What those white spots on your tonsils mean and how to get rid of them

• White spots typically show up on tonsils as the result of a bacterial, viral, or yeast infection.
• Usually, the best method of treatment is antibiotics to fight the infection.

Imagine waking up with a sore throat. Maybe it hurts to swallow, or maybe your throat feels a little "off." You go to the mirror and open wide. There, way in the back of your throat, you see white spots on your tonsils. They may be small and pimple-like, or they could be lumpy patches or streaks.

These tonsil spots typically don't hurt, but they can definitely look concerning. They're part of your body's immune response. They often appear during an infection or as a reaction to a foreign object lodged in your tonsils.

"White spots on tonsils are most likely to disappear on their own after a few days," says Kire Stojkovski, MD, a doctor and medical consultant at Farr Institute. "Treating the underlying or primary medical condition will help get rid of the white spot more quickly."

Learn more about the various reasons why these white spots appear and how to deal with them.

Tonsillitis

Tonsillitis occurs when your tonsils become inflamed due to an infection. White spots are a common symptom of tonsillitis along with:

• Sore throat
• Difficulty swallowing
• Bad breath
• Fever (over 100.4 °F)

Medical term: Your tonsils are dimpled lumps in the back of your throat. The most well-known and visible pair lay on the left and right sides of your mouth, called the palatine tonsils. But you also have two pairs of tonsils on the top and bottom of your mouth.

When you see spots on your tonsils, often you are witnessing the aftermath of a microscopic battle between your immune system's white blood cells and the infectious germs they're fighting. The dead white blood cells and germs collect together in a liquid called pus.

The pus may swell under the lining of your mouth like a zit, or it could become a creamy patch that sits on the surface. This is called chronic caseous tonsillitis (CCT). These white spots generally are harmless.

Your doctor can prescribe antibiotics to get rid of tonsillitis caused by a bacterial infection. But if tonsillitis is from a viral infection, you may need to wait for it to pass on its own. In the meantime, you can soothe your sore throat by gargling salt water or drinking warm liquids.

Peritonsillar abscess

However, there are rare cases when the white spots can pose a danger. If the infection gets too severe, or your body is fighting off multiple pathogens at once, those spots can grow into a large lump. This is called a peritonsillar abscess (PTA).

In addition to causing severe tonsillitis symptoms, a peritonsillar abscess can:

• Swell and block your airway, making it difficult to breathe
• Spread the infection to your neck tissue and cause nerve damage
• Rupture and cause you to breathe in pus, allowing the infection to travel to your lungs

Fortunately, PTAs are rare, only affecting .03% of Americans a year.

How to treat it: They are also very treatable. You can get the abscess drained at an outpatient center or by an ENT. After your doctor extracts the pus, they will likely prescribe you corticosteroids or antibiotics to speed up the healing process.

Bacterial Infection

Bacteria cause 15% to 30% of acute tonsillitis cases. The most common culprit is a type of bacteria called group A strep, the same bacteria that cause strep throat.

Strep Throat

Group A strep bacteria thrive in the nose and throat. If the bacteria get in your tonsils, you may develop milky white spots. You might also see a grayish patch coating your tonsils called a pseudomembrane.

Note: Strep throat is a very common disease, affecting millions of people per year. It is most common in kids ages 5 through 15. If you are a parent, teacher, or other adult who spends lots of time with kids in this age range, you also have a higher risk of catching it.

According to the Centers for Disease Control and Prevention, other symptoms of strep throat include:

• Tiny red spots on the roof of your mouth
• Pain while swallowing
• Sore throat
• Swollen lymph nodes
• Fever

How to treat it: A doctor will prescribe you antibiotics and your tonsil spots and other symptoms should disappear in two to three days after starting the medication. It is important to take all the antibiotics you are given. If you stop too early, the white spots may return.

Viral Infection

Viruses cause up to 70% of acute tonsillitis cases. Here are several viral diseases that can cause spots on your tonsils.

Infectious Mononucleosis

Infectious mononucleosis, called "mono" for short, is caused by the Epstein-Barr virus (EBV). Mono is most common among adolescents and young adults. EBV spreads through saliva, hence why mono is sometimes called the "kissing disease."

Mono can look a lot like strep throat at first. Often doctors need to do an antibody test to tell which one is which.

Telltale signs of mono are:

• Extreme tiredness — fatigue is much more pronounced in mono than strep and will usually last a month or more
• Headache that will probably last for up to two weeks
• Red spots on the roof of your mouth
• Swollen lymph nodes that can stay swollen for over a month
• Sore throat that lasts 6-10 days, much longer than for strep

• Fever that will usually last for a couple of weeks

Tonsils infected with mono will look slightly different than those fighting off bacteria. With mono:

• Your tonsils may be much redder and more swollen.
• The pus may appear in extensive gray patches rather than spots.
• The white patches can spread to the tongue.
• Any white spots on the tonsils or tongue will probably last 6-10 days

How to treat it: Mono is caused by a virus, so antibiotics won't work on it. You just have to wait it out. Typically, it will take four to six weeks to fully recover.

During recovery, it is important to listen to your body and rest when you are tired. Your doctor may recommend you avoid vigorous exercise for a month. Mono can cause your spleen to swell, and there is a risk of it rupturing if you strain your body too much.

Oral Herpes

If you've ever had a cold sore, you can probably blame herpes simplex virus type 1 (HSV-1). Don't worry, you aren't alone: Over half of US adults have had oral herpes.

Most people get oral herpes through non-sexual contact. You might have come into contact with infected saliva by sharing silverware or dipping your pretzels in communal dip. Since the virus is so common, the older you are, the more likely you are to have been exposed.

Oral herpes rarely causes tonsillitis. But if HSV-1 does reach your tonsils, you might see white or red spots in the form of cold sores. If those sores leak fluid they can cause shallow cavities called ulcers.

Once you've contracted HSV-1, the virus stays with you, usually lying dormant in your body. Some lucky people never develop symptoms. Others will have recurring outbreaks from time to time that may look like:

• Itching and burning around your mouth
• Swollen lymph nodes
• Blisters (cold sores) on your lips, tongue, and gums

You're more likely to show symptoms during the first few outbreaks, when your body's immune system is still getting used to the virus.

How to treat it: Oral antiviral medications can help reduce herpes-related tonsil spots. Cold sores outside the body may respond well to topical ointments. You can take anti-inflammatory agents and pain relievers for other symptoms.

Yeast Infections

Your body is naturally host to a community of bacteria and yeast called your microbiome. Normally these organisms live in harmony with your body and support your everyday functioning. But when something disrupts the microbiome in your mouth, white patches can appear.

Oral thrush

The most common yeast infection in the mouth is caused by Candida albicans. If this yeast grows too much in your mouth and throat, you can develop oral thrush (also called candidiasis).

Signs of oral thrush include:

• Lack of taste
• Pain while eating or swallowing
• A "cottony feeling" in your mouth
• Cracks at the corners of your mouth
• White or light yellow patches around your mouth and throat

In oral thrush, you'll probably see patches and streaks rather than defined spots. The patches often look creamy like cottage cheese. The patches are most likely to be on the tongue or the lining of your cheeks and lips, but they can show up on your tonsils, too.

You are more at risk for oral thrush if you:

• Have a weakened immune system due to age or a health condition like uncontrolled diabetes
• Have been taking antibiotics for a long time
• Have been undergoing chemotherapy
• Have not been eating enough iron
• Have dentures that don't fit your mouth

How to treat it: You can treat oral thrush with antifungal medication. This might take the form of a pill, lozenge, or liquid. This treatment regimen usually takes one to two weeks.

Non-Infectious causes

Not all tonsil spots are caused by infection. Sometimes they are caused by foreign objects.

Tonsil Stones

Sometimes food and debris can get caught in your tonsil's crevices. If the object stays there for too long, it will harden into a mineral deposit we call a tonsil stone.

Tonsil stones are very common, affecting up to 10% of people in their lifetime. They become more common as people get older, peaking between ages 50 to 69.

Usually, these tonsil stones are too small to see and cause no symptoms. Most people don't realize they have tonsil stones until they get a routine X-ray or CT scan at their dental office.

When tonsil stones are visible, they often look like white or yellow pebbles. They may attract bacteria, which may cause your breath to smell. Pus can also collect in the gap and harden, making the stone larger.

Unlike tonsillitis, tonsil stones generally don't cause fever. They won't make your tonsils red and swollen either. Often they cause no pain at all.

How to treat it: If you have a tonsil stone that's bothering you, gargling with salt water can help. You can swallow a tonsil stone without choking, but spitting one out is quicker than digesting it.

You can also try dislodging a tonsil stone with a water pick or cotton swab. Don't use your fingers to pick it out, since you could scratch your tonsils and cause further infection.

Insider's takeaway

White spots on your tonsils can look scary, but they generally aren't dangerous. They're simply a sign that your immune system is doing its job to keep you safe.