Tonsillitis is an inflammation of the tonsils. It is usually caused by a viral infection. Less often the cause is a bacterial infection. It is most common in children, but adults can be affected too.
What are tonsils?
Tonsils are made of soft gland tissue and they 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.
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Symptoms of tonsillitis
- Sore throat.
- Coughing or sneezing.
- High temperature (fever).
- Feeling sick (nausea).
- Feeling tired.
- Pain when swallowing.
- Swollen lymph nodes in the neck.
- Swollen, red tonsils.
- White spots (pus) on the tonsils.
Symptoms typically get worse over 2-3 days and then gradually go, usually within a week. For a deeper read into tonsillitis symptoms - click here.
What does tonsillitis look like?
The picture below shows inflamed tonsils.
How long does tonsillitis last?
Tonsillitis normally goes after 4-5 days. Tonsillitis treatment can ease the symptoms until the infection goes. See a doctor if the symptoms are severe or don't get better quickly.
What causes tonsillitis?
Tonsillitis can be caused by:
- Viral infections such as colds and flu.
- Bacterial infections such as group A streptococcus - which can cause scarlet fever, and very rarely in the UK, rheumatic fever.
For a deeper read into causes of tonsillitis - click here.
Glandular fever (infectious mononucleosis - or 'mono') is caused by a virus - the Epstein-Barr virus. It tends to cause a severe bout of tonsillitis as well as other symptoms. See the separate leaflet called Glandular Fever (Infectious Mononucleosis) for more details.
Is tonsillitis contagious?
Contagious means you can pass the infection to someone else. Tonsillitis is contagious so infection may indeed spread by close physical contact with other people, or by droplets in the air, caused by sneezing or coughing.
Mild tonsillitis often doesn't need any treatment. However, it is important to drink plenty of water.
- Paracetamol (acetaminophen) or ibuprofen will help to ease pain, headache and high temperature.
- Gargles, lozenges and sprays may help to soothe a sore throat but they do not shorten the illness.
Antibiotics can kill bacteria but do not kill viruses. Even if tonsillitis is caused by a bacterium, treatment with an antibiotic does not make much difference in most cases. However, if symptoms persist or you are feeling very unwell and meet the criteria - the doctor may prescribe antibiotics.
If you have repeated bouts of tonsillitis you may be considered for surgery to have your tonsils removed (tonsillectomy).
Having no treatment at all is one option. Many tonsil infections are mild and soon get better on their own.
At home treatments
Treatment options include:
- Have plenty to drink. It is tempting not to drink very much if it is painful to swallow. You may become mildlydehydrated if you don't drink much, particularly if you also have a high temperature (fever). This can make headaches and tiredness much worse.
- Paracetamol or ibuprofen eases 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 - at least 4-6 hours apart - 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. See the leaflet Fever in Children (High Temperature) or Fever treatment for children: a doctor's advice for further information.
- 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.
- Get plenty of rest.
See the separate article called 9 home remedies for tonsillitis for more details.
Do you need antibiotics for tonsillitis?
Usually not. Most throat and tonsil infections are caused by viruses, although some are caused by bacteria. Without tests, it is usually not possible to tell if it is a viral or bacterial tonsillitis.
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).
Do I need my tonsils removing?
If you have repeated (recurring) tonsillitis you may wonder about having your tonsils removed. Guidelines suggest removing the tonsils may be an option (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 for young children taking time off from school. Read our article on how to manage tonsillitis in children.
- If you have had two bouts of quinsy - see below - in one year.
The tonsils and adenoids may 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 the separate leaflet called What do tonsils do? for more details.
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 chronic 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.
When should you contact a doctor about tonsillitis?
Seek medical advice if symptoms of a sore throat cause severe symptoms, or if they do not ease within 3-4 days. In particular, you should seek urgent medical attention if you develop:
- Difficulty in breathing.
- Difficulty swallowing saliva or eating.
- 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 is the outlook for tonsillitis?
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.
What is quinsy?
- 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.
Quinsy needs to be treated in hospital so if you or your doctor suspect you may have one, you need to go to your nearest emergency department.
Further reading and references
Sore throat (acute): antimicrobial prescribing; NICE Guideline (January 2018)
Sore throat - acute; NICE CKS, January 2023 (UK access only)
Burton MJ, Glasziou PP, Chong LY, et al; Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014 Nov 19(11):CD001802. doi: 10.1002/14651858.CD001802.pub3.
Spinks A, Glasziou PP, Del Mar CB; Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021 Dec 9 11:CD000023.
Tonsillectomy - Commissioning Guide; ENT UK and Royal College of Surgeons, 2021