What Is Tonsillitis?

Tonsillitis is when the tonsils—the two oval-shaped lymph nodes located at the back of your throat—become inflamed and swollen. A viral or bacterial infection typically causes it, leading to sore throat, difficulty swallowing, fever, headache, fatigue, and a white coating on the tonsils. Tonsillitis is not contagious, but the viruses and bacteria that lead to inflamed tonsils usually are.

Treatment for tonsillitis depends on the cause of the infection. Viral tonsillitis treatment focuses on managing symptoms. Bacterial tonsillitis may require antibiotics to clear the infection. Tonsillitis can affect people of all ages, although it is most common in children ages 5-15.


Tonsillitis is categorized into types based on its cause and severity. Healthcare providers determine the type of tonsillitis you have to help them choose the best treatment. 

One way to categorize tonsillitis is based on what is causing tonsil inflammation:

  • Viral tonsillitis: Caused by a virus, such as rhinoviruses (common cold) or influenza viruses. It is the most common type of tonsillitis, accounting for about 70% of all cases, and often resolves within a week or two. 
  • Bacterial tonsillitis: Caused by bacteria, such as Streptococcus pyogenes (group A streptococcus). It is less common than viral tonsillitis, but symptoms are often more severe.

Another way to categorize tonsillitis is based on how long symptoms last:  

  • Acute tonsillitis: Characterized by a sudden onset of symptoms, such as sore throat, fever, and swollen tonsils. It typically lasts a few days to a week and can be caused by a viral or bacterial infection.
  • Chronic tonsillitis: Characterized by persistent inflammation of the tonsils, lasting for two weeks or more. It can occur if you have an antibiotic-resistant bacterial infection or a weakened immune system.

Tonsillitis Symptoms 

Symptoms of tonsillitis typically come on suddenly and, in most cases, last anywhere from a few days up to two weeks. Symptoms of tonsillitis can also vary based on the type (acute vs chronic).

Acute Tonsillitis Symptoms 

Acute tonsillitis symptoms can include:

Chronic Tonsillitis Symptoms

Symptoms of chronic tonsillitis can persist for several weeks to months and can include:

  • Chronic sore throat, which may be severe 
  • Bad breath 
  • Chronic swollen, tender lymph nodes
  • Tonsil stones (small, hardened lumps of material that collect on the tonsils) 

What Causes Tonsillitis? 

A viral or bacterial infection typically causes tonsillitis. The most common cause of tonsillitis are viruses, such as:

Bacterial tonsillitis is less common, accounting for 15-30% of all cases. Bacteria that can cause tonsillitis include:

  • Streptococcus pyogenes (group A streptococcus), which can cause infections such as strep throat and scarlet fever 
  • Bacterial pneumonia 
  • Staphylococcus aureus, associated with skin and soft tissue infections such as methicillin-resistant Staphylococcus aureus, or MRSA

Tonsillitis is not contagious, but the viruses and bacteria that cause inflamed tonsils can be. These pathogens can spread through contact with respiratory droplets from an infected person, such as through coughing, sneezing, or sharing utensils and drinks. 

Risk Factors

Certain factors can increase your risk of tonsillitis, including:

  • Young age: Children ages 5-15 are more prone to tonsillitis.
  • Germ exposure: Frequent exposure to bacteria and viruses in daycares and school settings can increase your risk.
  • Smoking: People who smoke are at an increased risk of experiencing complications due to tonsillitis.


A healthcare provider diagnoses tonsillitis through a physical exam, symptom and medical history evaluation, and diagnostic tests.

During the physical exam, the provider will look for tonsillitis signs and symptoms, including swollen lymph nodes in the neck, red and swollen tonsils, and pus or white spots on the tonsils.

Healthcare providers usually can't tell whether a virus or bacteria is causing tonsillitis based on a physical exam alone. They may use diagnostic tests, such as a throat swab culture or rapid antigen test, to check for certain bacteria. 

For both tests, a sample of mucus is taken from the back of your throat with a swab. Rapid tests can quickly detect the presence of certain bacterial infections, such as strep throat. A throat swab sample may be sent to a lab to identify the type of bacteria causing the infection.

Treatments for Tonsillitis  

Treatment options for tonsillitis vary, depending on whether a virus or bacteria is the underlying cause. 

Viral Tonsillitis Treatment

Treatment for viral tonsillitis focuses on managing symptoms like pain and fever while your body fights the infection. This may include over-the-counter pain relievers (such as acetaminophen or ibuprofen), throat lozenges, and plenty of rest and fluids. Antibiotics are not effective against viral infections.

Bacterial Tonsillitis Treatment 

Antibiotics are usually prescribed to clear the infection and prevent complications. Penicillin or macrolides are commonly used for streptococcal infections, while other antibiotics may be used to treat other bacterial infections.


If you or your child have recurrent or chronic tonsillitis, your healthcare provider may recommend a tonsillectomy, the surgical removal of the tonsils. This procedure is usually only recommended for people with frequent episodes of tonsillitis or if your quality of life is impacted (e.g., missing a lot of work or school). After the surgery, you may get infections less frequently.

At-Home Remedies 

There are things you can do at home to alleviate symptoms of tonsillitis:

  • Gargle with salt water to reduce inflammation and soothe the throat 
  • Use a cool-mist humidifier to add moisture to the air and reduce dryness in the throat 
  • Avoid irritants that can worsen symptoms, such as exposure to cigarette smoke and pollutants
  • Try throat lozenges or over-the-counter throat spray to help relieve throat pain
  • Drink plenty of fluids, including water, teas, soups, and broths
  • Take over-the-counter pain relievers, such as Tylenol (acetaminophen) or Advil (ibuprofen), for pain relief and to bring down a fever


While it is not always possible to prevent tonsillitis, there are steps you can take to lower your risk of infection:

  • Practice good hand hygiene: Frequent hand washing with soap and water or alcohol-based hand sanitizer can help prevent the spread of viruses and bacteria that can cause tonsillitis.
  • Avoid close contact with sick people: Avoiding close contact with people who are sick can help reduce the risk of contracting the infection.
  • Keep your immune system healthy: A healthy immune system can help fight infections. While there are many factors that affect your immune system that are out of your control, maintaining a healthy balanced diet, getting enough sleep, and regular exercise can help keep your immune system strong and reduce your risk of infections and complications.
  • Don't share personal items: Avoid sharing utensils, drinks, or other personal items that can spread bacteria and viruses.
  • Quit smoking: Smoking can irritate the throat and increase your risk of infections, including tonsillitis.


In most cases, the risk of tonsillitis complications is low. Tonsillitis usually goes away on its own or with treatment without any problems. However, severe or recurrent cases can lead to complications, such as:

  • Peritonsillar abscess: An abscess, or collection of pus, that forms in the tissues around the tonsils. This can cause severe pain, difficulty swallowing, and difficulty opening the mouth.
  • Otitis media: A middle ear infection in which bacteria grows in fluid behind the eardrum, causing pain and muffled hearing.  
  • Rheumatic fever: A rare but serious complication of untreated streptococcal tonsillitis. It can cause inflammation throughout your entire body, leading to joint pain, rash, and involuntary body movements. 
  • Difficulty breathing: In rare cases, tonsillitis can cause swelling that obstructs the airway and makes breathing difficult, especially while sleeping.

Living With Tonsillitis  

For most people, tonsillitis is a temporary condition easily treated with self-care measures or medication. With proper treatment, symptoms typically improve within a few days to a week, and most people fully recover without complications. 

Tonsillitis can cause severe throat pain, especially when it first develops. Resting, staying hydrated, and eating soft, easy-to-swallow foods can help ease discomfort and promote healing. If you or your child have tonsillitis, it is important to follow the advice of your healthcare provider to help your body fight the infection. Talk to your healthcare provider if your symptoms do not improve with time and treatment. 

Frequently Asked Questions

  • How contagious is tonsillitis?

    Tonsillitis is not contagious, but the bacterial and viral infections that cause it can be. Viruses and bacteria can spread through contact with respiratory droplets from coughing, sneezing, or sharing utensils or drinking glasses. 

  • What is the difference between strep throat and tonsillitis?

    Strep throat is an infection caused by group A streptococcus bacteria, while tonsillitis is a general term used to describe inflammation of the tonsils, which can have various causes, including viral and bacterial infections.

    The symptoms of strep throat and tonsillitis can be similar; a throat culture or rapid strep test can help determine which is causing a sore throat. 

  • Will tonsiliitis go away on its own?

    Tonsillitis can sometimes go away on its own, especially when a viral infection causes it. However, it is important to seek medical care if symptoms are severe or do not improve within a few days, as tonsillitis caused by bacteria can lead to serious complications if left untreated.

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12 Sources
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