Abnormal appearance of the throat

With a sore throat, the tonsils may swell and become red, and pus may appear as white spots on them. Symptoms typically get worse over two to three days and then gradually go, usually within a week. Often described as tonsillitis, this does not normally require treatment.

The presence of tonsillar exudate (pus on the tonsils) may increase the likelihood of a bacterial infection and is one of the items included in the FeverPAIN and CENTOR scoring systems. However, exudate is sometimes seen with viral infection and sometimes the throat can appear almost normal without exudates in a streptococcal (bacterial) infection. The image below depicts an example of exudates on the tonsils.

Tonsils often have white patches on them in healthy people. These are part of the lymphatic immune system and are sometimes called tonsillar crypts.

An important point is that some people may not have tonsils. They may not volunteer this information, so their absence on examination may be a surprise. Tonsillectomy has been a relatively common procedure until recent years. It is still possible to have a sore throat and potentially a bacterial infection after a tonsillectomy.

Picture credit: Doc James CC BY-SA 4.0 creativecommons.org/licenses/by-sa/4.0 via Wikimedia Commons