are similar to those of other infections, the clinician will try to determine whether your symptoms are those of mono, strep throat or another viral infection. The clinician may swab the back of your throat.
  • If streptococcus (strep) is present, you may be treated with an antibiotic.
  • Blood tests for mono measure antibodies to the virus and therefore testing is not usually positive until symptoms have been present for one week or more.
  • If streptococcus is not present and your symptoms continue for 7-10 days, you should return to your clinician for possible further testing.

Treatment:

Like the common cold, mono is a viral infection with no cure. Antibiotics do not work as a treatment for mono.

You can follow these self-care measures to feel better.

  • Gargle: To reduce throat pain, gargle with one teaspoon of salt (or baking soda) dissolved in a glass of very warm water. You can purchase non-prescription medications like Chloraseptic gargle or lozenges, or your clinician may write a prescription for gargles that reduce throat pain and make swallowing easier.
  • Take medication: For fever, sore throat, head and body aches, ibuprofen or naproxen (Aleve) are available without prescription. Follow directions on packaging. Avoid acetaminophen (Tylenol) because of possible liver inflammation that can be associated with mono.
  • In addition, you need to take special care of yourself during recovery.
  • Refrain from vigorous activities: Because mono can affect the entire lymph system, including the spleen (located under your left lower rib cage), avoid vigorous activities such as football, soccer or running. Do not play contact sports until at least 6-8 weeks after diagnosis or onset of symptoms. You can do mild exercises such as walking or swimming, as long as the activity doesn’t increase fatigue.
  • Rest at least eight hours per night: Attend classes if you feel able, but plan to rest often.
  • Eat nutritious foods: To strengthen your immune system and help reduce symptoms, eat antioxidant rich foods like leafy vegetables, peppers, and blueberries, avoid refined foods like sugar and white breads, and blend your foods or eat them with a liquid to soothe a sore throat.
  • Drink plenty of non-caffeinated fluids to avoid dehydration: Non-caffeinated Green tea has beneficial antioxidants and anti-inflammatory effects.
  • Avoid alcoholic beverages and drugs not prescribed by your clinician for at least six weeks, because of possible liver inflammation.

You will probably feel most ill for the first two weeks of the infection. After this time, you should gradually improve, but your energy level may be reduced longer. The recovery process varies from person to person, so base your activities and check-ups on how you feel.

Prevention:

Mono is usually spread by close contact from one person to another, hence the name “kissing disease.” The infection is not highly contagious and does not usually spread to roommates. As a precaution, you should avoid sharing drinking glasses, eating utensils, food, and kissing until your sore throat and other symptoms have disappeared for several (4-6) weeks. Be sure to cover coughs and sneezes, and wash your hands thoroughly and often.

There is no test available for exposure to mono.

For more information:

For health care at UHS:

  • Nurse Advice by Phone is available day and night, which may save a trip to UHS or the ER.
  • See How to Get Health Care — Appointments are required for most medical services, although options are available for urgent problems

For more on mono, see Medline Plus

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