Strep throat is a common bacterial infection that affects the throat and tonsils. Caused by group A Streptococcus bacteria, it is highly contagious and spreads through respiratory droplets when an infected person coughs or sneezes. While many people associate white spots on the tonsils with strep throat, these spots are not always present, nor do they exclusively indicate a strep infection.
White Spots and Strep Throat
White spots on the tonsils, often appearing as patches, spots, or streaks of pus, can be a sign of strep throat. These white areas, known as exudates, form when the tonsils become inflamed as the body fights the bacterial infection. While their presence can be a strong indicator, it is not a universal symptom, as some individuals with strep throat may not develop them.
The appearance of these white spots can vary, from small, white, or yellowish patches against the red, swollen tonsils. It is possible to have strep throat without visible white spots, just as it is possible to have white spots from other conditions. Therefore, relying solely on their presence or absence for self-diagnosis is not accurate.
Other Indicators of Strep Throat
Beyond white spots, several other symptoms commonly accompany strep throat. A sudden and severe sore throat is a hallmark sign, often making swallowing difficult. Fever is also a frequent symptom. Tonsils also become red and swollen.
Other signs include tiny red spots on the roof of the mouth, called petechiae, and swollen, tender lymph nodes in the neck. Headache, stomach ache, nausea, or vomiting may occur, particularly in younger children. A red, sandpaper-like rash (scarlet fever) can also develop. Cough, runny nose, or congestion are generally not symptoms of strep throat and may suggest a viral infection.
Alternative Causes of White Spots on the Throat
White spots or patches on the throat are not exclusive to strep throat and can indicate various other conditions. Viral infections, such as mononucleosis (mono), are a common cause, often presenting with flu-like symptoms, fatigue, and swollen lymph nodes. Other viral infections, including those causing viral tonsillitis, can also lead to a white or yellow coating on the tonsils.
Oral thrush, a fungal infection caused by Candida albicans, can also result in white, creamy patches on the tonsils and other areas of the mouth. Tonsil stones, or tonsilloliths, are another possibility; these are small, hardened formations of debris that get trapped in the tonsil’s crevices. While generally harmless, tonsil stones can cause bad breath, a sore throat, or a feeling that something is stuck in the throat. Less common bacterial infections, distinct from strep, can also cause white spots or inflammation of the tonsils.
Confirming a Strep Throat Diagnosis
Accurately diagnosing strep throat is important because its symptoms can overlap with other conditions. A healthcare provider will perform a physical examination, inspecting the throat for signs like redness, swelling, and white patches. Diagnostic tests are then used to confirm the presence of Streptococcus bacteria.
A rapid strep test (RADT) can provide results within minutes from a throat swab. While highly specific, rapid tests can sometimes miss an infection, leading to a false negative. For this reason, a throat culture may be performed, sending a swab sample to a laboratory to grow any bacteria. Throat cultures are considered highly accurate but take 1 to 2 days for results. Prompt diagnosis and treatment with antibiotics are important to alleviate symptoms and prevent potential complications, such as rheumatic fever (which can affect the heart) or kidney inflammation.