Why do I have white spots, stuff or patches on my tonsils? Could these patches, spots, dots or bumps be caused by STDs, tonsillitis, oral thrush, herpes, tonsil stones, strep, mono or cancer? Learn more including their causes and some possible treatments.
Tonsils (Waldeyer's tonsillar ring) are a collection or set of the lymphatic tissues that help the body in fighting against gastrointestinal and respiratory infections. They are composed of the adenoid, lingual, two tubal and two palatine tonsils.
When unspecified, and for the sake of this discussion, we will use the term tonsils to refer to the palatine ones which “are masses of lymphatic material situated at either side at the back of the human throat” [en.wikipedia.org].
Sometimes, due to the many reasons we are going to discuss, one might end up with white spots, bumps, patches, chunks, stuff or things on their tonsils which you could just a single one, in clusters or widespread. Furthermore, they could be small or large.
Finally, spots or patches can be with or without pain, swelling, fever, sore throat, pus, difficulty in breathing, swallowing (hurts to swallow), among other symptoms.
Causes and Treatments
1. Tonsillitis spots
The first possible cause is tonsillitis. This is the inflammation of tonsils often caused by a virus infection. However, bacteria could also cause this problem but this is not common. When you get this infection, a sore throat is the most common symptom.
Furthermore, your tonsils “will be red and swollen and your throat may be very painful, making swallowing difficult” [nhs.uk] and at times you could have whitish patches or your tonsils i.e., “coated or have white, pus-filled spots on them” [nhs.uk]. Sometimes, you might have grey exudates.
Other symptoms you expect include high temperature (fever), headache, feeling sick and tired, coughing, pain in ears, voice changes including loss of voice, painful and swollen neck lymph glands. These symptoms generally improve after about 4 days.
Tonsillitis caused by a bacterial infection such as streptococcus will have severe symptoms that might include a very sore throat, fever, swollen tonsils and a bad breath i.e. stinky or white smelly stuff. Viral infections especially if by the viruses that cause cold and flu will have milder symptoms.
On treatment, when caused by bacteria, your doctor will recommend some antibiotics.
2. Strep throat
The second reason for why you could have white spots on throat and tonsils is strep throat, a bacterial infection caused by streptococcus bacteria that often results in throat pain and inflammation.
When you have it, you will have a sudden fever, headache, chills, swollen neck lymph nodes, loss of appetite, swallowing difficulties and a sore throat i.e. “red throat with white patches” [healthline.com] or some stripes or streaks of pus on your throat and red colored tonsils.
Treatment is by antibiotics where penicillin and amoxicillin are often preferred. Some home remedies you should try include drinking hot teas and lemon water (warm drinks), cold drinks to numb your throat, OTC pain relievers, suck throat lozenges, use your humidifier and gargle a mixture of salt and water (a half a tsp of salt in a cup of water).
3. Tonsil stones or tonsillolith – Bumpy
Tonsilloliths are formed when bacteria, foods, dead cells, mucus, dirt, etc. are trapped and calcifies on tonsil pockets or groves, and you end up with hard whitish bumps on tonsils i.e., white balls on tonsils or white solid lumps that might be visible or hidden in the tonsils folds.
Whereas you could be having many small tonsilloliths, it is possible to have a few or even large ones. Owing to their cause, they won’t go away unless you removed even after weeks. These balls could be on one side or on both sides.
Besides the whitish solid bumps, expect to suffer from an excessively bad breath, which is often accompanied by chronic tonsillitis.
Other symptoms include swallowing difficulties depending on the size of the bumps and their location, a sore throat (some pain where the debris are lodged), ear pain (due to shared nerves), swollen tonsils due to inflammation by collected debris.
Most cases might not need any treatment when they do not have symptoms i.e. they no other symptoms. However, treatment is by antibiotics and surgical removal when they are very big.
At home, gargling warm salty water can easy symptoms or easy dislodging the stones by swabs or picks.
4. Oral thrush or candidiasis
Another possible cause is oral thrush especially when it is also on the back of tongue and throat. Oral thrush is a Candida albicans yeast infection common in children, pregnant women and people with compromised immune systems including the HIV, cancer, and diabetes patients.
Oral thrush often causes “creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums and tonsils” [mayoclinic.org] or even on the uvula. When scraped off, they leave areas that red that might slightly bleed.
Besides the plagues or patches, one will have a burning or painful sensation in the mouth i.e. redness and soreness, cracks on mouth corners, loss of appetite, cottony feeling in the mouth, and redness inside your mouth and throat.
Treatment is by antifungal medications.
5. Oral herpes
Oral herpes caused by HSV-1 herpes simplex virus can be a cause of this problem. This is not an STD and it is often referred as cold sores or fever blisters. It is mainly transmitted through oral-to-oral contact. However, The World Health Organization notes that “It can also be transmitted through oral sex to cause genital herpes” [who.int].
Common symptoms include tingling, burning pain and itchiness, red mildly swollen gums, swollen neck lymph nodes and oral sores (yellowish or white blisters on tonsils).
Oral sores “may occur on the lips, the gums, the front of the tongue, the inside of the cheeks, the throat and the roof of the mouth” [webmd.boots.com] making drinking or eating difficult. On teens and people in 20’s it might cause “painful throat with shallow ulcers and a grayish coating on the tonsils” webmd.boots.com
Although blisters are common on lips, and around your mouth, according to DermNet New Zealand, oral herpes in infants and toddlers aged 1-5 years can have “vesicles (little blisters) occur in whitish patches on the tongue, throat, palate, and insides of the cheeks” [ dermnetnz.org]. The patches may be followed with ulcers that have a yellow coating and a bad breath.
Mononucleosis or mono is a viral infection caused by a herpes virus known as Epstein-Barr virus especially in teenagers and adults in 20’s can be responsible for your pus and white patches on tonsils and throat. However, other viruses can cause mono.
Some of its common symptoms include a sore throat, swollen neck, groin, arm area lymph glands, white patches in the throat, skin rash, headache, loss of appetite, and muscle weakness or aches.
This is a condition characterized by mainly by “thickened, white patches form on your gums, the insides of your cheeks, the bottom of your mouth and, sometimes, your tongue” [mayoclinic.org] and even your throat and tonsils. These whitish or graying patches cannot be wiped away as in the case of oral thrush.
Although most cases are non-cancerous, some could be an early sign of cancer especially if the whitish patches have red spots.
Cheek biting, uneven and rough teeth, improperly fitting dentures and tobacco chewing has been associated with leukoplakia.
If you have white follicles-like structures on tonsils, this could be one type of leukoplakia, the hairy leukoplakia can cause fuzzy, or hairy whitish patches that look like folds or ridges on your tongue side. It affects people with a weakened immune system especially those using medications or suffering from disease especially HIV/AIDS.
8. Syphilis infection
Syphilis, a sexually transmitted disease (STD) caused by Treponema pallidum can be responsible this problem including inside your mouth especially if they are wart-like grey or white i.e. it can cause “white patches inside the mouth and other mucous membranes” [drugs.com], especially during its secondary stages.
Other symptoms of secondary stage syphilis include skin rashes on the trunk, legs or arms, fine red dots feet sole and palms, fever, headache, sore throat, loss of appetite, weight loss, swollen lymph nodes, feeling very tired, etc.
Treatment is by penicillin injection or other antibiotics. During treatment, it is advisable for the doctor to check other diseases such as Chlamydia, HIV, gonorrhea and other STDs.
9. Oral cancer
Another possible cause is cancer, especially if it tonsils cancer. “It may appear as a white or red patch of tissue in the mouth, or a small-indurated ulcer, which looks like a common canker sore” [oralcancerfoundation.org]. It is likely to be cancer if the patch does not heal after two weeks.
Before concluding the whitish spots are cancerous, you will be having other symptoms such as lump inside your neck or mouth, difficulty in swallowing, chewing or speaking, voice hoarseness that stays for long, ulcers, swollen lymph nodes, weight loss, numbness and mouth bleeding, loose teeth and difficult in jaw movement.
To be specific this cancer causes mouth pain, a persistent sore throat, swallowing pain, bloodstained saliva, an enlargement on side of your tonsil, bad breath, sore on the back of your mouth that won’t heal, severe ear pain, and intolerance to some drinks and foods (especially citrus).
When you have diphtheria, “a grey-white coating (membrane) can develop inside your throat. It covers the back of your throat and tonsils and can obstruct your breathing” [www.nhs.uk]. When you have it, you will notice whitish stuff or things.
Other symptoms include high fever, chills, fatigue, a sore throat, hoar voice, cough, headache, swallowing difficulties or pain, breathing difficulties, swollen neck lymph glands, blue or pale skin and bloodstained, bad smelling nasal discharge.
Since it is caused by Corynebacterium diphtheria, treatment is by antibiotics and antitoxins where a 14-day course of antibiotics is required for most people. Vaccination is also done during childhood.
11. Oral gonorrhea
Gonorrhea is a sexually transmitted infection STI caused by Neisseria gonorrhoeae bacterium passed through anal, vaginal or oral sex.
Common symptoms include vaginal or penis discharge, burning sensation when passing urine, foreskin swelling and testicle tenderness in men while women will have pain and tenderness in their lower abdomen and bleeding between periods.
Sometimes, one could end up with “gonococcal infections of the throat include redness and swelling of the tonsils, sometimes accompanied by exudate (white spots) on the tonsils” [mckinley.illinois.edu] or as medicine.net puts it, “redness and occasionally may have some white spots or whitish/yellow discharge” [medicinenet.com] from the throat.
12. Pharyngitis or a sore throat
Pharyngitis or a sore throat refers to the inflammation of the pharynx that could be caused by a number of causes including diphtheria, mononucleosis, gonorrhea, acute HIV infection, among infections.
Common symptoms include swallowing pain or difficulty, feeling itchy, and the “throat often appears red, swollen, or puffy, and may have white spots of purulent exudate (pus)” [healthcommunities.com].
Sometimes, the whitish spots of pus can extend to the base of your tonsils (behind ). This makes a sore throat a possible cause too.
13. Other causes
Other possible causes include allergies, post-nasal dry, excessive hair dryness, chemical exposure, infections after tonsillectomy and peritonsillar abscess, which is just a complication of tonsillitis.
We have seen all common causes, It is time to make a few deductions to help you quickly identify what could be behind your case.
Are they a sign of STDs
Many people often connect the presence of them with an STD. For instance, here is what someone posted on healthcaremagic.om
“I have white spots on my tonsils. My throat is not sore and I do not have a fever. However, I recently had unprotected oral sex and am concerned this is an STD . Can you tell me if these symptoms are typical of any in particular?”
As we have seen, acute HIV infection (makes the body vulnerable to infections), oral gonorrhea and syphilis can all cause throat and/or tonsils infections that might result in whitish spots pus discharges. Check other symptoms to be certain it is an STD.
Although a recent research on Chlamydia Trachomatis Tonsillopharyngitis where chlamydia trachomatis can spread to the oropharynx, causing whitish pus discharge, the number of reported cases for chlamydia trachomatis causing tonsillar infections are very limited.
With white pus
From the above causes, there are some causes, which we have said are likely to cause not just spots but white pus or exudate. Top possible causes include pharyngitis or a sore throat, oral gonorrhea STD, tonsillitis, strep throat, mono among others.
It is important to look at other symptoms associated with each of the most probable causes of pus such as fever or no fever, sore throat or no sore throat, etc.
On how you will cure or treat each of them, it will depend on the actual cause. The way you treat whitish pus pockets behind your tonsils from tonsillitis will be different from those caused by strep.
With no pain
Although most of the cases are accompanied by pain, i.e. they are sore, tender or painful. However, it is possible to have them but no pain.
The common causes of painless ones are leukoplakia and tonsilloliths, which happen to have no fever.
Finally, even tonsils cancer at its initial stages might present itself as painless whitish patches which could be confused for leukoplakia.
With or with no sore throat
If you have a sore throat, the most probable cause is tonsillitis, strep throat, tonsilloliths, mononucleosis, syphilis infection, oral cancer, diphtheria, and pharyngitis.
By examining the other symptoms such as whether or not there is fever, swollen glands, cough, etc., that accompany your white spots and sore throat; you should have a hint of what it could possibly be.
On the other hand, if you have them with no sore throat, some of the most likely include oral thrush or candidiasis, oral herpes, leukoplakia and oral gonorrhea. Sometimes, tonsilloliths when small might not cause a sore throat.
What about having them swollen or what causes it? If your tonsils are swollen, yet they have whitish spots, patches, plagues or stuff, probably you have tonsillitis, tonsilloliths, strep, mononucleosis, herpes simplex viruses, oral cancer, or oral gonorrhea (STD).
Besides the swelling, check for other symptoms such as high temperature (fever), cough, swallowing difficulties or pain ( i.e. swollen painful tonsils with white spots), swollen glands, sore throat, etc.
You will need a diagnosis to be sure what causes them before embarking on treatment since some infections have symptoms that closely mimic each other. Different causes will require different treatments.
Home remedies include eating Popsicle (flavored ice pops), OTC medications such as acetaminophen or ibuprofen, using a humidifier while sleeping, throat lozenges, having plenty of rest and gargling salty water (one teaspoon in 250 ml water).
Finally, if you have swollen tonsils with no whitish spots, the causes could be many, most of which we have not focused on this discussion.
With white lump
The most obvious cause of a white lump on tonsils is tonsilloliths, which could cause no pain or cause pain while swallowing, depending on where this lump is located as well as its size. Furthermore, ear pain might arise. If the while lump on tonsils does not heal after two weeks, see a doctor.
Also, having a white growth on tonsil could be a sign of tonsil cancer. At initial stages, it can be painless i.e. cause no pain. A sore throat, difficulties in talking, chewing or swallowing is also possible.
Following by our analysis above, deductions for what could be behind white sores, pockets or spots on tonsils with or without no fever (no temperature) and other symptoms should help you find out the possible causes.
On how to get rid of them, it all depends on the cause. There are no general treatments. The best practice is to visit your ENT doctor for proper diagnosis.
Our references and sources
- Tonsil: https://en.wikipedia.org/wiki/Tonsil
- Tonsillitis – Symptoms: http://www.nhs.uk/Conditions/Tonsillitis/Pages/Symptoms.aspx
- What is strep throat: http://www.healthline.com/health/strep-throat#Symptoms2
- Oral Thrush: http://www.mayoclinic.org/diseases-conditions/oral-thrush/basics/symptoms/con-20022381
- Herpes Simplex Virus: http://www.who.int/mediacentre/factsheets/fs400/en/#hsv1
- Oral herpes: http://www.webmd.boots.com/oral-health/guide/oral-herpes
- Herpes simplex: http://www.dermnetnz.org/viral/herpes-simplex.html
- Syphilis http://www.drugs.com/health-guide/syphilis.html
- Oral Cancer Facts: http://www.oralcancerfoundation.org/facts/
- A sore throat (Pharyngitis) Overview: http://www.healthcommunities.com/pharyngitis-sore-throat/overview-of-sore-throat.shtml
- Diphtheria – Symptoms: http://www.nhs.uk/Conditions/Diphtheria/Pages/Symptoms.aspx
- Leukoplakia http://www.mayoclinic.org/diseases-conditions/leukoplakia/basics/symptoms/con-20023802
- Can the white spot on tonsils be a symptom of a STD? http://www.healthcaremagic.com/questions/Can-white-spot-on-tonsils-be-a-symptom-of-a-STD/269939
- Chlamydia and Gonorrhea: http://www.mckinley.illinois.edu/handouts/chlamydia_gonorrhea.html
- Oral Gonorrhea Symptoms:http://www.medicinenet.com/oral_gonorrhea_symptoms-page2/views.htm