What causes white spots on the tonsils? 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Treatment is available for most of these conditions. The tonsils are part of the lymphatic system and located on the back of the throat. Changes to the appearance of the tonsils may be a sign that the body is reacting to an infection. Often, there will also be a sore throat or swollen tonsils. In some cases, the spots may contain pus. Possible causes include:strep throatoral thrushviral tonsilitismononucleosis, or “mono”tonsil stones Here, find out about some causes of white spots on the tonsils, when to see a doctor, and which treatment they might prescribe. Symptoms Symptoms will depend on the cause, but a person may notice: white spots, streaks, or blotches on the tonsils or throata sore throatdifficulty swallowingother symptoms, such as a fever, fatigue, or nasal congestion, depending on the cause Causes The most common cause of white spots on the tonsils is a bacterial, viral, or fungal infection. Some of the more common infections that can cause white spots include: Strep throat Strep throat is a bacterial infection caused by Streptococcus. Additional symptoms that may indicate strep throat include:sore throatfeverswollen lymph nodes in the neckheadacheinflamed and swollen tonsils Strep throat is a common infection. According to the Centers for Disease Control and Prevention (CDC), it is most common in: children aged 5–15 yearsadults who spend time with school-aged childrenthose who spend time in crowded settings, such as day care centers and military training facilities If a person suspects they or someone they are caring for has strep throat, they should seek medical advice. While rare, complications can arise if the bacteria spread to other parts of the body, such as the heart. They include rheumatic fever, ear and sinus infections, and post-streptococcal glomerulonephritis, which affects the kidneys. Oral thrush Oral thrush is a fungal infection that can affect the mouth and throat. Possible other symptoms include:pain when swallowingdifficulty swallowingredness and sorenessloss of tastea feeling like cotton in the mouthcracking at the corners of the mouth White spots may also appear on the cheeks, tongue, and roof of the mouth. Oral thrush can affect anyone but is most common in those who:use dentureshave a weakened immune system, as with HIV and some cancers and cancer treatmentshave diabetesuse antibiotics or corticosteroids for a long-term condition, such as asthmause inhale corticosteroids without a spacerhave a dry mouth or use medications to treat dry mouthsmoke It can affect infants and babies. Fungal spores are often present in the mouth, throat, and digestive tract, but they do not usually cause an infection. However, symptoms can appear if conditions change, for example, if the immune system becomes weakened. Viral tonsillitis Tonsillitis involves inflammation or swelling of the tonsils. It usually results from a viral infection but can occur with strep throat. Symptoms of viral tonsillitis include:red and swollen tonsils, possibly with pusa white or yellow coating on the tonsilsa sore throatpain and difficulty when swallowingswollen lymph nodes in the neckfeverbad breathmouth breathing or sleep apnea Tonsillitis may occur with the following viruses: the Epstein-Barr virus, which causes infectious mononucleosisthe herpes simplex virusmeaslescytomegalovirus It can also occur with strep throat, which is a bacterial infection. Infectious mononucleosis Mononucleosis is a viral infection caused by the Epstein-Barr virus, which affects certain blood cells. Along with white spots on the back of the throat, symptoms may include:feversore throatsevere fatiguehead and body achesswollen lymph nodes in the neck and underarmsswollen liver, spleen, or botha rash Infectious mononucleosis spreads easily from person to person. Those most at risk are teenagers and young adults. Tonsil stones Tonsil stones, also called tonsilloliths, are like hard, white stones that form on the tonsils. Often, a person will not notice they are there, but sometimes they can become large. One case report from 2005 describes a tonsil stone 2.5 centimeters (cm) by 1.5 cm. However, this is unusual. Tonsil stones, or tonsilloliths, can form when bacteria and debris, such as mucosa and food, become stuck in crevices in the tonsils. As the debris hardens or calcifies, white spots can become visible on the tonsils. Many people with tonsil stones do not notice them, but symptoms can include:bad breathear paina feeling of having something stuck in the throatpainful swallowing Leukoplakia Some tissue changes can lead to leukoplakia, white or gray areas in the mouth or throat that do not disappear when a person scrapes them. Common causes include: smokingchewing tobaccodentures that do not fit wellchewing betel nut In rare cases, it can be an early sign of cancer. For this reason, a doctor may recommend a biopsy. Other causes of white spots on tonsil Other possible causes include:oral herpesoral cancercanker sores in the throat When to see a doctor A person should seek medical advice if they have:severe or persistent symptomssymptoms that may indicate strep throatrecurrent infectionsdifficulty breathingany other concerns about white spots on the throathoarseness lasting over 2 weeksa fever over 101°F (38.3°C)blood in saliva or phlegma lump in the neckearache Diagnosis A doctor will: Look in the back of the throat.Feel around the neck for any swelling.Ask about other symptoms. They may also take a throat swab or do blood tests for testing in a laboratory. These can show if bacteria are present, in which case they may prescribe antibiotics. Treatments Treatment will depend on the cause of the white spots. A doctor may recommend the following:TreatmentOther notesStrep throatantibiotics, such as penicillin or amoxicillinIf a person tests positive but has no symptoms, they will not need antibiotics.Oral thrushantifungal medications, such as clotrimazole, miconazole, or nystatin, applied to the area for 7–14 daysFor more severe infections, a doctor may prescribe fluconazole.Viral tonsilitismanaging symptoms through rest, drinking fluids, eating soft food, avoiding exposure to smoke, gargling with salt water, acetaminophen for pain relief, and other home remediesAntibiotics will not help with a viral infection; it usually gets better without medical treatment.Infectious mononucleosismanaging symptoms through rest, drinking plenty of fluids, over-the-counter medication, such as acetaminophen for pain and fever, and other home remediesAntibiotics will not help with a viral infection. Symptoms usually go away after 2–4 weeks but can last 6 months or more.Tonsil stonesminor surgery to remove the stones if they are troublesomeMore severe cases may need removal of the tonsils.Leukoplakiaif necessary, minor surgery or laser surgeryFurther treatment will depend on the result of a biopsy, if appropriate.Other causestreatment as appropriate A person who has recurrent infections of the tonsils may need surgery to remove them, known as a tonsillectomy. At-home treatment Depending on the cause, treatment at home can help manage symptoms. This may include:drinking warm liquids to decrease throat paineating only soft foods if swallowing is difficultavoiding smoking or exposure to smokeeating popsicles to soothe a sore throattaking over-the-counter pain relievers, such as acetaminophengetting plenty of rest, which allows the body to fight any infectionusing a humidifiersucking on throat lozenges to ease discomfort, but only from the age of 4 years or over, due to the risk of choking The time it takes for white spots to clear up will depend on the cause, treatment, and individual factors. Preventing white spots on the tonsils It is not always possible to prevent white spots on the tonsil, but people can reduce the risk of some conditions that cause them. Tips include:washing the hands often to reduce the risk of infectionsboosting the immune system through a well-balanced diet, exercise, and regular sleepcovering the nose and mouth when coughing to avoid passing on infections to otherslimiting close contact with others who have an infectionpracticing good oral hygiene, including regular dental checkupsbeing aware of how the tonsils usually appear and monitoring any changesavoiding or quitting smokinguse a spacer when using an inhaler for thrush Frequently asked questions Here are some questions people often ask about white spots on the tonsils. Should I be worried about white spots on the tonsils If white spots occur with severe or persistent symptoms or if symptoms do not disappear after 2–3 weeks, it is a good idea to seek medical advice. Can you have white spots without having strep throat Yes, other causes include viral or bacterial tonsillitis, oral thrush, and tonsil stones. How can I get rid of white spots on my tonsils This will depend on the cause. Often, they go away as an infection clears, either with home remedies or with medical treatment. A doctor can advise on specific options. Summary White spots can occur on the tonsils for various reasons, including infections, tonsil stones, and oral thrush. Sometimes other symptoms occur, such as a sore throat, bad breath, or difficulty swallowing. Often, the condition that causes white spots either goes away without medical treatment, but home remedies can help manage symptoms. In some cases, surgery may be necessary. Anyone who has concerns about white spots appearing on their tonsils should seek medical advice. Read the article in Spanish. Last medically reviewed on April 13, 2022Ear, Nose, and ThroatFlu / Cold / SARSInfectious Diseases / Bacteria / Viruses 13 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.About infectious mononucleosis. (2020).https://www.cdc.gov/epstein-barr/about-mono.htmlAbu Naser, S. S., et al. (2016). An expert system for mouth problems in infants and children.https://www.researchgate.net/publication/301886798_An_Expert_System_for_Mouth_Problems_in_Infants_and_ChildrenCandida infections of the mouth, throat, and esophagus. (2021).https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.htmlMaster, K. G., et al. (2021). Anatomy, head and neck, tonsils.https://www.ncbi.nlm.nih.gov/books/NBK539792/Mohammed, F., et al. (2021). Oral leukoplakia.https://www.ncbi.nlm.nih.gov/books/NBK442013/Oropharyngeal / esophageal candidiasis ("thrush"). (2014, February 13)https://www.cdc.gov/fungal/diseases/candidiasis/thrush/Shikino, K., et al. (2021). Tonillolith.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218315/Silvestre-Donat, F. J., et al. (2005). Giant tonsillolith: Report of a case.https://pubmed.ncbi.nlm.nih.gov/15876967/Sore throats. (2020).http://www.entnet.org/content/sore-throatsStrep throat: All you need to know. (2022).https://www.cdc.gov/groupastrep/diseases-public/strep-throat.htmlTonsillitis. (2019).https://www.enthealth.org/conditions/tonsillitis/Tonsilitis. (2022).https://medlineplus.gov/tonsillitis.htmlWhat are oral cavity and oropharyngeal cancers? (2021).https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.htmlFEEDBACK:Medically reviewed by Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP — By MaryAnn De Pietro, CRT — Updated on April 13, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhat are the symptoms of oral thrush and how to treat itMedically reviewed by Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP Oral thrush is typically caused by a fungal infection that develops on the mucous membranes of the mouth. 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