Purulent tonsillitis is one of the most common infections that can suddenly and severely trouble us. We’ve all had an annoying sore throat at some point, but when it’s accompanied by high fever, difficulty swallowing, and marked weakness, it may be something more serious. Tonsillitis affects both children and adults and is closely tied to everyday life from childhood through adulthood. It’s worth knowing how it presents, how it spreads, and—most importantly—how it is properly treated, so we can avoid complications and get back to our activities quickly.
What is purulent tonsillitis?
Tonsillitis is essentially inflammation of the tonsils—two small lymphoid organs at the back of the throat that help defend the body against viruses and bacteria. When the inflammation is bacterial in origin, pus often forms on the tonsils, a condition known as purulent (or suppurative) tonsillitis. This is a more severe form of tonsillitis, accompanied by intense sore throat, difficulty swallowing, high fever, and bad breath. It usually appears in school-aged children but is not uncommon in adults.
Causes and transmission
Purulent tonsillitis is mainly caused by bacteria, most commonly group A streptococcus. Other bacteria that may be responsible include Staphylococcus aureus, Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae. In a smaller proportion of cases, the inflammation may be due to viruses such as adenoviruses, rhinoviruses, influenza virus, or even Epstein–Barr virus, which causes infectious mononucleosis.
Transmission occurs primarily via saliva droplets through coughing, sneezing, or close contact—explaining why the disease spreads easily in schools, daycare centers, and crowded spaces. Sometimes a pre-existing viral infection can weaken the immune system, allowing microbes already present in the body to multiply and cause infection.
Symptoms of purulent tonsillitis
Symptoms are characteristic and usually appear suddenly. The patient may have:
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Severe sore throat that worsens with swallowing
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High fever, often with chills
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Red, swollen tonsils with whitish plugs of pus
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Bad breath and increased salivation
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Swollen, tender lymph nodes in the neck
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Weakness, malaise, headache, and sometimes abdominal pain
In children, loss of appetite and sleepiness may be observed, and the pain can radiate to the ears due to the close anatomical relationship between the throat and ears. It’s important to note that the presence of pus on the tonsils is a strong indicator of bacterial infection, though there are exceptions such as infectious mononucleosis.
Diagnosis
Diagnosis is based primarily on clinical examination by an otorhinolaryngologist (ENT). The doctor examines the throat with a special light, assesses the appearance of the tonsils, and palpates the cervical lymph nodes. To confirm a bacterial cause, a rapid strep test or a throat swab culture may be performed. In more complex cases, blood tests such as a complete blood count and inflammatory markers (CRP, ESR) provide valuable information.
Treatment of purulent tonsillitis
Management depends on whether the infection is viral or bacterial. In general:
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Conservative care: For viral tonsillitis, antibiotics are not needed. Rest, plenty of fluids, salt-water gargles, analgesics, and antipyretics are recommended.
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Antibiotic therapy: When a bacterial cause is proven or strongly suspected, antibiotics are prescribed—usually penicillin or cephalosporins. The course typically lasts about 10 days to prevent complications.
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Tonsillectomy: For patients with recurrent episodes or severe complications, surgical removal of the tonsils may be recommended.
Taking the full course of antibiotics as prescribed is essential—even if symptoms improve earlier—to avoid relapses and antimicrobial resistance.
Possible complications of purulent tonsillitis
Although the illness usually resolves without problems, complications can occur in some cases. The most common include:
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Peritonsillar abscess: A collection of pus around the tonsil causing severe pain and difficulty opening the mouth.
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Parapharyngeal or retropharyngeal abscess: Serious conditions requiring hospitalization and often surgical intervention.
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Rheumatic fever: An inflammatory reaction that can affect the heart and joints.
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Glomerulonephritis: Kidney inflammation following streptococcal infection.
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Scarlet fever: An illness caused by a streptococcal toxin that produces a characteristic rash.
Timely diagnosis and appropriate treatment significantly reduce the risk of such complications.
Prevention and everyday tips
Preventing purulent tonsillitis involves hygiene measures such as frequent handwashing, avoiding close contact with people who are ill, using tissues when coughing or sneezing, and staying well hydrated. A balanced diet and adequate rest help strengthen the immune system. In cases of frequent recurrences, consultation with a specialist physician is crucial to decide whether surgery is needed.
Overall, purulent tonsillitis is an infection that requires serious attention, as it can cause not only considerable discomfort but also serious complications. Seeking medical care promptly, obtaining an accurate diagnosis, and receiving the right treatment are the best ways to manage it effectively. Although in most cases the illness is self-limiting, the bacterial form with visible pus must be taken seriously. With appropriate care, patients can return quickly to their daily routines while avoiding the unpleasant consequences of a neglected infection. ENT Surgeon in Athens Dr. Olga Papadopoulou treats every case of tonsillitis with due care so that patients can resume their normal activities as soon as possible.
Frequently asked questions about purulent tonsillitis
1. What is purulent tonsillitis?
It’s a bacterial inflammation of the tonsils with visible pus, usually due to streptococcus, accompanied by sore throat, fever, and difficulty swallowing.
2. How many days does tonsillitis last?
The viral form usually subsides within 3–5 days, while the bacterial form requires about 7–10 days of antibiotic treatment.
3. Can I have tonsillitis without a fever?
Yes. Especially with mild viral infections or in people with a strong immune system, there may be throat pain and swollen tonsils without fever.
4. Is it contagious?
Yes. It spreads easily through saliva droplets from coughing, sneezing, or close contact—particularly in enclosed spaces.
5. How long does purulent tonsillitis last?
With appropriate treatment, symptoms usually improve within about a week, although a feeling of fatigue may linger a bit longer.