White patches on the tonsils are a common symptom with various underlying causes. These spots often indicate an infection or irritation. Understanding their causes is key to appropriate management.
Understanding the Common Causes
Bacterial infections frequently cause white patches on tonsils. Strep throat, caused by Streptococcus pyogenes, often presents with white streaks or pus on the tonsils and throat. These patches form as the immune system combats bacteria, accumulating dead white blood cells and bacterial debris. Bacteria can lodge in the tonsil’s small crevices, known as crypts, leading to localized inflammation.
Viral infections also cause white patches on tonsils. Infectious mononucleosis (“mono”), caused by the Epstein-Barr virus, often causes white spots or pus on the tonsils. Common cold viruses, such as rhinovirus or adenovirus, can also lead to viral tonsillitis, which may present with a white or yellow coating.
Fungal infections, such as oral thrush (candidiasis), can cause white patches on the tonsils. This condition, an overgrowth of Candida albicans, often presents as creamy white, slightly raised patches resembling cottage cheese. These patches can also appear on the tongue, inner cheeks, and roof of the mouth.
Non-infectious factors also contribute to white patches. Tonsil stones (tonsilloliths) are hardened deposits forming when bacteria, food particles, and debris become trapped in tonsil crevices and calcify. They appear as small white or yellowish spots. Canker sores (aphthous ulcers) are small lesions that can develop in the mouth or throat, including on a tonsil, appearing as a white or gray spot with a red border.
Other Accompanying Signs
White patches on the tonsils often occur alongside other symptoms. A sore throat is a frequent accompanying symptom, often worsening with swallowing. This discomfort can range from mild to sharp, depending on the inflammation.
Fever is another common sign, particularly with infections like strep throat or mononucleosis, indicating the body’s response. Swollen lymph nodes in the neck are also often present, as they filter and fight infection.
Other symptoms include bad breath, especially with tonsil stones due to trapped debris and bacteria. Difficulty swallowing, fatigue, headache, and body aches may also occur. In some cases, the tonsils may appear red and swollen.
Knowing When to Seek Medical Attention
While white patches on tonsils can sometimes resolve on their own, certain signs indicate medical evaluation is needed. Consult a doctor if symptoms are severe, persistent, or cause significant pain.
Also consult a healthcare provider if symptoms worsen or do not improve after a few days. Red flags include difficulty breathing or swallowing, a high fever above 101°F (38.3°C), or severe, draining fatigue. Recurrent infections or white patches that do not disappear also warrant a medical visit.
Diagnosis and General Management
A healthcare professional diagnoses white patches on tonsils with a physical throat examination. They may also ask about other symptoms to understand the full clinical picture. A common diagnostic step is a throat swab, tested for bacterial infections like strep throat using a rapid strep test or culture. Blood tests may also identify viral infections, such as mononucleosis.
Management strategies depend on the identified cause. For bacterial infections, antibiotics are typically prescribed to clear the infection and reduce symptoms. It is important to complete the full course of antibiotics as prescribed. Viral infections often do not require specific medication, managed with supportive care including rest, adequate fluid intake, and pain relievers.
Fungal infections like oral thrush are generally treated with antifungal medications. For recurrent or severe issues, such as chronic tonsillitis or problematic tonsil stones, a tonsillectomy (surgical removal) might be considered. For tonsil stones not causing significant discomfort, treatment might not be necessary, or they may be dislodged with gargling.