Throat plaques are whitish or yellowish deposits (exudate) that form mainly on the tonsils and the back of the throat. They are not a disease in themselves, but a visible sign of an ongoing inflammatory or infectious process.
Seeing white plaques in the throat or on the tonsils often leads people to immediately think of a “bacterial infection” and therefore “antibiotics.” In reality, plaques are almost always a sign, not a diagnosis: they indicate the presence of exudate and inflammatory material on the mucosa of the tonsils and/or pharynx, which can appear in both viral and bacterial infections, as well as in some less common conditions.
Throat plaques: where they appear and how they look
Plaques are most commonly found:
- on the tonsils (tonsillitis)
- on the back of the throat (pharynx)
- sometimes in both areas (pharyngotonsillitis)
Plaques can present in different ways:
- White or yellowish plaques: typical of acute infections.
- Persistent plaques without pain: often linked to tonsil stones (tonsilloliths).
- Diffuse plaques: spreading to the palate or the pharynx.
The amount of plaque does not automatically indicate severity: it is the combination of appearance, symptoms, and clinical course that guides proper evaluation.
Throat plaques: most common symptoms
In everyday practice, throat plaques are often associated with:
- sore throat (ranging from mild to severe)
- pain when swallowing
- bad breath
- hoarse voice
- sensation of a foreign body in the throat
- swollen and/or tender neck lymph nodes
- fever (not always present)
- fatigue and general malaise (more common in many viral forms)
An important point to remember: the presence of plaques alone is not enough to define an infection as “bacterial.” Many viral infections can also cause plaques.
Causes: viral or bacterial throat plaques?
1) Viral causes (very common)
Many cases of tonsillitis and pharyngitis are viral and tend to improve with supportive care. This is also emphasized by public health sources such as the NHS, which note that many tonsillitis cases are viral and can resolve without antibiotics.
Signs that often (though not always) point toward a viral cause include:
- cough and cold symptoms
- burning or irritation rather than sharp pain
- widespread flu-like or cold-like symptoms
2) Bacterial causes (streptococcus and others)
The most commonly discussed bacterial cause is group A streptococcus (GAS). In these cases, antibiotics may be indicated, but the diagnosis should not rely on visual examination alone. Clinical guidelines stress the importance of confirmation with a rapid test and/or throat swab culture when appropriate.
3) Mononucleosis and other conditions that can mimic plaques
Mononucleosis is a condition that often resembles bacterial tonsillitis because it can also cause throat plaques, but its cause is viral, so antibiotics are not effective.
Other possible conditions include:
- oral candidiasis (creamy white plaques, more typical in certain contexts)
- tonsil stones (tonsilloliths): small white “pellets” in the tonsil crypts, often associated with bad breath and frequently without fever
Summary table of the main causes: bacterial vs viral
Distinguishing the underlying cause is key to choosing the correct treatment.
| Feature | Viral Infection | Bacterial Infection (Streptococcus) |
|---|---|---|
| Fever | Absent or mild | Often high (>38.5°C) |
| Cough / Cold | Often present | Usually absent |
| Pain | Moderate | Severe and sudden |
| Plaques | Small and scattered | Large, purulent, and concentrated |
| Treatment | Symptomatic care (rest, NSAIDs) | Antibiotics (by prescription) |
Throat plaques without fever
Why can plaques appear without fever?
In most cases, this happens because:
- the cause is viral or irritative (so the body does not trigger a high fever)
- the inflammation is local rather than systemic
- you are in an early stage or a mild episode
The absence of fever does not completely rule out streptococcal infection, but it often makes it less likely. For this reason, when uncertainty is high, the correct approach is testing, not a “trial” course of antibiotics.
Throat plaques without fever: when antibiotics are NOT needed
A conservative approach is usually appropriate when:
- you are able to drink and eat (even with some discomfort)
- there is no rapid worsening of symptoms
- you have cough or cold symptoms (more consistent with a viral cause)
- symptoms started recently and are not severe
Plaques without fever: when a throat swab makes sense
A doctor may reasonably suggest “let’s do a test” when:
- the pain is significant and “isolated” (without obvious cold symptoms)
- you have tender lymph nodes and clearly visible plaques
- there has been close contact with confirmed streptococcal cases at home or school
- symptoms do not improve after a few days
The CDC emphasizes that with clearly viral symptoms testing is often unnecessary, while in other situations the diagnosis should be confirmed with a rapid test and/or throat culture (especially in children).
72-hour” checklist
During the first 72 hours, if you have throat plaques without fever, focus on:
- frequent hydration and soft foods
- rest and reduced voice strain
- avoiding smoking, alcohol, and dry air
- managing pain with symptomatic medications when appropriate
- monitoring your condition: improvement vs. worsening
Then reassess: if you do not improve within 5–7 days, or if symptoms worsen, a medical evaluation is recommended.
Tabella: placche senza febbre – cosa significa e cosa fare
| Situation | Likely cause | What to do |
|---|---|---|
| Plaques + cough/cold | Often viral | Supportive care + monitoring |
| Plaques + severe pain + tender lymph nodes | Possible GAS | Medical visit + rapid test/throat swab |
| Plaques + marked fatigue + prolonged duration | Consider mononucleosis | Medical visit and further tests |
| Recurrent plaques + bad breath | Consider tonsil stones/cryptic tonsils | Oral hygiene + ENT evaluation if frequent |
If you have throat plaques and are unsure whether you need antibiotics or a throat swab, contact us on WhatsApp: we’ll help you understand which signs to consider and when a medical evaluation may be useful.
Throat plaques: when antibiotics are needed (and when they are not)
Antibiotico sì: quando è indicato
Antibiotics are indicated when there is a confirmed or highly suspected group A streptococcal pharyngotonsillitis, based on clinical criteria and/or testing. International guidelines (IDSA) and the CDC emphasize confirmation with appropriate tests and correct management.
Antibiotics: when they do not help
Antibiotics are not helpful (and are best avoided) when:
- the condition is likely viral
- there are clear viral symptoms
- plaques are related to irritation or lifestyle factors
- the diagnosis has not been clearly established
This approach is also important to reduce antibiotic resistance and avoid unnecessary treatments.
Video su placche in gola
How to remove throat plaques safely
Throat plaques should not be removed manually. Trying to detach them with cotton swabs or improvised tools can irritate the mucosa and increase the risk of complications.
The safest way to help plaques regress is to:
- address the underlying cause (supportive care if viral, targeted therapy if bacterial)
- reduce irritation and pain with simple, consistent measures
Practical and natural remedies for throat plaques
In addition to any medication prescribed by your doctor, several measures can help relieve discomfort:
Symptomatic (pharmacological) support
- Anti-inflammatory drugs (NSAIDs): ibuprofen or paracetamol to reduce pain and fever.
- Soothing sprays and lozenges: products containing flurbiprofen or local antiseptics to calm inflamed mucosa.
Natural remedies and lifestyle measures
- Saltwater gargles: a natural disinfectant that helps “clean” the tonsils through osmosis.
- Honey and propolis: known for their soothing and antibacterial properties (best taken in warm, not hot, drinks).
- Adequate hydration: drinking plenty of water helps keep the mucosa moist and supports the body’s natural cleansing processes.
- Humidifying the environment: avoiding overly dry air, especially in the bedroom, helps prevent further throat irritation.
Important: Never try to remove plaques manually with cotton swabs or fingers. This can cause injuries, bleeding, and worsen the infection by pushing bacteria deeper into the tissue.
Throat plaques without pain: is it possible?
Yes. This can happen when:
- the inflammation is mild or at an early stage
- plaques are due to tonsil stones (tonsilloliths)
- there is chronic irritation (reflux or dry air)
If plaques persist or recur frequently, a medical evaluation (including an ENT assessment) is recommended. The goal is not to treat the “plaque” itself, but the underlying cause.
When should you see a doctor?
Contact an ENT specialist or your primary care physician if:
- pain prevents you from drinking or eating properly
- fever persists for more than 3 days despite medication
- a skin rash appears (possible scarlet fever)
- you develop breathing difficulties or an extremely muffled, “hot potato” voice
- plaques do not begin to improve after about one week
Contagion: are throat plaques contagious?
It depends on the cause. If the infection is streptococcal and appropriate antibiotic therapy is started, contagiousness usually decreases significantly after about 12–24 hours. In viral forms, contagiousness varies depending on the virus, but it is generally higher during the first days of symptoms.
Good practical rules:
- wash your hands frequently
- do not share cutlery or glasses
- limit close contact while you are in the acute phase
When to worry: warning signs
Contact a doctor promptly (or seek urgent care if severe) if you experience:
- difficulty breathing
- inability to swallow saliva
- very intense pain, especially on one side
- muffled voice or difficulty opening the mouth
- persistent high fever
- rapid worsening of symptoms
- plaques that do not improve after about 7 days
ymptoms getting worse or doubts about throat plaques? Contact us on WhatsApp for quick support and guidance on the most appropriate next steps.
Links for further reading
- CDC – Group A Strep Pharyngitis: diagnosi e gestione
- IDSA – Guideline su faringite streptococcica
- NHS – Tonsillitis (linical overview and management)
- Bambino Gesù Children’s Hospital – When a sore throat is streptococcal
- Lab Tests Online – Streptococcal throat swab (rapid test/culture)
Frequently Asked Questions about Throat Plaques (FAQ)
Yes, it is very common. Throat plaques without fever may be caused by mild viral infections, tonsil stones (tonsilloliths), or chronic irritation. When there is no fever, a streptococcal bacterial infection is less likely, but observation for about 48 hours is still recommended.
In most cases, no. Throat plaques without fever are often viral or irritative. Antibiotics are useful only if the cause is bacterial, especially streptococcal, and ideally should be decided after medical evaluation and testing. If pain is significant, there are no obvious viral symptoms, or there is no improvement within 5–7 days, a medical visit and, if indicated, a throat swab or rapid test are recommended.
Looking at the throat alone is not enough, as symptoms can overlap. Clinical criteria and, when appropriate, a rapid test and/or throat swab are used. The CDC emphasizes that with clear viral symptoms, testing is often unnecessary, while in other cases confirmation helps avoid unnecessary antibiotics and ensures proper treatment when streptococcus is present.
No, they should not be removed manually. Detaching plaques can irritate the mucosa and increase the risk of complications. The correct approach is to treat the underlying cause: supportive care if viral, targeted therapy if bacterial and prescribed by a doctor. If plaques persist for more than a week or are very painful, a medical check is needed.
If there is significant pain that prevents drinking, rapid worsening, difficulty swallowing saliva, symptoms lasting more than 5–7 days, or recurrent episodes. Marked fatigue and prolonged symptoms may also suggest other diagnoses, such as mononucleosis, which require targeted evaluation.
Throat plaques without pain are often a sign of tonsil stones. These are small accumulations of calcium and food debris that lodge in the tonsil crypts. They are not dangerous but can cause bad breath. In rare cases, they may indicate a chronic, low-grade infection.
Absolutely not. Manually removing plaques can cause trauma to the tonsils, bleeding, and may push bacteria deeper into the tissues, worsening inflammation. Plaques should resolve naturally with appropriate treatment.
Yes. Infectious mononucleosis (caused by the Epstein–Barr virus) often presents with extensive whitish plaques covering the tonsils, along with severe fatigue and enlarged lymph nodes and spleen. In this case, common antibiotics (such as amoxicillin) are not indicated and may cause skin rashes.
In viral infections, plaques typically disappear within 3–5 days. If the infection is bacterial and appropriate antibiotic therapy is followed, symptoms often improve within 24–48 hours, but complete resolution of plaques may take 7–10 days.
