Tonsillitis: Viral or Strep, What Helps, and the Warning Signs of an Abscess
Tonsillitis is inflamed, swollen tonsils, usually from a virus and sometimes from strep. Here's how it's tested, what helps, and when a sore throat is an emergency.
Tonsillitis means inflamed tonsils: red, swollen tonsils, a sore throat, pain when swallowing, and often fever and swollen glands in the neck. Most tonsillitis is caused by viruses and gets better on its own in about a week. Some is caused by strep bacteria and needs antibiotics. A rapid strep test tells the difference in minutes. Severe one-sided throat pain, a muffled voice, drooling, or trouble opening your mouth can mean an abscess and needs the ER.
Tonsillitis symptoms
- Red, swollen tonsils, sometimes with white or yellow patches
- Sore throat and pain when swallowing
- Fever
- Swollen, tender glands in the neck
- Bad breath
- A scratchy or muffled voice
- In young children: drooling, refusing to eat, or fussiness
Viral or strep?
Viral tonsillitis often comes with a cough, runny nose, hoarseness or red eyes. Strep is more likely with a sudden sore throat and fever without a cough, white patches, tender glands, and sometimes a headache, stomachache or a sandpaper-like rash, especially in children 5 to 15. You can't tell for sure by looking, so a test is the way to know. Mono can cause tonsillitis too. Our posts on the rapid strep test and mono explain those.
What helps
- Rest and plenty of fluids, including warm tea with honey (not for babies under 1) or cold drinks and ice pops
- Gargle with warm salt water
- Throat lozenges or sprays for older children and adults
- Acetaminophen or ibuprofen for pain and fever, dosed for age and weight
- Soft, cool foods
If it's strep, finish the whole course of antibiotics, even once you feel better.
Frequent tonsillitis
If you or your child gets tonsillitis many times a year, talk to a primary care provider. Removing the tonsils is sometimes recommended for frequent, well-documented strep infections or tonsils large enough to affect breathing or sleep.
When to get seen
Come in for a sore throat with fever, white patches or swollen glands, a sore throat that's severe or lasting more than a few days, or if someone at home has strep. At an AfterOurs clinic, a standard self-pay visit is $175, a visit with a rapid strep test is $250, and a self-pay in-clinic visit never costs more than $330. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our strep throat page and the cost and insurance page.
Go to the ER or call 911 if you have trouble breathing, can't swallow your own saliva or are drooling, have severe pain on one side of the throat with a muffled "hot potato" voice or trouble opening your mouth, a stiff neck, or signs of dehydration. These can be signs of a peritonsillar abscess or another serious infection.
Where to find us
Four clinics across metro Denver, all ages welcome, se habla español:
- Hampden (Southeast Denver): 8 AM–11 PM daily
- Littleton: 8 AM–11 PM daily
- Thornton: 8 AM–11 PM daily
- Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM
Walk in, or book online.
Medically reviewed by Peter Martinuzzi, MD
This article is general health information, not medical advice for your situation. If you are worried, come in or book a telehealth visit — and if it is an emergency, call 911.