Tonsillitis in Adults: Symptoms, Causes, Treatment and When Tonsil Removal Makes Sense

Written by Cherlie Joseph, MSN, FNP-BC · Medically reviewed by Naurah Gaspard, DNP, FNP-C, FNP-BC · Updated November 2026

Tonsillitis is swelling and infection of the tonsils, and in adults it is usually caused by a virus that clears in about a week with rest, fluids and pain relievers. When a test shows strep bacteria, a 10-day antibiotic course is the standard treatment. Severe one-sided pain, drooling or trouble opening your mouth can mean an abscess and needs same-day in-person care.

What tonsillitis feels like in adults

Your tonsils are two pads of lymph tissue at the back of the throat that help trap germs. Tonsillitis is more common in children, but adults get it too, especially people who live or work around kids. According to MedlinePlus, common symptoms include:

• Sore throat lasting more than a couple of days, with pain when swallowing
• Red, swollen tonsils, sometimes with white or yellow spots
• Fever and chills
• Tender, swollen glands under the jaw and in the neck
• Ear pain (the throat and ears share nerves)
• Headache and bad breath

Adults sometimes also notice tonsil stones, small white, foul-smelling lumps that collect in the tonsil crevices. These are not an infection by themselves but can cause irritation and bad breath.

Viral vs. bacterial tonsillitis

Knowing the cause decides whether antibiotics will help.

	Viral	Bacterial (usually strep)
How common in adults	Most cases	Less common
Typical clues	Cough, runny nose, hoarse voice, pink eye	Sudden pain, fever, swollen front neck glands, no cough
Test	Usually none needed	Rapid strep test or throat culture
Treatment	Symptom relief; antibiotics do not help	Antibiotic, usually penicillin or amoxicillin for 10 days
Usual length	About 7 to 10 days	Better within 2 to 3 days of antibiotics

One viral cause deserves special mention: mononucleosis (mono) can cause very swollen tonsils with white coating, plus deep fatigue. Mono is not treated with antibiotics, and amoxicillin taken during mono often causes a widespread rash. If your tonsillitis comes with exhaustion that feels out of proportion, read our guide to mono symptoms in adults.

Treatment and home care

Whatever the cause, these steps ease pain while your body recovers:

• Acetaminophen or ibuprofen, used as directed on the label, for pain and fever
• Warm salt-water gargles several times a day
• Cold drinks, ice pops, or warm, bland fluids like broth or tea with honey
• Throat lozenges or an over-the-counter numbing spray
• Rest, and a cool-mist humidifier at night

If a strep test is positive, your provider will prescribe an antibiotic. Penicillin or amoxicillin is first choice; people with a penicillin allergy have other options. Take every dose for the full course. Our article on strep throat treatment covers the choices in detail.

Steroids are sometimes used for a short time when swelling is severe, but they are not routine for ordinary tonsillitis and are a decision for your provider.

Complications to watch for

The most important complication in adults is a peritonsillar abscess, a pocket of pus beside one tonsil. MedlinePlus lists its signs as severe throat pain usually on one side, ear pain on the same side, trouble opening the mouth, drooling, a muffled voice and fever. An abscess usually needs to be drained by a clinician, so it cannot be managed by phone or video alone.

Untreated strep can also, rarely, lead to rheumatic fever (which can affect the heart) or kidney inflammation. Prompt testing and full antibiotic treatment lower that risk.

Recurring tonsillitis and tonsillectomy

Some adults get tonsillitis again and again. Tonsillectomy (surgical removal of the tonsils) may be considered when infections are frequent. MedlinePlus describes common thresholds as 7 or more infections in one year, or 5 or more a year for two years in a row. Other reasons include a tonsil abscess, enlarged tonsils that block breathing during sleep, or frequent bothersome tonsil stones.

Recovery from tonsillectomy is often harder for adults than for children, with about 1 to 2 weeks of throat pain, and a small risk of bleeding during healing. An ear, nose and throat (ENT) specialist can help you weigh the benefits. Keeping a simple log of each episode, with dates and test results, makes that conversation much easier.

Frequently asked questions

Is tonsillitis contagious in adults?

The viruses and bacteria that cause tonsillitis spread through saliva and respiratory droplets, so yes. With strep, most people are no longer contagious once they have no fever and have taken antibiotics for 12 to 24 hours.

How long does tonsillitis last in adults?

Viral tonsillitis usually improves within about a week. Strep tonsillitis typically improves within 2 to 3 days of starting an antibiotic.

Can tonsillitis go away on its own?

Viral tonsillitis does. Bacterial tonsillitis may also improve, but confirmed strep is treated with antibiotics to shorten illness and prevent rare complications.

Sources

• MedlinePlus: Tonsillitis
• MedlinePlus: Tonsil and adenoid removal
• CDC: Clinical Guidance for Group A Streptococcal Pharyngitis

Keep reading

• Strep throat treatment for adults
• Strep throat vs. viral sore throat
• Sore throat remedies for adults
• Browse all conditions and treatments A to Z

This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.