Tonsillitis normally goes after a few days. Treatment can ease the symptoms until the infection goes. See a doctor if symptoms are severe or continue.
What are tonsils and what is tonsillitis?
Tonsils are made of soft glandular tissue and are part of the body's defence against infections (the immune system). You have two tonsils, one on either side at the back of the mouth. The picture below shows large non-infected tonsils (no redness or pus).
Tonsillitis is an infection of the tonsils. A sore throat is the most common of all tonsillitis symptoms. In addition, you may also have a cough, high temperature (fever), headache, feel sick, feel tired, find swallowing painful, and have swollen neck glands. The tonsils may swell and become red. Pus may appear as white spots on the tonsils. Symptoms typically get worse over 2-3 days and then gradually go, usually within a week. The picture below shows inflamed tonsils.
Is tonsillitis contagious/infectious?
Infectious means it can cause an infection. Contagious means the infection can be spread from person to person. The infection may spread by physical contact or droplets in the air caused by the person sneezing or coughing.
What is the treatment for tonsillitis?
- Not treating is an option, as many tonsil infections are mild and soon get better.
- Have plenty to drink. It is tempting not to drink very much if it is painful to swallow. You may become mildly dehydrated if you don't drink much, particularly if you also have a high temperature (fever). Some lack of fluid in the body (mild dehydration) can make headaches and tiredness much worse.
- Paracetamol or ibuprofen ease pain, headache, and fever. To keep symptoms to a minimum it is best to take a dose at regular intervals as recommended on the packet of medication rather than now and then. For example, take paracetamol four times a day until symptoms ease. Although either paracetamol or ibuprofen will usually help, there is some evidence to suggest that ibuprofen may be more effective than paracetamol at easing symptoms in adults. Paracetamol is usually the preferred first-line option for children, but ibuprofen can be used as an alternative. Note: some people with certain conditions may not be able to take ibuprofen. So, always read the packet label.
- Other gargles, lozenges, and sprays that you can buy at pharmacies may help to soothe a sore throat. However, they do not shorten the illness.
Do I need an antibiotic for tonsillitis?
Usually not. Most throat and tonsil infections are caused by germs called viruses, although some are caused by germs called bacteria. Without tests, it is usually not possible to tell if it is a viral or bacterial infection. Antibiotics kill bacteria, but do not kill viruses.
Even if a bacterium is the cause of a tonsil or throat infection, an antibiotic does not make much difference in most cases. Your body defences (immune system) usually clear these infections within a few days whether caused by a virus or a bacterium. Also, antibiotics can sometimes cause side-effects such as diarrhoea, rash, and stomach upsets.
So, most doctors do not prescribe antibiotics for most cases of tonsillitis or sore throat.
An antibiotic may be advised in certain situations. For example:
- If the infection is severe.
- If it is not easing after a few days.
- If your immune system is not working properly (for example, if you have had your spleen removed, if you are taking chemotherapy, etc).
Things to look out for
In nearly all cases, a tonsillitis or sore throat clears away without leaving any problems. However, occasionally tonsillitis may progress to cause a complication. Also, a sore throat or tonsillitis is sometimes due to an unusual, but more serious, illness. The sort of things to look out for include the following:
Glandular fever (infectious mononucleosis)
Infectious mononucleosis is caused by a virus (the Epstein-Barr virus). It tends to cause a severe bout of tonsillitis as well as other symptoms. See separate leaflet called Glandular Fever (Infectious Mononucleosis) for more details.
Quinsy - also known as peritonsillar abscess
Quinsy is an uncommon condition where a collection of pus (abscess) develops next to a tonsil, due to a bacterial infection. It usually develops just on one side. It may follow a tonsillitis or develop without tonsillitis. The tonsil on the affected side may be swollen or look normal, but is pushed towards the middle by the abscess next to the tonsil. Quinsy is very painful and can make you feel very unwell. It is treated with antibiotics, but also the pus often needs to be drained with a small operation.
Non-infective causes of a painful or swollen tonsil
These are rare. For example, cancer of the tonsil is rare, but pain can be the first symptom.
The 'take home' message is ... see a doctor if symptoms of a sore throat are severe, unusual, or if they do not ease within 3-4 days. In particular, seek urgent medical attention if you develop:
- Difficulty in breathing.
- Difficulty swallowing saliva.
- Difficulty opening your mouth.
- Severe pain.
- A persistent high temperature.
- A severe illness, especially when symptoms are mainly on one side of the throat.
What about having my tonsils taken out?
If you have repeated (recurring) tonsillitis you may wonder about having your tonsils removed. Guidelines suggest it may be an option to have your tonsils removed (tonsillectomy) if you:
- Have had seven or more episodes of tonsillitis in the preceding year; or
- Five or more such episodes in each of the preceding two years; or
- Three or more such episodes in each of the preceding three years.
- And ...
- The bouts of tonsillitis affect normal functioning. For example, they are severe enough to make you need time off from work or from school.
The adenoids may also be removed at the same time. The adenoids are also part of the body's defence against infections (the immune system). Adenoids hang from the upper part of the back of the nasal cavity (see also the separate leaflet called Tonsils and Adenoids).
Although full-blown episodes of tonsillitis are prevented after tonsillectomy, other throat infections are not prevented. However the overall number and severity of throat infections may be reduced. Also, the risk of developing quinsy is reduced. Many people say they generally feel better in themselves after having their tonsils removed if they previously had frequent episodes of tonsillitis.
Tonsillectomy is usually a straightforward minor operation. But, as with all operations, there is a risk. For example, there is a small risk of life-threatening severe bleeding from the throat during or just after the operation.
Further reading & references
- Respiratory tract infections – antibiotic prescribing: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care; NICE Clinical Guideline (July 2008)
- Management of sore throat and indications for tonsillectomy; Scottish Intercollegiate Guidelines Network - SIGN (April 2010)
- Burton MJ, Glasziou PP; Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001802.
- Indications for Tonsillectomy: Position Paper; ENTUK, December 2009
- Spinks A, Glasziou PP, Del Mar CB; Antibiotics for sore throat. Cochrane Database Syst Rev. 2013 Nov 5;11:CD000023.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Colin Tidy
Prof Cathy Jackson