Can You Get Strep Without Tonsils? Symptoms + Treatment

If you had your tonsils out, you might think strep without tonsils is not possible. However, that is a common myth. While tonsil removal does cut down on throat infections, it does not rule out strep entirely. Here is what you should know.

Can You Get Strep Without Tonsils?

Yes. You can get strep without tonsils. Here is why:

• Strep throat comes from Group A Streptococcus (GAS) bacteria.
• These bacteria infect the pharynx (back of the throat), not just the tonsils.
• After a tonsillectomy, the tonsil tissue is gone. However, the back throat wall, soft palate, and other tissue remain.
• As a result, strep can still grow in these areas.

However, a tonsillectomy does lead to fewer and milder throat infections. Because the tonsils often serve as the main home for strep bacteria, removing them helps. Still, strep without tonsils is possible.

What Does Strep Without Tonsils Look Like?

Without tonsils, strep looks a bit different than the classic case. For example, you will not see the usual white patches on swollen tonsils. Instead, watch for these signs:

Symptoms That Still Happen

• Sore throat, often milder than before the tonsillectomy
• Red, swollen back of the throat
• Fever between 101 and 103 degrees F
• Pain when swallowing
• Swollen lymph nodes in the neck
• Headache and body aches
• Tiredness

Symptoms Less Likely Without Tonsils

• White patches or pus on the throat, because the tonsil tissue is gone
• A throat that feels blocked or very swollen

Specifically, strep without tonsils often feels like a moderate sore throat with fever and swollen glands. Because the usual visual clues are missing, testing matters even more.

How Do You Get Strep Without Tonsils?

Strep spreads through tiny droplets in the air. You can catch it the same way whether or not you have tonsils. Here are the most common ways it spreads:

• Close contact: For example, breathing in droplets when someone nearby coughs or sneezes.
• Shared items: Also, drinking from the same glass or sharing utensils can pass the bacteria.
• Touching surfaces: In addition, the bacteria live briefly on doorknobs and other surfaces.
• Carriers: Meanwhile, some people carry GAS bacteria without symptoms. As a result, they can pass it to others without knowing.

Also, certain settings raise your risk. For example, schools, daycare centers, and military housing have higher strep rates because people are in close quarters. In addition, strep is most common from late fall through early spring.

How Is Strep Diagnosed Without Tonsils?

Even without tonsils, a rapid strep test still works well. The test uses a throat swab of the back wall of the throat. It picks up cells that may contain GAS bacteria, no matter whether tonsils are there or not.

At CityHealth San Leandro, here is what happens:

1. First, a provider swabs the back of your throat. It takes about 15 seconds.
2. Then, rapid strep test results come back in 5 to 10 minutes.
3. If the rapid test is negative but symptoms point to strep, a throat culture may be sent. This gives a more sensitive result in 24 to 48 hours.
4. If positive, treatment starts during the same visit.

However, diagnosis can be trickier without tonsils. Because the classic “white patches” are absent, the provider looks for other clues. For example, redness of the back throat, tiny red dots on the soft palate, and swollen glands all suggest strep. Also, the lack of a cough is a helpful sign. Colds usually cause a cough, while strep usually does not.

Strep Throat Treatment

Strep throat needs antibiotics. It will not go away on its own. Also, if left untreated, it can cause serious problems like rheumatic fever and kidney disease. Here are the main treatment options:

• Amoxicillin or penicillin: This is the first choice. It is a 10-day course.
• Azithromycin (Z-Pak): This is used if you are allergic to penicillin. It is a 5-day course.
• Cephalexin: Also an option for those with penicillin allergy.

Symptoms usually get better within 24 to 48 hours of starting antibiotics. However, you must finish the full course even if you feel better. This prevents resistance and lowers the risk of problems.

For more details on strep throat and its risks, visit the CDC’s strep throat page.

Why Did I Get Strep After a Tonsillectomy?

If strep keeps coming back after your tonsillectomy, there are several possible reasons:

• Close contacts: For example, someone at home or school may have strep or carry the bacteria without symptoms.
• Carriers in the home: Some family members carry GAS bacteria. As a result, they can pass it to you again and again.
• Shared items: Also, sharing water bottles, cups, or towels with an infected person spreads strep.
• Leftover tonsil tissue: In rare cases, small bits of tonsil tissue remain after surgery. These can still harbor bacteria.

If strep keeps returning, your provider may test family members for carrier status. Also, replacing toothbrushes after a strep diagnosis helps prevent reinfection.

Home Comfort While Recovering

While antibiotics kill the strep bacteria, you can ease symptoms at home too. First, gargle with warm salt water several times a day. This helps reduce throat swelling. Also, drink warm liquids like broth or tea with honey. In addition, use over-the-counter pain relievers like ibuprofen or acetaminophen to bring down fever and ease throat pain. However, avoid giving aspirin to children because of the risk of Reye’s syndrome. Finally, rest your voice and get extra sleep. Most people feel much better within 48 hours of starting antibiotics.

Risks of Untreated Strep

Whether or not you have tonsils, untreated strep carries the same risks. Because these problems can be serious, getting treated quickly matters:

• Rheumatic fever: This can harm heart valves for life. It is rare in the U.S. but still happens.
• Kidney problems: Specifically, a condition called post-streptococcal glomerulonephritis can follow strep.
• Abscess near the throat: Even without tonsils, pus can build up in the tissue nearby. This needs drainage.
• Scarlet fever: This is a rash caused by strep toxins. However, it responds to the same antibiotics.

Frequently Asked Questions

Can you still get strep throat after a tonsillectomy?
Yes. Removing the tonsils reduces strep but does not end it. The bacteria can still infect the back of the throat. However, infections tend to be less common and milder.

How do you test for strep when you don’t have tonsils?
A rapid strep swab still works after tonsillectomy. The swab is taken from the back wall of the throat. Results are ready in 5 to 10 minutes at CityHealth.

How long is strep contagious?
Strep is contagious until you have been on antibiotics for 24 hours and have no fever. Without antibiotics, it stays contagious for 2 to 3 weeks.

Is strep throat dangerous if untreated?
Yes. Untreated strep can cause rheumatic fever, kidney problems, and throat abscess. Therefore, always finish the full antibiotic course.