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Purulent Tonsils: Causes, Symptoms and Treatment

Purulent tonsils are a sign of bacterial tonsillitis. They are characterized by severe sore throat, difficulty swallowing, and white or yellow pus patches on the tonsils.

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Things worth knowing about "Purulent Tonsils"

Purulent tonsils are a sign of bacterial tonsillitis. They are characterized by severe sore throat, difficulty swallowing, and white or yellow pus patches on the tonsils.

What Are Purulent Tonsils?

Purulent tonsils occur when the palatine tonsils become infected with bacteria, leading to the formation of pus on their surface. Medically, this condition is called purulent tonsillitis or bacterial tonsillitis. The tonsils are part of the immune system and are located on both sides at the back of the throat. When infected, they become swollen and may be covered with white or yellowish pus spots.

Causes

The most common cause of purulent tonsils is bacterial infection, particularly:

Streptococcus pyogenes (Group A streptococci) – the most frequent bacterial cause
Staphylococci
Other bacteria such as Haemophilus influenzae

Viruses such as the Epstein-Barr virus (infectious mononucleosis) can also cause tonsillitis with pus-like coatings, though true pus is less common in viral infections.

Symptoms

Typical symptoms of purulent tonsils include:

Severe sore throat, which may be one-sided or on both sides
Difficulty swallowing, sometimes to the point of being unable to swallow
Fever, often above 38.5 degrees Celsius
Swollen, tender lymph nodes in the neck
White or yellowish pus patches or coatings on the tonsils
Bad breath (halitosis)
Hoarseness or muffled voice
General feeling of illness and fatigue

Diagnosis

Diagnosis is typically made through a clinical examination of the throat. The doctor assesses the appearance of the tonsils, the state of the lymph nodes, and the overall symptoms. To distinguish between viral and bacterial causes, the following tests may be used:

Throat swab with bacterial culture or rapid streptococcal antigen test
Blood count to check for elevated inflammatory markers (e.g., CRP, white blood cells)
Antibody test if infectious mononucleosis is suspected

The McIsaac score is a clinical tool that helps doctors estimate the probability of a streptococcal throat infection.

Treatment

Bacterial Tonsillitis

When a bacterial cause is confirmed or likely, antibiotics are prescribed. The first-line treatment is typically phenoxymethylpenicillin (Penicillin V), or in case of penicillin allergy, erythromycin or another macrolide antibiotic. The treatment usually lasts 7 to 10 days. It is important to complete the full course of antibiotics to prevent complications and antibiotic resistance.

Symptomatic Treatment

Pain relievers such as ibuprofen or paracetamol for pain and fever
Adequate fluid intake to prevent dehydration
Throat lozenges or sprays with local anesthetic effects
Cool, soft foods (e.g., ice cream, yogurt) to ease swallowing
Physical rest and recuperation

Surgical Treatment

For recurrent purulent tonsillitis (more than 5 to 7 episodes per year) or complications such as a peritonsillar abscess, surgical removal of the tonsils (tonsillectomy) may be recommended.

Possible Complications

Untreated or inadequately treated purulent tonsillitis can lead to serious complications, including:

Peritonsillar abscess: A collection of pus next to the tonsil, often on one side
Rheumatic fever: An inflammatory condition that can affect the heart, joints, and kidneys following streptococcal infection
Glomerulonephritis: Kidney inflammation as a consequence of streptococcal infection
Spread of infection to adjacent structures in the neck or throat

When to See a Doctor

Medical attention is strongly advised when experiencing:

Severe sore throat with fever above 38.5 degrees Celsius
Visible pus spots on the tonsils
Difficulty swallowing or opening the mouth
Symptoms persisting for more than 3 to 4 days despite self-treatment
Children with high fever and swallowing difficulties

References

Bisno AL et al. - Practice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Clinical Infectious Diseases, 2002.
Windfuhr JP et al. - Clinical practice guideline: tonsillitis. Deutsches Ärzteblatt International, 2016.
World Health Organization (WHO): Streptococcal Pharyngitis and Rheumatic Fever. www.who.int

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