White Spots on Tonsils: Causes, Diagnosis & Treatment

White spots on tonsils are usually caused by pus, and they tend to appear with bacterial infections like strep throat. White spots can also appear with viral infections, such as mononucleosis or cytomegalovirus. These types of infections typically appear with other symptoms like fever, fatigue and general malaise. Presence of yellow or whitish spots on the tonsils, without other symptoms, may may also just be a sign of tonsil stones.

Ideally, any white spots should be assessed by a doctor, who will assess the underlying cause and start appropriate treatment. Treatment for a bacterial infection, for example, requires antibiotics like amoxicillin, while a viral infection may require anti-inflammatories like ibuprofen.

Pus that appears in the throat should not be removed with your finger or a swab as it will just continue to form until the inflammation improves. Attempting to remove pus may create wounds, as well as worsen the pain and swelling in that area.

Main causes

The most common causes of white spots on the tonsils are: 

1. Viral infections

Some viral infections that can cause white spots on the tonsils include: 

• Viruses that cause the common cold, like rhinovirus and adenovirus 
• Flu virus, like influenza A and B 
• Syncytial respiratory virus
• Epstein-Barr virus, which causes mononucleosis 

Although it is less common, HIV and mumps infections can also cause white spots on the tonsils. 

2. Bacterial infections

White spots in the throat are mostly caused by infections from Streptococcus pyogenes, also known as strep a. This bacteria is naturally present on the throat, and can overgrow when the immune system is weakened. This bacteria can also be transmitted from one person to another.  

Confirming a diagnosis

To diagnose the underlying cause of white spots on the tonsils, you should see a family doctor or ENT specialist. The doctor will evaluate the presenting symptoms, and may additionally order blood work and a throat swab. Combining the finding from the assessment and lab testing will allow the doctor to confirm the cause of pus in the throat and will guide the appropriate treatment. 

Treatment for white spots

The cause of the infection will determine the treatment required. A diagnosis must first be made by your family doctor or otolaryngologist.

Pharmacy medication 

The doctor may opt to prescribe any of the following medication, or a combination of them: 

• Anti-inflammatory drugs, such as ibuprofen, nimesulide and ketoprofen. These help to improve inflammation, redness, difficulty swallowing and fever;
• Corticosteroids, such as prednisone or dexamethasone. These are used when anti-inflammatory drugs do not resolve the problem, or if the throat pain is unbearable
• Antibiotics, such as penicillin, amoxicillin or azithromycin. These are prescribed if a bacterial infection is present.

In some cases, the infection may form an abscess in the tonsils, and when this happens, the doctor may drain the accumulated pus.

Natural treatment options

The home remedies can be used to treat any type of sore throat, however they should be used only as a complement to prescribed treatment. These only help to speed-up recovery and help with symptoms. Some options you can try include:  

• Gargling with lukewarm water and salt, or with lemon, water and honey;
• Honey teas with ginger, eucalyptus, mauve, salvia or althea;
• Drinking grapefruit juice. Ideally, grapefruit juice should not be used if you are already taking medication prescribed by your doctor, as it may reduce the effectiveness of the medication.

When undergoing treatment, it is important to rest and drink plenty of fluids, which will help the body recover. Check out other sore throat home remedies that you can use to compliment your medical treatment.