Causes
Tonsillitis is most often caused by viruses, typically the same viruses that cause the common cold, including:
Other more serious viruses like Epstein-Barr virus, hepatitis A, and HIV can also cause tonsillitis.
Sometimes a bacterial infection — usually by Streptococcus pyogenes (group A streptococcus or strep) — can cause tonsillitis. Other bacterial causes of tonsillitis include:
- Staphylococcus aureus
- Streptococcus pneumoniae
- Haemophilus influenza
Symptoms
Tonsillitis can cause many of the same symptoms of the common cold, though they typically last longer and become more severe. Symptoms include:
- Sore throat
- Swollen or red tonsils
- White or yellow coating (pus) on your tonsils
- Fever and chills
- Trouble swallowing
- Bad breath
- Swollen lymph nodes in the neck
- Stomachache
- Headache
- Stiff neck
- Ear pain
- Hoarse voice
The tonsils can also swell large enough to cause problems with breathing, eating, and drinking.
Diagnosis
To determine if you have tonsillitis, your healthcare provider will review your symptoms and perform a physical exam. They will look specifically for:
- Tonsils that are red, swollen, or have white patches or pus
- Swollen lymph nodes in the neck
- Fever
- The absence of cough
- Rapid antigen testing, which detects whether you have proteins associated with group A streptococcus in your mucus
- Throat culture, which involves laboratory testing of a throat swab
The rapid antigen test provides results in minutes but sometimes produces false negative results. A throat culture takes a few days for results but is more reliable and can detect multiple types of bacteria.
If these tests are negative, you have viral tonsillitis.
Treatment
In rare cases, the body isn’t able to kill the virus completely and tonsillitis may return — five or more tonsillitis episodes in a year is considered recurrent tonsillitis. This typically only occurs in people with compromised immune systems.
Bacterial tonsillitis requires treatment with antibiotics.