Tonsillitis is an infection of the tonsils, the two oval-shaped pads of tissue at the back of your throat. You get it when a virus or bacteria enters your mouth or nose and infects these tissues. The most common cause is a virus, such as the same viruses that cause the common cold, while a specific type of bacteria called group A Streptococcus causes the bacterial form often known as strep throat.
What Exactly Causes Tonsillitis?
Tonsils are part of your immune system. They act as the first line of defense against germs that enter through your mouth. When they trap a virus or bacteria, they can become infected and swollen.
Viruses cause most cases of tonsillitis. The adenoviruses, rhinoviruses, and influenza viruses that cause colds and the flu are common culprits. The Epstein-Barr virus, which causes mononucleosis, can also lead to tonsillitis, especially in teenagers and young adults.
Bacteria cause a smaller percentage of cases. Group A Streptococcus is the most common bacterial cause. This is what doctors call strep throat. Other bacteria can cause it too, but they are far less common.
How Is Tonsillitis Spread From Person to Person?
Tonsillitis spreads through respiratory droplets. When an infected person coughs, sneezes, or talks, they release tiny droplets into the air. You can inhale these droplets or touch a surface they land on and then touch your nose or mouth.
You can also get it through direct contact. Kissing someone who is infected or sharing a drink, utensil, or toothbrush can transfer the germs. This is why tonsillitis often spreads quickly through households, schools, and daycare centers.
Good hand hygiene is the most effective way to reduce your risk. Washing your hands with soap and water for at least 20 seconds, especially after being in public spaces, makes a real difference.
What Are the First Signs You Have Tonsillitis?
Symptoms usually appear suddenly. The most common sign is a sore throat that comes on quickly. Your throat may feel raw, scratchy, or painful when you swallow.
Other common symptoms include:
- Red, swollen tonsils that may have white or yellow patches on them
- Pain when swallowing
- A fever
- Swollen lymph nodes in the neck
- A scratchy or muffled voice
- Bad breath
In younger children, symptoms can be less specific. They may have a stomach ache, drool more than usual, or refuse to eat because swallowing hurts.
If your tonsils become very swollen, they can make it hard to breathe. This is a medical emergency. Seek immediate care if you or your child struggles to breathe, drools uncontrollably, or has difficulty swallowing liquids.
How Can You Tell If It Is Viral or Bacterial?
The distinction matters because treatment differs. Viral tonsillitis usually resolves on its own. Bacterial tonsillitis may need antibiotics to prevent complications and reduce how long you are contagious.
Viral tonsillitis often comes with a cough, runny nose, or hoarse voice. Bacterial tonsillitis more commonly causes a high fever, severe throat pain, and swollen lymph nodes without a cough.
Doctors can do a rapid strep test in the office to check for group A Streptococcus. The test involves swabbing the back of your throat. Results come back in minutes. If the rapid test is negative but your doctor still suspects strep, they may send a throat culture to a lab. This takes a day or two but is more accurate.
Do not assume a sore throat is strep just because it hurts. Most sore throats are viral. Treating a viral infection with antibiotics does not help and contributes to antibiotic resistance.
How Long Are You Contagious With Tonsillitis?
If you have viral tonsillitis, you are typically contagious from a day or two before symptoms appear until your symptoms resolve. For most people, this means about 5 to 7 days.
If you have bacterial tonsillitis and take antibiotics, you are usually no longer contagious after 24 hours of treatment. Without antibiotics, you can spread the bacteria for up to 2 to 3 weeks.
Fevers are a useful guide. Most experts recommend staying home until you have been fever-free for 24 hours without using fever-reducing medication. This helps prevent spreading the infection to others.
What Treatments Actually Work for Tonsillitis?
For viral tonsillitis, treatment focuses on symptom relief. Your immune system will clear the infection on its own, usually within a week. Drinking warm liquids, gargling with salt water, and using over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.
For bacterial tonsillitis, doctors prescribe antibiotics. Penicillin and amoxicillin are the most common choices for strep throat. It is essential to finish the entire course of antibiotics even if you feel better before they run out. Stopping early can leave some bacteria alive and increase the risk of complications.
Some research suggests that honey can soothe a sore throat. A spoonful of honey may reduce coughing and improve sleep quality. Do not give honey to children under 1 year old due to the risk of infant botulism.
When Should You See a Doctor?
Most cases of tonsillitis do not require a doctor visit. If your symptoms are mild and you can manage them at home, your body will likely recover on its own.
See a doctor if you have:
- A sore throat lasting more than 2 days
- A fever above 101°F (38.3°C)
- Difficulty or pain when swallowing
- Swollen, tender lymph nodes in your neck
- White patches on your tonsils
Seek emergency care immediately if you have trouble breathing, excessive drooling, or severe difficulty swallowing. These can be signs of a blocked airway.
Can You Get Tonsillitis More Than Once?
Yes. Having tonsillitis does not make you immune. Your body develops antibodies to the specific virus or bacteria that caused your infection, but there are many different viruses and bacteria that can cause tonsillitis.
Some people get recurrent tonsillitis. This is defined as multiple episodes in a single year. If you or your child has frequent episodes that interfere with daily life, a doctor may discuss a tonsillectomy, which is surgical removal of the tonsils.
Tonsillectomy is not recommended for every case of recurrent tonsillitis. Current guidelines suggest it only for specific situations, such as 7 or more episodes in one year, 5 or more episodes per year for 2 consecutive years, or 3 or more episodes per year for 3 consecutive years. These numbers can vary based on individual circumstances, so discuss your specific situation with your doctor.
What Complications Can Arise From Tonsillitis?
Most people recover fully without complications. However, untreated bacterial tonsillitis can lead to more serious problems.
A peritonsillar abscess is a collection of pus behind the tonsil. It causes severe pain, difficulty opening the mouth, and a muffled voice. This requires drainage and antibiotics, often in a hospital setting.
Rarely, untreated strep throat can trigger rheumatic fever, which can damage the heart valves. This is now uncommon in developed countries because most people seek treatment for strep throat. It remains a concern in areas with limited access to healthcare.
You cannot prevent rheumatic fever with home remedies. Antibiotics are the only way to prevent this complication from a strep infection.
Frequently Asked Questions
Can you get tonsillitis from kissing?
Yes. Kissing can transfer the viruses or bacteria that cause tonsillitis through saliva. This is a common way the infection spreads, especially among teenagers and young adults.
Can you get tonsillitis from sharing drinks or food?
Yes. Sharing utensils, cups, or food can spread the germs that cause tonsillitis. The germs live in saliva and can survive on surfaces for a short time.
How long does tonsillitis last without antibiotics?
Viral tonsillitis usually lasts about 5 to 7 days. Bacterial tonsillitis can last longer without treatment, and you remain contagious for up to 2 to 3 weeks.
Is tonsillitis the same as strep throat?
No. Tonsillitis is inflammation of the tonsils, which can be caused by many viruses or bacteria. Strep throat is a specific bacterial infection caused by group A Streptococcus.
