Common causes of white spots on tonsils
- Viral tonsillitis: the most common cause, often with cold symptoms.
- Bacterial tonsillitis and strep throat: usually group A streptococcus; see strep throat.
- Glandular fever (infectious mononucleosis): caused by the Epstein–Barr virus.
- Tonsil stones (tonsilloliths): trapped debris that hardens in tonsil crypts.
- Oral thrush: a yeast infection with creamy white patches.
- Scarlet fever: strep infection with a sandpaper-like rash.
- Less common: leukoplakia, sexually transmitted infections and, rarely, tonsil cancer (usually one-sided, persistent).
How to tell the causes apart
- Cold symptoms, cough, hoarse voice: viral tonsillitis is more likely.
- High fever, very sore throat, swollen tender neck glands, no cough: strep is more likely.
- Extreme tiredness, swollen glands in the neck and armpits, sometimes a large spleen: glandular fever.
- Small, hard, smelly lumps, bad breath, no fever: tonsil stones.
- White patches that can be scraped off, leaving red areas: thrush.
- A persistent one-sided ulcer or lump for more than three weeks: needs specialist assessment.
Tonsil stones
Tonsil stones form when food particles, dead cells and bacteria collect in the small pockets of the tonsils and harden. They are harmless but can cause bad breath, a feeling of something stuck in the throat, a metallic taste or ear discomfort. Gargling with salt water, brushing the tongue, staying hydrated and using a water flosser on a low setting can help. Avoid poking them with sharp objects. Recurrent, troublesome stones can be treated by an ENT specialist. Read more in our guide to tonsil stones.
Strep throat and when antibiotics are needed
Doctors use scores such as FeverPAIN or Centor, based on fever, pus on the tonsils, rapid onset, swollen glands and absence of cough, to estimate the chance of strep. A rapid test or throat swab may be done. Antibiotics are recommended when strep is confirmed or very likely, to shorten symptoms and reduce complications. Most viral tonsillitis does not need antibiotics. Read more in antibiotics for sore throat.
Home treatment
- Rest and drink plenty of fluids.
- Paracetamol or ibuprofen for pain and fever, if suitable.
- Gargle with warm salt water several times a day (adults and older children).
- Cold foods, ice lollies or warm drinks, whichever feels better.
- Throat lozenges or sprays for adults.
- Avoid smoking and smoky environments.
- Good oral hygiene, including brushing the tongue.
Glandular fever
Glandular fever is common in teenagers and young adults. Symptoms include a very sore throat with white patches, fever, swollen glands, and fatigue that can last weeks. There is no specific cure; rest, fluids and painkillers help. Avoid contact sports for at least a month because the spleen can enlarge and rupture. Some antibiotics, such as amoxicillin, can cause a rash in people with glandular fever, so a correct diagnosis matters.
When to see a doctor
- Sore throat with white spots and fever lasting more than three or four days.
- Severe pain, or difficulty swallowing food and drink.
- Swollen, tender glands with high fever.
- Recurrent tonsillitis several times a year.
- White patches in someone with a weakened immune system.
- A persistent one-sided lump, ulcer or white patch lasting more than three weeks.
Three common situations
- Child with fever, white spots and no cough: strep is possible; see a doctor for a test.
- Adult with a cold and a few white spots: viral tonsillitis is likely; rest and painkillers usually suffice.
- Bad breath and small white lumps, no pain: tonsil stones; gargling and oral hygiene help.
Possible complications
Most tonsil infections settle without problems. Occasionally, bacterial tonsillitis leads to a peritonsillar abscess (quinsy): severe one-sided throat pain, difficulty opening the mouth, a muffled voice and drooling, which needs urgent treatment. Untreated strep infections can rarely cause rheumatic fever or kidney inflammation, which is one reason doctors treat confirmed strep. Repeated, severe tonsillitis, typically seven or more episodes in a year or several episodes a year over two or three years, may be a reason to consider removing the tonsils. Swollen tonsils without infection are covered in swollen tonsils.
Key points to remember
- White spots on tonsils are usually tonsillitis or tonsil stones.
- Fever, swollen glands and no cough suggest strep.
- Most cases clear within a week with home care.
- Breathing or swallowing difficulty needs urgent care.
Questions about white spots on tonsils
These answers are general information and do not replace an examination or individual medical advice.
Can white spots on tonsils go away on their own?
Yes, viral tonsillitis and tonsil stones often clear on their own. Strep throat may need antibiotics.
Are white spots on tonsils contagious?
If caused by an infection such as strep or glandular fever, yes. Tonsil stones and leukoplakia are not contagious.
Can you have white spots without a sore throat?
Yes. Tonsil stones often cause no pain, only bad breath or a feeling of something stuck.
Should I pop white spots on my tonsils?
No. Squeezing or scraping can damage the tonsils and spread infection. Gargle instead and see a doctor if needed.
Do white spots on tonsils always mean strep?
No. Viral infections, glandular fever, thrush and tonsil stones are also common causes.
Can white spots on tonsils be cancer?
Rarely. Tonsil cancer usually causes a persistent one-sided lump, ulcer or swelling, sometimes with ear pain, a neck lump or difficulty swallowing, lasting more than three weeks. It is more common in smokers, heavy drinkers and with HPV infection. Any persistent one-sided change should be examined by a doctor.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.