Ulcers on tonsils are lesions that develop on lymphoid tissues. These painful sores typically appear as small, round or oval lesions with a distinct red edge and a white, gray, or yellowish center. Understanding their origins can help clarify their presence.
Viral Origins
Viruses are a common cause of tonsil ulcers, often leading to inflammation. The herpes simplex virus (HSV) can cause painful blisters on the tonsils that then rupture into ulcers.
Coxsackievirus, particularly the strains responsible for hand, foot, and mouth disease, produces painful, shallow, yellow ulcers surrounded by red halos on various oral structures, including the tonsillar pillars and posterior pharynx. The Epstein-Barr Virus (EBV), known for causing infectious mononucleosis, can lead to severe throat inflammation and prominent tonsil enlargement with possible exudates, which may also result in ulceration. Adenoviruses are also known to cause pharyngitis, which can present with symptoms like sore throat, fever, and sometimes lead to follicular hyperplasia of the tonsils, potentially resulting in ulcerated areas.
Bacterial and Fungal Origins
Bacterial infections are another significant source of tonsil ulcers, often leading to intense inflammation. Streptococcus pyogenes, the bacterium responsible for strep throat, can cause severe inflammation and white patches on the tonsils, which in some cases can progress to ulceration. While less common, certain bacterial infections can cause abscesses or severe inflammation that lead to ulcer formation on the tonsils.
Syphilis, a bacterial infection caused by Treponema pallidum, can also manifest with oral lesions, including ulcers on the tonsils, especially during its primary or secondary stages. Primary syphilis typically presents as a painless ulcer, known as a chancre, which can appear on the tonsillar area. During secondary syphilis, multiple scattered lesions or ulcers with irregular, whitish edges may be observed on the oral mucosa and oropharynx, including the tonsils. Fungal infections, primarily Candidiasis or oral thrush, can also contribute to tonsil ulcers. This condition causes white, curd-like patches that, when removed, may reveal underlying red, ulcerated tissue.
Other Non-Infectious Factors
Not all tonsil ulcers stem from infections; various non-infectious factors can also be responsible. Physical injury or trauma, such as that caused by sharp food items, vigorous coughing, or even certain dental procedures, can directly create open sores on the tonsils. Persistent irritation or friction can also delay the healing process of these traumatic ulcers.
Autoimmune conditions represent another category of non-infectious causes. Aphthous ulcers, commonly known as canker sores, are small, painful lesions that can appear on the soft tissues of the mouth, including the tonsils. Behçet’s disease, a chronic inflammatory condition, frequently causes recurrent and painful mouth ulcers that can affect the tonsils, often appearing as one of the first symptoms. Additionally, certain inflammatory bowel diseases, such as Crohn’s disease, can manifest with oral or tonsillar ulcers, sometimes even before intestinal symptoms appear. Nutritional deficiencies, particularly severe shortages of vitamins like B12, folate, or minerals such as iron and zinc, can impair tissue repair mechanisms, leading to recurrent ulcer formation; in rare instances, a persistent tonsil ulcer may be a symptom of oral or throat cancer, making medical evaluation important for any unexplained or non-healing lesions.