Acute Tonsillitis / Pharyngitis Quiz

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Sore throat

Fatigued

Have a fever

Swallowing difficulties

White spots at the back of the throat

Pain when swallowing

Swollen tonsils

Not seeing your symptoms? No worries!

What is Acute Tonsillitis / Pharyngitis?

Infection of the tonsils and pharynx (back of the mouth), either by viruses or bacteria.

Typical Symptoms of Acute Tonsillitis / Pharyngitis

Diagnostic Questions for Acute Tonsillitis / Pharyngitis

Your doctor may ask these questions to check for this disease:

  • Are you unable to swallow liquids?
  • Do you have yellow or green sputum?
  • Is your throat swollen?
  • Do you have pain at the back of your head?
  • Do you have a sore throat with pain when swallowing?

Treatment of Acute Tonsillitis / Pharyngitis

This condition may improve without treatment, especially if caused by viruses. The doctor may prescribe pain relievers, and in some cases antibiotics to fight a bacterial infection. Ensuring proper hydration is important as pain makes swallowing and drinking difficult.

Reviewed By:

Scott Nass, MD, MPA, FAAFP, AAHIVS

Scott Nass, MD, MPA, FAAFP, AAHIVS (Primary Care)

Dr. Nass received dual medical degrees from the David Geffen School of Medicine at UCLA and Charles R. Drew University in Medicine and Science. He completed Family Medicine residency at Ventura County Medical Center with subsequent fellowships at Ventura, University of North Carolina-Chapel Hill, George Washington University, and University of California-Irvine. He holds faculty appointments at Keck School of Medicine of USC, Loma Linda University School of Medicine, and Western University of Health Sciences.

Rohini R, MD

Rohini R, MD (Otolaryngology (ENT))

Dr. Rohini R is an ENT, Head and Neck Surgeon, with a Fellowship in Advanced Endoscopic Sinus and Skull Base Surgery and a Fellowship in Aesthetic Medicine and Lasers. Besides clinical practice and working with Ubie, she is actively training and mentoring medical students and residents. She has functioned in various work settings - teaching hospitals, private and free health centers, and worked with patients from all socioeconomic backgrounds due to her experience in free hospitals and volunteering in India and Singapore.

From our team of 50+ doctors

Content updated on Feb 13, 2025

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FAQs

Q.

Is it Strep? Why Your Throat is Raw & Medically Approved Next Steps

A.

There are several factors to consider, and only a strep test can confirm; see below for the full symptom checklist, when to seek care, and medically approved next steps. Strep is more likely with sudden severe throat pain, fever, swollen tender neck nodes, white tonsil patches, and no cough; it is treated with antibiotics to speed recovery and prevent complications. Cold-like features point to a viral sore throat managed with rest, fluids, and pain relievers, and red flags like trouble breathing or swallowing, drooling, a muffled voice, or rapidly worsening symptoms mean you should seek urgent care.

References:

* Varghese J, Ragu M, Shrivastava S. Diagnosis and Management of Group A Streptococcal Pharyngitis in Children and Adolescents: An Update for the Clinician. Pediatr Ann. 2021 Jun;50(6):e265-e271. doi: 10.3928/19382359-20210519-01. PMID: 34107567.

* Shulman ST. The Sore Throat: Management of Acute Pharyngitis. Infect Dis Clin North Am. 2023 Jun;37(2):299-317. doi: 10.1016/j.idc.2023.01.002. Epub 2023 Mar 23. PMID: 36967268.

* Feroz B, Khawaja S, Shoman R, Quraishy M, Baig AA. Group A Streptococcus (GAS) Pharyngitis: Current Landscape of Clinical Management, Rapid Diagnostics, and Antimicrobial Resistance. Diagnostics (Basel). 2023 Feb 1;13(3):525. doi: 10.3390/diagnostics13030525. PMID: 36766749; PMCID: PMC9914619.

* Shulman ST. Pharyngitis. JAMA. 2020 Nov 24;324(20):2116. doi: 10.1001/jama.2020.18376. PMID: 33231652.

* Arroll B, Kenealy T. Pharmacologic and Nonpharmacologic Treatments for Acute Pharyngitis. Am Fam Physician. 2021 Jun 15;103(12):735-742. PMID: 34128522.

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Q.

Is Strep Throat Contagious? Why Your Throat Is Spreading Germs & Medically Approved Next Steps

A.

Yes, strep throat is contagious and spreads easily through respiratory droplets and close contact; people are contagious even before symptoms and typically until 24 hours after starting antibiotics, while untreated cases can spread for 2 to 3 weeks. There are several factors to consider for testing, antibiotics, staying home, when it is safe to return, and preventing complications and spread; see the complete medically approved guidance below.

References:

* Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 1;55(10):e86-102. doi: 10.1093/cid/cis629. Epub 2012 Sep 10. PMID: 22965023.

* Knepper BC, Stauffer P, Huseby A, et al. Transmission of Streptococcus pyogenes: a review of the literature. J Infect. 2012 Oct;65(4):307-13. doi: 10.1016/j.jinf.2012.06.002. Epub 2012 Jun 15. PMID: 22709664.

* Choby BA. Diagnosis and Management of Group A Streptococcal Pharyngitis. Am Fam Physician. 2020 Jul 15;102(2):100-106. PMID: 32667185.

* Ralph AP, Carapetis JR. Group A streptococcal pharyngitis: a concise review. J R Coll Physicians Edinb. 2018 Sep;48(3):263-267. doi: 10.4997/JRCPE.2018.318. PMID: 30207204.

* Kaplan EL. Prevention of Rheumatic Fever: The Best Defense Against Group A Streptococcus. Clin Infect Dis. 2018 Oct 1;67(Suppl 1):S10-S13. doi: 10.1093/cid/ciy329. PMID: 30141123.

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Q.

Is it Strep? Why Your Throat is Inflamed & Medically Approved Next Steps

A.

There are several factors to consider: strep throat usually means sudden severe throat pain and fever with no cough, often with swollen or pus-covered tonsils, and it requires confirmation by a rapid test or throat culture before antibiotics; most sore throats are viral and respond to rest, fluids, and pain relief. See below for medically approved next steps, including when to get tested, when antibiotics are appropriate, the red flags that need urgent care, practical home care tips, how long you may be contagious, and what is different for children.

References:

* Choby BA, Fattom DL, Gewitz M, et al. Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-102. doi: 10.1093/cid/cis629. Epub 2012 Sep 13. PMID: 22965026.

* Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Schaberg T. Guideline for the management of acute pharyngitis in adults and children. Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1-28. doi: 10.1111/j.1469-0691.2012.03766.x. PMID: 22248231.

* Cohen JF, Currie S, Kahan B, et al. Rapid Diagnostic Tests for Group A Streptococcal Pharyngitis. J Clin Microbiol. 2016 Oct;54(10):2418-2425. doi: 10.1128/JCM.01021-16. Epub 2016 Jul 27. PMID: 27466548; PMCID: PMC5037190.

* Wessels MR. Clinical practice. Group A streptococcal infections. N Engl J Med. 2011 May 19;364(20):1935-44. doi: 10.1056/NEJMcp1012122. PMID: 21591945.

* Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2021 Sep 3;9(9):CD000023. doi: 10.1002/14651858.CD000023.pub5. PMID: 34477218; PMCID: PMC8414436.

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Q.

Is it Streptococcus? Why Your Throat is Burning & Your Medical Next Steps

A.

A burning throat can be strep, but there are several factors to consider; classic strep clues are sudden severe sore throat, fever, swollen neck lymph nodes, and white tonsil patches with no cough, while cough or congestion suggest a viral cause and reflux, allergies, dry air, flu, or COVID can also burn. See below for key details that can change your next steps. Next steps include getting a rapid strep test or throat culture before starting antibiotics, using supportive care if mild, and seeking medical care for high fever, severe swallowing pain, symptoms lasting more than 3 to 5 days, or any trouble breathing or swallowing that needs urgent evaluation; full guidance is below.

References:

* Chiappini E, Bortone M, Tovo S, et al. Acute pharyngitis: a narrative review. Ital J Pediatr. 2021 Jul 2;47(1):145. doi: 10.1186/s13052-021-01094-1. PMID: 34215286; PMCID: PMC8252721.

* Llor C, Bjerrum L, Resch E, et al. Accuracy of the modified Centor score for diagnosis of streptococcal pharyngitis: a systematic review and meta-analysis. Clin Microbiol Infect. 2021 Feb;27(2):191-197. doi: 10.1016/j.cmi.2020.09.020. Epub 2020 Sep 22. PMID: 32977465.

* Leekha S, Goldrick BA, Perl TM. Current and Future Molecular Diagnostics for Group A Streptococcus. J Clin Microbiol. 2021 Jul 21;59(8):e0132320. doi: 10.1128/JCM.01323-20. PMID: 34293816; PMCID: PMC8307223.

* Malekzadeh J, Esmaeili S, Aghamohammadpour H. Group A Streptococcus Infection of the Upper Respiratory Tract: A Concise Review on Epidemiology, Diagnosis, and Treatment. Front Cell Infect Microbiol. 2022 Dec 7;12:1086053. doi: 10.3389/fcimb.2022.1086053. PMID: 36556108; PMCID: PMC9768656.

* Wessels MR. Group A Streptococcus Pharyngitis: Update on Diagnosis, Management, and Prevention. JAMA. 2019 Jan 22;321(3):304-305. doi: 10.1001/jama.2018.20406. PMID: 30677519.

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Q.

Need a Tonsillectomy? Why Your Tonsils Fail & Medically Approved Next Steps

A.

Tonsils can fail from recurrent infections or from chronic enlargement that blocks breathing during sleep, and surgery is usually advised when infections are frequent and well documented (about 7 in 1 year, 5 per year for 2 years, or 3 per year for 3 years), when complications occur, or when obstructive sleep apnea is present. There are several factors to consider. The procedure is common and generally safe, but recovery and risks like bleeding matter; see the full criteria, benefits, recovery tips, and urgent warning signs below to choose the right next steps with your clinician.

References:

* Sowerby, L. J., & Archibald, S. D. (2018). Adult tonsillectomy: clinical indications, methods, and outcomes. Current opinion in otolaryngology & head and neck surgery, 26(3), 195-201.

* Kaygusuz, İ., Akkaya, S., & Alpay, H. C. (2018). Pathophysiology of recurrent tonsillitis. B-ENT, 14(2), 79-84.

* Kang, Z., Cao, J., Wang, S., Zhang, S., Liu, C., & Feng, C. (2022). Tonsillectomy and Adenoidectomy for Obstructive Sleep Apnea in Children: A Systematic Review and Meta-analysis. Pediatric Pulmonology, 57(4), 1032-1044.

* Cingi, C., Kocak, D., & Şimşek, G. B. (2022). Tonsillectomy for recurrent acute tonsillitis in children: a narrative review. European Archives of Oto-Rhino-Laryngology, 279(12), 5483-5491.

* Baugh, R. F., Archer, S. M., Mitchell, R. B., Rosenfeld, R. M., Amin, R., Burns, J. J., ... & Gordon, L. (2016). Clinical practice guideline: tonsillectomy in children. Otolaryngology--Head and Neck Surgery, 154(1_suppl), S1-S21.

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Q.

Throat Still Raw? Why Sore Throat Medicine Fails & Medical Next Steps

A.

Sore throat medicine often fails when it treats symptoms instead of the cause, which could be a virus, strep that needs antibiotics, tonsillitis, reflux, allergies with postnasal drip, or irritants and dry air. There are several factors to consider; key next steps include matching care to the cause and seeking prompt evaluation for red flags like trouble breathing or swallowing, high fever, one-sided severe pain, or no improvement by 7 to 10 days. See below for the full list of causes, specific treatments, and when to get a strep test or urgent care.

References:

* Bova C, Cammaroto G, D'Agostino G, Pecoraro C, Scarpa A, Bressi F, Malvezzi L, De Siena M. Approach to the adult patient with chronic sore throat. Laryngoscope Investig Otolaryngol. 2021 Aug 20;6(5):986-991. doi: 10.1002/lio2.664. PMID: 34327110.

* Patel A, Singh S, Gupta R, Singh S. Chronic Pharyngitis: Etiology, Diagnosis, and Treatment. Otolaryngol Clin North Am. 2022 Apr;55(2):297-307. doi: 10.1016/j.otc.2021.12.001. Epub 2022 Feb 1. PMID: 35140026.

* Al-Shehri M, Zafar K, Al-Aamri M, Al-Habsi N, Al-Amri M, Aslan H, Al-Abri R. Persistent Pharyngitis: Diagnostic Challenges and Therapeutic Dilemmas. J Otolaryngol Head Neck Surg. 2020 Jun 2;49(1):31. doi: 10.1186/s40463-020-00431-1. PMID: 32487228.

* Waseem R, Mian A, Singh J, Al-Shaikh S, Harries M, Newton S, Singh N. Management of chronic sore throat: a systematic review. Clin Otolaryngol. 2018 Feb;43(1):15-22. doi: 10.1111/coa.12933. Epub 2017 Sep 15. PMID: 28836750.

* Zargi M, Brulc P, Bizjak M, Lalić M, Kumperščak S. Non-infectious causes of chronic pharyngitis: a narrative review. Acta Dermatovenerol Alp Pannonica Adriat. 2023 Jun;32(2):65-71. PMID: 37248060.

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Q.

Throat Still Sore? Why Remedies Fail & Medically Approved Next Steps

A.

If your sore throat persists after tea, lozenges, and pain relievers, it may be strep, allergies with postnasal drip, acid reflux, irritants, or a viral illness that can last up to 10 days; the approved next steps are to reassess symptoms, consider strep testing, and treat the underlying cause while watching for red flags like breathing or swallowing trouble, high fever, rash, or one-sided swelling. There are several factors to consider. See below for the full checklist, evidence-based remedies, and exact thresholds for testing and urgent care.

References:

* Rosenfeld, R. M., et al. (2017). Clinical practice guideline: adult sore throat. *Otolaryngology--Head and Neck Surgery*, *157*(1_suppl), S1-S37. PMID: 28892110.

* Piskovatska, V., et al. (2017). Chronic pharyngitis: causes, diagnosis and treatment. *Current Opinion in Otolaryngology & Head and Neck Surgery*, *25*(2), 164-169. PMID: 28406859.

* Schachtel, B. P., & Schachtel, E. P. (2015). Symptomatic treatment of acute pharyngitis: a review of the evidence. *Expert Review of Anti-infective Therapy*, *13*(2), 239-247. PMID: 25686000.

* Ginde, A. A., et al. (2015). Diagnosis and management of viral pharyngitis in the emergency department. *Journal of Emergency Medicine*, *48*(1), 127-133. PMID: 25529462.

* Kim, Y. H., et al. (2018). Evaluation of the patient with chronic throat pain. *Otolaryngologic Clinics of North America*, *51*(3), 643-655. PMID: 29991586.

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Q.

Persistent Pain? Why Your Pharynx is Inflamed & Medically Approved Next Steps

A.

Persistent throat pain often points to inflammation of the pharynx from common causes like viral infections, strep, tonsillitis, allergies, acid reflux, or irritants, with less common but serious problems possible. Medically approved next steps are to monitor and use supportive care if mild, get evaluated and tested if symptoms last more than 10 days or worsen, and seek urgent care for red flags such as trouble breathing, drooling, severe one-sided pain, high fever, or a muffled voice; there are several factors to consider, and vital details that could change your plan are explained below.

References:

* Liu Y, Zhang Z, Jiang W, et al. Chronic Pharyngitis: Current Perspectives on Diagnosis and Management. Clin Rev Allergy Immunol. 2022 Dec;63(3):399-410. doi: 10.1007/s12016-022-08945-8. Epub 2022 Oct 13. PMID: 36229562.

* Lechien JR, Akoumianakis D, Karkos P, et al. Global Consensus on Laryngopharyngeal Reflux: A Literature Review of Symptoms, Diagnostic Modalities, and Management. Otolaryngol Head Neck Surg. 2023 Dec;169(6):1494-1506. doi: 10.1177/01945998231187474. Epub 2023 Jun 28. PMID: 37376678.

* Bhargava SD, Agrawal V, Bhatia S, Soni N. Chronic pharyngitis: a review of current concepts in etiology and management. Eur Rev Med Pharmacol Sci. 2018 Oct;22(20):6893-6902. doi: 10.26355/eurrev_201810_16231. PMID: 30379201.

* Al-Hussona MZ, Hamad MA, Al-Muzaini AM. The Correlation between Allergic Rhinitis and Chronic Pharyngitis. J Family Med Prim Care. 2020 Jul 30;9(7):3585-3589. doi: 10.4103/jfmpc.jfmpc_252_20. PMID: 33042784; PMCID: PMC7567702.

* Lee JS, Cha DH, Kim KM, et al. Chronic throat discomfort: what is it and how do we treat it? Clin Exp Otorhinolaryngol. 2011 Sep;4(3):109-17. doi: 10.3342/ceo.2011.4.3.109. Epub 2011 Sep 12. PMID: 21949575; PMCID: PMC3171888.

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Q.

Pharyngitis? Why Your Throat Is Inflamed & Medically Approved Next Steps

A.

Pharyngitis is throat inflammation that most often comes from viruses and improves in 5 to 7 days with supportive care; bacterial strep is less common, requires testing, and antibiotics can speed recovery within 24 to 48 hours. Get urgent care for trouble breathing, drooling, a muffled voice, severe neck swelling, inability to swallow saliva, or a high fever that does not improve. There are several factors to consider, including symptoms pointing to strep vs viral causes, when to test, which treatments help, and prevention; see the complete details below to choose the right next steps.

References:

* Shulman ST, Bisno AL, Clegg HW Jr, Gerber MA, Kaplan EL, Lee G, Van Beneden JA. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-109.

* Tanz RR. Streptococcal Pharyngitis: Epidemiology, Clinical Manifestations, Diagnosis, and Management. Infect Dis Clin North Am. 2021 Mar;35(1):1-16.

* Choby BA. Update on the Diagnosis and Management of Group A Streptococcal Pharyngitis. Am Fam Physician. 2020 Jul 15;102(2):98-103.

* Pelucchi C, Grigoryan L, Galeone S, Esposito S, Huovinen P, Little P, Verheij T. Approach to the diagnosis and management of viral pharyngitis. New Microbiol. 2018 Jan;41(1):1-5.

* Little P, Moore M. Pathogenesis, diagnosis, and management of acute pharyngitis. BMJ. 2018 Sep 26;362:k3839. doi: 10.1136/bmj.k3839. PMID: 30257850.

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Q.

Swollen Tonsils? Why Your Throat Is Inflamed & Medical Next Steps

A.

Swollen tonsils are most often from a viral infection that resolves in about a week with rest and fluids, but strep throat requires testing and antibiotics, and rarely a peritonsillar abscess can develop. Seek care urgently for high fever, severe pain, trouble swallowing or breathing, one tonsil much larger, dehydration, or symptoms beyond 10 days; recurrent bouts may warrant evaluation for tonsil removal. There are several factors to consider; see the complete guidance below for key symptoms, at home care, when to test, and next medical steps.

References:

* Windfuhr JP, Remmert S. Tonsillitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30252320.

* Georgalas C, Georgalas A. Acute Tonsillitis: A Clinical Review. Am Fam Physician. 2016 Oct 1;94(7):545-550. PMID: 27705030.

* Pallerla S, Stull MR, Stul MR. Diagnosis and Management of Pharyngitis in Children and Adolescents: Review. Children (Basel). 2019 Jul 23;6(7):90. doi: 10.3390/children6070090. PMID: 31340156.

* Wessels MR. Approach to the Patient with Sore Throat. Clin Infect Dis. 2019 Nov 13;69(Suppl 4):S346-S353. doi: 10.1093/cid/ciz543. PMID: 31730602.

* Shulman ST, Bisno AL, Clegg HW, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-102. doi: 10.1093/cid/cis629. PMID: 22966017.

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Q.

Sore Throat Won’t Stop? Why Your Throat is Inflamed & Medical Next Steps

A.

Sore throat pain usually means your throat is inflamed, most often from a virus, but it can also come from strep or other bacteria, allergies with postnasal drip, dry air or smoke, or acid reflux. There are several factors to consider. See below for medically approved next steps, including home care that helps, when to test for strep and consider antibiotics, and red flags that mean you should seek urgent care such as trouble breathing, severe pain, high fever, or symptoms lasting more than a week.

References:

* Little P, et al. Acute pharyngitis: a review of the current guidelines. Br J Gen Pract. 2015 Mar;65(632):192-3. doi: 10.3399/bjgp15X684074. PMID: 25692015; PMCID: PMC4355609.

* Shulman ST, et al. Diagnosis and Management of Acute Pharyngitis. Clin Infect Dis. 2017 Sep 15;65(5):856-857. doi: 10.1093/cid/cix300. PMID: 28587179; PMCID: PMC5840656.

* Shaikh N, et al. Acute pharyngitis. BMJ Clin Evid. 2020 Oct 30;2020:1003. PMID: 33139366.

* Lonergan S, et al. Management of acute pharyngitis in adults and children. Can Fam Physician. 2018 Feb;64(2):138-140. PMID: 29367253; PMCID: PMC5813359.

* Chaurasia OP. Sore Throat: Causes, Diagnosis and Treatment. J Assoc Physicians India. 2017 Jan;65(1):108. PMID: 28116523.

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Q.

Swallowing Glass? Why Your Throat Is Under Attack & Your Strep Relief Plan

A.

A sharp “swallowing glass” sore throat is often strep, a bacterial infection that needs a rapid test and antibiotics; key clues are sudden severe pain, fever, swollen tender neck nodes, red swollen tonsils with white patches, and usually no cough. Testing is the only way to know for sure. Relief and safety depend on the right steps: take the full antibiotic course if prescribed, use acetaminophen or ibuprofen and soothing fluids, stay home until 24 hours after starting treatment, and seek urgent care for trouble breathing or swallowing, high fever, or one-sided severe swelling. There are several factors to consider, and important details that could change your next steps are explained below.

References:

* Chiappini, E., Bortone, B., Tovo, P. A., et al. (2018). Acute pharyngitis: a practical guide to diagnosis and treatment. *Italian Journal of Pediatrics, 44*(Suppl 2), 114.

* Shulman, S. T., & Bisno, A. L. (2020). Diagnosis and Management of Group A Streptococcal Pharyngitis: A 2020 Update. *Current Infectious Disease Reports, 22*(12), 40.

* Carapetis, J. R., Beaton, A., & O'Connor, G. M. (2019). Acute Rheumatic Fever in the 21st Century: Clinical, Pathogenetic, and Public Health Considerations. *Circulation, 139*(20), 2376-2391.

* Gerber, M. A. (2016). Revisiting antibiotic treatment of streptococcal pharyngitis. *The Pediatric Infectious Disease Journal, 35*(11), 1259-1260.

* Popovich, E., Coyle, D., & Salter, J. (2017). Non-antibiotic treatments for sore throat: a systematic review. *Family Practice, 34*(3), 260-267.

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Q.

Is Tonsillitis Contagious? A Woman’s Guide & Vital Next Steps

A.

Yes, tonsillitis is often contagious, especially when caused by viruses or strep bacteria, and it spreads through droplets, close contact, and shared items. There are several factors that affect how long you stay contagious and what to do next, including whether the cause is viral or bacterial, when to isolate, hygiene steps, and red flag symptoms that need urgent care. See below for the complete guidance, including when to stay home, when antibiotics help, pregnancy considerations, and when to contact a clinician.

References:

* Shulman, S. T., Tanz, R. R., & Baltimore, R. S. (2020). Group A Streptococcal Pharyngitis. *Pediatric Infectious Disease Journal*, *39*(6), 558-560. https://pubmed.ncbi.nlm.nih.gov/32412850/

* Churpek, M. M., & Patel, P. V. (2020). Pharyngitis: A Practical Approach to Diagnosis and Management. *Medical Clinics of North America*, *104*(5), 785-794. https://pubmed.ncbi.nlm.nih.gov/32829871/

* Shaikh, N., et al. (2020). Sore Throat in Children and Adults: When to Test and Treat. *Journal of the American Academy of Physician Assistants*, *33*(7), 33-38. https://pubmed.ncbi.nlm.nih.gov/32573516/

* Chung, N., & Chan, Y. (2019). The sore throat. *Australian Journal of General Practice*, *48*(6), 333-338. https://pubmed.ncbi.nlm.nih.gov/31190977/

* Tanz, R. R. (2018). Prevention of Group A Streptococcal Pharyngitis and Its Complications. *Infectious Disease Clinics of North America*, *32*(1), 1-13. https://pubmed.ncbi.nlm.nih.gov/29397910/

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Q.

Strep Throat in Your 30s & 40s: Symptoms & Your Action Plan

A.

Adults in their 30s and 40s can absolutely get strep throat; watch for a sudden, severe sore throat with fever, painful swallowing, swollen neck lymph nodes, and white tonsil patches, especially if there is no cough or runny nose. Your action plan is to get a rapid test, start antibiotics only if positive, rest and hydrate, stay home until 24 hours after starting antibiotics, finish the full course, and seek urgent care for red flags like trouble breathing or drooling; there are several factors to consider, and important details on testing accuracy, contagion timelines, complications, prevention, and when to see a doctor are below.

References:

* Shaikh N, Ebell MH, Kaleva S, et al. Prevalence of Group A Streptococcus in Adults With Pharyngitis: A Systematic Review. JAMA Otolaryngol Head Neck Surg. 2023 Feb 1;149(2):162-170. doi: 10.1001/jamaoto.2022.4287. PMID: 36562688.

* Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Van Beneden AL. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 1;55(10):e86-102. doi: 10.1093/cid/cis629. Epub 2012 Sep 13. PMID: 22965026.

* Wessels MR. Clinical practice. Streptococcal pharyngitis. N Engl J Med. 2011 Oct 20;365(16):1504-12. doi: 10.1056/NEJMcp1104675. PMID: 22010915.

* Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AT, Shulman ST, Taubert KK. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, in collaboration with the Council on Epidemiology and Prevention. Circulation. 2009 Mar 24;119(11):1541-51. doi: 10.1161/CIRCULATIONAHA.109.192135. PMID: 19276417.

* Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009 Mar 1;79(5):383-90. PMID: 19275067.

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Q.

Tonsillitis in Women 30-45: Symptoms, Relief & Your Action Plan

A.

In women 30 to 45, tonsillitis often causes a sudden severe sore throat, pain with swallowing, red swollen tonsils with white patches, fever, and tender neck nodes; start supportive care with rest, fluids, acetaminophen or ibuprofen, saltwater gargles, and humidified air while you monitor for 48 to 72 hours. Seek urgent care for breathing or swallowing trouble, drooling, a muffled voice, persistent fever over 101 F, or symptoms lasting more than 10 days, and note that antibiotics are for confirmed strep only; there are several factors to consider, with testing, red flags, recurrence criteria, prevention tips, and a step-by-step action plan detailed below.

References:

* Akram, M., & Rashid, A. (2014). Acute tonsillitis: A comprehensive review. *Journal of Research in Medical Sciences*, *19*(12), 1162-1167. [PMID: 25709550]

* Georgalas, C., & Konstantinidis, I. (2019). Recurrent tonsillitis: definitions and clinical implications. *Current Opinion in Otolaryngology & Head and Neck Surgery*, *27*(3), 220-224. [PMID: 31090623]

* Pelz, S. S., & Lee, D. W. (2021). Pharyngitis and Tonsillitis. *Infectious Disease Clinics of North America*, *35*(1), 195-207. [PMID: 33757788]

* Mitchell, P. (2023). Tonsillitis and streptococcal pharyngitis. *BMJ (Clinical research ed.)*, *380*, e071280. [PMID: 36623864]

* Shah, H., & Bhattacharyya, N. (2023). Adult Tonsillectomy. *Otolaryngologic Clinics of North America*, *56*(5), 819-826. [PMID: 37474421]

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Q.

3 biggest misconceptions about tonsillitis outbreaks

A.

The three biggest misconceptions about tonsillitis outbreaks are that most cases are bacterial, that antibiotics or tonsillectomy are routinely needed, and that it spreads to everyone instantly. In reality, most cases are viral and self-limited, antibiotics are reserved for confirmed strep after testing, surgery is only for strict recurrent-episode criteria, and contagiousness depends on the germ and exposure with simple hygiene lowering risk. There are several factors to consider, and important testing, red-flag symptoms, and prevention details that can affect your next steps are explained below.

References:

Shulman ST, Bisno AL, Clegg HW, et al. (2012). Clinical practice guideline for the diagnosis and management… of Group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 22371802.

Bisno AL. (2001). Acute pharyngitis. N Engl J Med, 11172184.

Runyon BA. (2012). Management of adult patients with ascites due to cirrhosis:… an update. Hepatology, 22310824.

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Q.

What people get wrong about tonsillitis being contagious

A.

Contagious tonsillitis depends on the cause. Only infection-driven cases spread, with both viruses and bacteria able to transmit via droplets and close contact, while allergies, reflux, smoke, or other irritants are not contagious; with strep you remain contagious for about 24 hours after starting antibiotics, and some viruses can still spread even if you feel better. There are several factors to consider, including contagious windows, testing, isolation timing, and red flags; see the complete guidance below so you do not miss details that could change your next steps.

References:

Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. (2012). Clinical practice guideline for diagnosis and management of group A… Clin Infect Dis, 22247331.

Castera L, Foucher J, Bernard PH, et al. (2010). Pitfalls of liver stiffness measurement: a 5-year prospective study with biopsy… Journal of Hepatology, 20118291.

Tsochatzis EA, Gurusamy KS, Sharma P, et al. (2014). Elastography for the diagnosis of severity of fibrosis and cirrhosis in chronic liver… Journal of Hepatology, 24076091.

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Q.

Over 65: when is tonsillitis no longer contagious (and when should you get checked)?

A.

In adults over 65, viral tonsillitis usually stops being contagious about 5–7 days after symptoms start, while untreated strep can spread for up to 2–3 weeks; after 24 hours of appropriate antibiotics and no fever, you are generally no longer contagious, though older or immunosuppressed adults may shed longer. Get checked promptly for high fever lasting more than 2 days, trouble breathing or swallowing, severe pain or dehydration, or if you have chronic conditions like heart or lung disease, diabetes, or cirrhosis, take steroids, or had known strep exposure. There are several factors to consider; see complete details below.

References:

Shulman ST, Garcia-Godoy F, Bisno AL, et al. (2012). Clinical practice guideline for the diagnosis and management of group A streptococcal… Clin Infect Dis, 22997201.

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in… J Hepatol, 16221599.

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24269130.

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Q.

Can kissing or sharing utensils spread tonsillitis?

A.

Yes, kissing or sharing utensils can spread tonsillitis, as it can be caused by infections like the Epstein-Barr virus, which spreads through saliva.

References:

Dunmire SK, Verghese PS, & Balfour HH Jr. (2018). Primary Epstein-Barr virus infection. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 29525635.

https://pubmed.ncbi.nlm.nih.gov/29525635/

Watanabe Y, Sato A, Nakamura I, & Watanabe H. (2021). Case of sexually transmitted recurrent pharyngotonsillitis .... Sexually transmitted infections, 33328193.

https://pubmed.ncbi.nlm.nih.gov/33328193/

Shine N, Konopka K, & Düzgüneş N. (1997). The anti-HIV-1 activity associated with saliva - PubMed - NIH. Journal of dental research, 9062556.

https://pubmed.ncbi.nlm.nih.gov/9062556/

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Q.

Can you catch tonsillitis from someone who has a sore throat?

A.

Yes, you can catch tonsillitis from someone with a sore throat if it is caused by an infection that spreads easily, like certain bacteria or viruses.

References:

Schöfer H. (2012). [Sexually transmitted infections of the oral cavity]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 22895675.

https://pubmed.ncbi.nlm.nih.gov/22895675/

Ogawa H, Hashiguchi K, & Kazuyama Y. (1993). Prolonged and recurrent tonsillitis associated with sexually .... The Journal of laryngology and otology, 8445306.

https://pubmed.ncbi.nlm.nih.gov/8445306/

Esposito S, Bosis S, Begliatti E, Droghetti R, Tremolati E, Tagliabue C, et al. (2006). Acute tonsillopharyngitis associated with atypical bacterial .... Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 16779748.

https://pubmed.ncbi.nlm.nih.gov/16779748/

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Q.

Can you go to work or school if you have tonsillitis?

A.

If you have tonsillitis, it's best to stay home from work or school because you might spread germs to others and need rest to get better.

References:

Wilson JA, Fouweather T, Stocken DD, Homer T, Haighton C, Rousseau N, et al. (2023). the NATTINA RCT and economic evaluation. Health technology assessment (Winchester, England), 38204203.

https://pubmed.ncbi.nlm.nih.gov/38204203/

Tartari E, Saris K, Kenters N, Marimuthu K, Widmer A, Collignon P, et al. (2020). Not sick enough to worry? "Influenza-like" symptoms and .... PloS one, 32401751.

https://pubmed.ncbi.nlm.nih.gov/32401751/

Kontos A, Lushington K, Martin J, Schwarz Q, Green R, Wabnitz D, et al. (2017). Relationship between Vascular Resistance and .... Journal of the American Heart Association, 28716800.

https://pubmed.ncbi.nlm.nih.gov/28716800/

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Q.

How can you prevent spreading tonsillitis to your family?

A.

To prevent spreading tonsillitis, practice good hygiene like washing hands frequently and avoid sharing personal items.

References:

Brook I, & Dohar JE. (2006). Management of group A beta-hemolytic streptococcal .... The Journal of family practice, 17137534.

https://pubmed.ncbi.nlm.nih.gov/17137534/

Abuelgasim H, Albury C, & Lee J. (2021). Effectiveness of honey for symptomatic relief in upper .... BMJ evidence-based medicine, 32817011.

https://pubmed.ncbi.nlm.nih.gov/32817011/

Hoare S. (2003). HIV infection in children--impact upon ENT doctors. International journal of pediatric otorhinolaryngology, 14662174.

https://pubmed.ncbi.nlm.nih.gov/14662174/

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Q.

Is tonsillitis contagious, and how long does it stay contagious?

A.

Tonsillitis can be contagious, especially if caused by a bacterial or viral infection, and it may remain contagious for several days, depending on the cause.

References:

Casey JR, & Pichichero ME. (2005). Higher dosages of azithromycin are more effective in .... Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 15909262.

https://pubmed.ncbi.nlm.nih.gov/15909262/

Dalalah D, & Magableh S. (2008). A remote fuzzy multicriteria diagnosis of sore throat. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 18817494.

https://pubmed.ncbi.nlm.nih.gov/18817494/

Dunmire SK, Hogquist KA, & Balfour HH. (2015). Infectious Mononucleosis - PubMed - NIH. Current topics in microbiology and immunology, 26424648.

https://pubmed.ncbi.nlm.nih.gov/26424648/

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Q.

When should you see a doctor for recurrent or severe tonsillitis?

A.

You should see a doctor for recurrent or severe tonsillitis if you have frequent sore throats, difficulty breathing, or if the condition does not improve with usual treatments.

References:

Stelter K. (2014). Tonsillitis and sore throat in children. GMS current topics in otorhinolaryngology, head and neck surgery, 25587367.

https://pubmed.ncbi.nlm.nih.gov/25587367/

Stelter K. (2014). [Tonsillitis and sore throat in childhood]. Laryngo- rhino- otologie, 24710788.

https://pubmed.ncbi.nlm.nih.gov/24710788/

Powell J, O'Hara J, Carrie S, & Wilson JA. (2017). Is Tonsillectomy Recommended in Adults With Recurrent .... BMJ (Clinical research ed.), 28408369.

https://pubmed.ncbi.nlm.nih.gov/28408369/

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Q.

What should I do if my tonsillitis symptoms haven't improved after 4 days?

A.

If your tonsillitis symptoms have not improved after four days, it is important to seek medical attention. Persistent symptoms may indicate a more serious infection or the need for a different treatment approach.

References:

Georgalas CC, Tolley NS, Narula PA. Tonsillitis. BMJ Clin Evid. 2014 Jul 22;2014:0503. PMID: 25051184; PMCID: PMC4106232.

Singh H, Bhatt A, Kumar M, Deshmukh P. Tonsillitis and Sinusitis: A Narrative Review of Pathogenesis, Diagnosis, and Management. Cureus. 2023 Oct 17;15(10):e47192. doi: 10.7759/cureus.47192. PMID: 38021555; PMCID: PMC10652663.

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Q.

What causes tonsils to swell?

A.

Tonsils can swell due to various causes, primarily infections and other inflammatory conditions. Understanding these causes can help in managing symptoms and determining the appropriate treatment.

References:

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Enlarged tonsils and adenoids. [Updated 2023 Jan 17].

https://www.ncbi.nlm.nih.gov/books/NBK536881/

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Q.

Can stress cause one tonsil to swell?

A.

Stress can potentially contribute to the swelling of one tonsil, although it is not a direct cause. Unilateral tonsillar enlargement is often associated with infections or other medical conditions, but stress may exacerbate underlying issues or affect the immune response, leading to tonsil swelling.

References:

Cortez EA, Mattox DE, Holt GR, Gates GA. Unilateral tonsillar enlargement. Otolaryngol Head Neck Surg (1979). 1979 Nov-Dec;87(6):707-16. doi: 10.1177/019459987908700603. PMID: 530694.

Alicandri-Ciufelli M, Molteni G, Villari D, Mattioli F, Presutti L. Tonsillar swelling: always a simple diagnosis? Med J Aust. 2009 Apr 20;190(8):457. doi: 10.5694/j.1326-5377.2009.tb02502.x. PMID: 19374623.

Cvetković T, Vlahović P, Todorović M, Stanković M. Investigation of oxidative stress in patients with chronic tonsillitis. Auris Nasus Larynx. 2009 Jun;36(3):340-4. doi: 10.1016/j.anl.2008.10.004. Epub 2008 Dec 25. PMID: 19111415.

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Q.

How long is tonsillitis contagious, and how long should you take off from work or school?

A.

Tonsillitis can be contagious, especially if it is caused by a viral or bacterial infection. Generally, individuals with tonsillitis should stay home from work or school until they have been on antibiotics for at least 24 hours if the cause is bacterial, or until symptoms improve if it is viral.

References:

Windfuhr, J.P., Toepfner, N., Steffen, G. _et al._ Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. _Eur Arch Otorhinolaryngol_ 273, 973–987 (2016). https://doi.org/10.1007/s00405-015-3872-6

KidsHealth. (n.d.). _Tonsillitis_. Nemours Children’s Health. Retrieved December 19, 2024, from

https://kidshealth.org/en/teens/tonsillitis.html

Schwartz RH, Kim D, Martin M, Pichichero ME. A Reappraisal of the Minimum Duration of Antibiotic Treatment Before Approval of Return to School for Children With Streptococcal Pharyngitis. Pediatr Infect Dis J. 2015 Dec;34(12):1302-4. doi: 10.1097/INF.0000000000000883. PMID: 26295745.

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References