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Purulent Tonsillitis: Causes, Symptoms and Treatment

Purulent tonsillitis is a bacterial infection of the palatine tonsils causing pus formation, severe sore throat, high fever, and difficulty swallowing. Medical treatment is essential.

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Purulent tonsillitis is a bacterial infection of the palatine tonsils causing pus formation, severe sore throat, high fever, and difficulty swallowing. Medical treatment is essential.

What is Purulent Tonsillitis?

Purulent tonsillitis, also known as suppurative tonsillitis or strep throat (when caused by streptococci), is an acute bacterial inflammation of the palatine tonsils. It is characterized by the formation of white or yellowish pus deposits on the surface of the tonsils. It is one of the most common conditions affecting the throat and is especially prevalent in children and adolescents, though it can affect people of all ages.

Causes

Purulent tonsillitis is primarily caused by bacteria. The most common pathogen is:

Streptococcus pyogenes (Group A Streptococcus) – responsible for the majority of purulent cases
Staphylococci and other bacteria (less commonly)

The infection spreads through droplet transmission, meaning through coughing, sneezing, or close contact with an infected person. Contributing factors include a weakened immune system, stress, or respiratory tract illnesses.

Symptoms

The symptoms of purulent tonsillitis typically appear suddenly and include:

Severe sore throat, often on one or both sides
High fever (often above 38.5 °C / 101.3 °F)
Significant difficulty swallowing
Visible pus deposits or white spots on reddened, swollen tonsils
Swollen and tender cervical lymph nodes
Bad breath caused by the pus
General malaise, fatigue, and weakness
Occasional headaches or earaches

Diagnosis

Diagnosis is made by a physician based on the characteristic symptoms and a throat examination, which reveals enlarged, reddened tonsils with pus deposits. A throat swab may be taken to confirm the presence of streptococcal bacteria. Blood tests may also be ordered to measure inflammatory markers such as C-reactive protein (CRP) or white blood cell count. The McIsaac score (also known as the Centor score) is a clinical tool used to estimate the probability of a streptococcal infection.

Treatment

Antibiotics

When a bacterial cause is confirmed or highly probable, antibiotics are prescribed. The first-line treatment is phenoxymethylpenicillin (Penicillin V). For patients with penicillin allergy, alternatives such as amoxicillin-clavulanate or cephalosporins may be used. The full course of antibiotics (typically 7 to 10 days) must be completed to prevent relapse and complications.

Symptomatic Treatment

Alongside antibiotics, the following measures can help relieve symptoms:

Pain-relieving and fever-reducing medications such as ibuprofen or paracetamol
Drinking plenty of fluids (water, herbal teas)
Cold drinks or ice to soothe throat pain
Antiseptic throat gargles or lozenges
Bed rest and avoiding physical exertion

Surgical Treatment

In cases of recurrent tonsillitis (e.g., more than 5 to 7 episodes per year), a tonsillectomy (surgical removal of the tonsils) may be considered. This decision is made individually in consultation with an ear, nose, and throat (ENT) specialist.

Possible Complications

If left untreated or inadequately treated, purulent tonsillitis can lead to complications, including:

Peritonsillar abscess: a collection of pus next to the tonsil, usually requiring surgical drainage
Middle ear infection or sinusitis
Rheumatic fever (if the streptococcal infection is untreated)
Post-streptococcal glomerulonephritis (a kidney condition)

Prevention

While complete prevention is not always possible, the following steps can reduce the risk of infection:

Frequent and thorough handwashing
Avoid sharing utensils, glasses, or towels
Maintaining distance from infected individuals
Supporting the immune system through a balanced diet, adequate sleep, and regular physical activity

References

Shulman ST et al.: Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Clinical Infectious Diseases, 55(10): e86–e102, 2012.
Windfuhr JP et al.: Clinical Practice Guideline: Tonsillitis. HNO Journal, Springer Medicine, 2016.
World Health Organization (WHO): Streptococcal Pharyngitis and Rheumatic Fever. WHO Technical Report, Geneva.

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