White spots, blotches, or streaks on the tonsils can be a sign of various conditions, including strep throat and oral thrush. Treatment is available for most of these conditions.
The tonsils are part of the lymphatic system and located on the back of the throat. Changes to the appearance of the tonsils may be a sign that the body is reacting to an infection.
Often, there will also be a sore throat or swollen tonsils. In some cases, the spots may contain pus.
Possible causes include:
- strep throat
- oral thrush
- viral tonsilitis
- mononucleosis, or “mono”
- tonsil stones
Here, find out about some causes of white spots on the tonsils, when to see a doctor, and which treatment they might prescribe.
Symptoms will depend on the cause, but a person may notice:
- white spots, streaks, or blotches on the tonsils or throat
- a sore throat
- difficulty swallowing
- other symptoms, such as a fever, fatigue, or nasal congestion, depending on the cause
The most common cause of white spots on the tonsils is a bacterial, viral, or fungal infection.
Some of the more common infections that can cause white spots include:
Strep throat
Strep throat is a bacterial infection caused by Streptococcus.
Additional symptoms that may indicate strep throat include:
- sore throat
- fever
- swollen lymph nodes in the neck
- headache
- inflamed and swollen tonsils
Strep throat is a common infection. According to the Centers for Disease Control and Prevention (CDC), it is most common in:
- children
aged 5–15 years - adults who spend time with school-aged children
- those who spend time in crowded settings, such as day care centers and military training facilities
If a person suspects they or someone they are caring for has strep throat, they should seek medical advice. While rare, complications can arise if the bacteria spread to other parts of the body, such as the heart. They include rheumatic fever, ear and sinus infections, and post-streptococcal glomerulonephritis, which affects the kidneys.
Oral thrush
Oral thrush is a fungal infection that can affect the mouth and throat.
Possible other symptoms
- pain when swallowing
- difficulty swallowing
- redness and soreness
- loss of taste
- a feeling like cotton in the mouth
- cracking at the corners of the mouth
White spots may also appear on the cheeks, tongue, and roof of the mouth.
Oral thrush can affect anyone but is most common in those who:
- use dentures
- have a weakened immune system, as with HIV and some cancers and cancer treatments
- have diabetes
- use antibiotics or corticosteroids for a long-term condition, such as asthma
- use inhale corticosteroids without a spacer
- have a dry mouth or use medications to treat dry mouth
- smoke
It can affect infants and babies.
Fungal spores are often present in the mouth, throat, and digestive tract, but they do not usually cause an infection. However, symptoms can appear if conditions change, for example, if the immune system becomes weakened.
Viral tonsillitis
Tonsillitis involves inflammation or swelling of the tonsils. It usually results from a viral infection but can occur with strep throat.
Symptoms of viral tonsillitis include:
- red and swollen tonsils, possibly with pus
- a white or yellow coating on the tonsils
- a sore throat
- pain and difficulty when swallowing
- swollen lymph nodes in the neck
- fever
- bad breath
- mouth breathing or sleep apnea
Tonsillitis may occur with the following viruses:
- the Epstein-Barr virus, which causes infectious mononucleosis
- the herpes simplex virus
- measles
- cytomegalovirus
It can also occur with strep throat, which is a bacterial infection.
Infectious mononucleosis
Mononucleosis is a viral infection caused by the Epstein-Barr virus, which affects certain blood cells.
Along with white spots on the back of the throat, symptoms may include:
- fever
- sore throat
- severe fatigue
- head and body aches
- swollen lymph nodes in the neck and underarms
- swollen liver, spleen, or both
- a rash
Infectious mononucleosis spreads easily from person to person. Those most at risk are teenagers and young adults.
Tonsil stones
Tonsil stones, also called tonsilloliths, are like hard, white stones that form on the tonsils. Often, a person will not notice they are there, but sometimes they can become large.
One
Tonsil stones, or tonsilloliths,
Many people with tonsil stones do not notice them, but symptoms can include:
- bad breath
- ear pain
- a feeling of having something stuck in the throat
- painful swallowing
Leukoplakia
Some tissue changes
Common causes include:
- smoking
- chewing tobacco
- dentures that do not fit well
chewing betel nut
In rare cases, it can be an early sign of cancer. For this reason, a doctor may recommend a biopsy.
Other causes of white spots on tonsil
Other possible causes include:
A person should seek medical advice if they have:
- severe or persistent symptoms
- symptoms that may indicate strep throat
- recurrent infections
- difficulty breathing
- any other concerns about white spots on the throat
- hoarseness lasting over 2 weeks
- a fever over 101°F (38.3°C)
- blood in saliva or phlegm
- a lump in the neck
- earache
A doctor will:
- Look in the back of the throat.
- Feel around the neck for any swelling.
- Ask about other symptoms.
They may also take a throat swab or do blood tests for testing in a laboratory. These can show if bacteria are present, in which case they may prescribe antibiotics.
Treatment will depend on the cause of the white spots.
A doctor may recommend the following:
| Treatment | Other notes | |
| Strep throat | antibiotics, such as penicillin or amoxicillin | If a person tests positive but has no symptoms, they will not need antibiotics. |
| Oral thrush | antifungal medications, such as clotrimazole, miconazole, or nystatin, applied to the area for 7–14 days | For more severe infections, a doctor may prescribe fluconazole. |
| Viral tonsilitis | managing symptoms through rest, drinking fluids, eating soft food, avoiding exposure to smoke, gargling with salt water, acetaminophen for pain relief, and other home remedies | Antibiotics will not help with a viral infection; it usually gets better without medical treatment. |
| Infectious mononucleosis | managing symptoms through rest, drinking plenty of fluids, over-the-counter medication, such as acetaminophen for pain and fever, and other home remedies | Antibiotics will not help with a viral infection. Symptoms usually go away after |
| Tonsil stones | minor surgery to remove the stones if they are troublesome | More severe cases may need removal of the tonsils. |
| Leukoplakia | if necessary, minor surgery or laser surgery | Further treatment will depend on the result of a biopsy, if appropriate. |
| Other causes | treatment as appropriate |
A person who has recurrent infections of the tonsils may need surgery to remove them, known as a tonsillectomy.
At-home treatment
Depending on the cause, treatment at home can help manage symptoms.
This may include:
- drinking warm liquids to decrease throat pain
- eating only soft foods if swallowing is difficult
- avoiding smoking or exposure to smoke
- eating popsicles to soothe a sore throat
- taking over-the-counter pain relievers, such as acetaminophen
- getting plenty of rest, which allows the body to fight any infection
- using a humidifier
- sucking on throat lozenges to ease discomfort, but only from the age of 4 years or over, due to the risk of choking
The time it takes for white spots to clear up will depend on the cause, treatment, and individual factors.
It is not always possible to prevent white spots on the tonsil, but people can reduce the risk of some conditions that cause them.
Tips include:
- washing the hands often to reduce the risk of infections
- boosting the immune system through a well-balanced diet, exercise, and regular sleep
- covering the nose and mouth when coughing to avoid passing on infections to others
- limiting close contact with others who have an infection
- practicing good oral hygiene, including regular dental checkups
- being aware of how the tonsils usually appear and monitoring any changes
- avoiding or quitting smoking
- use a spacer when using an inhaler for thrush
Here are some questions people often ask about white spots on the tonsils.
Should I be worried about white spots on the tonsils?
If white spots occur with severe or persistent symptoms or if symptoms do not disappear after 2–3 weeks, it is a good idea to seek medical advice.
Can you have white spots without having strep throat?
Yes, other causes include viral or bacterial tonsillitis, oral thrush, and tonsil stones.
How can I get rid of white spots on my tonsils?
This will depend on the cause. Often, they go away as an infection clears, either with home remedies or with medical treatment. A doctor can advise on specific options.
White spots can occur on the tonsils for various reasons, including infections, tonsil stones, and oral thrush. Sometimes other symptoms occur, such as a sore throat, bad breath, or difficulty swallowing.
Often, the condition that causes white spots either goes away without medical treatment, but home remedies can help manage symptoms. In some cases, surgery may be necessary.
Anyone who has concerns about white spots appearing on their tonsils should seek medical advice.