Can you get strep throat without having tonsils?

Can You Get Strep Throat Without Tonsils?

Yes, you can definitely get strep throat even if you've had your tonsils removed, as Group A Streptococcus (GAS) can still infect the pharyngeal tissue that remains after tonsillectomy. 1

Understanding Strep Throat After Tonsillectomy

Strep throat (Group A streptococcal pharyngitis) is an infection that affects the throat and tonsils. However, the infection can occur in any remaining pharyngeal tissue even after tonsillectomy:

• The infection targets the pharyngeal mucosa, which remains present after tonsil removal
• GAS bacteria can colonize and infect the posterior pharyngeal wall and other oropharyngeal tissues
• While tonsils are a common site of infection, they are not the only tissue susceptible to streptococcal infection

Diagnosis in Post-Tonsillectomy Patients

Diagnosis of strep throat in patients without tonsils follows the same protocol as those with tonsils:

• Evaluate using clinical features such as:

  • Sudden onset of sore throat
  • Fever (>100.4°F/38°C)
  • Pain with swallowing
  • Pharyngeal erythema/inflammation
  • Cervical lymphadenopathy (tender nodes)
  • Absence of cough and other viral symptoms 1

• Confirmation requires laboratory testing:

  • Rapid antigen detection test (RADT)
  • Throat culture (considered the diagnostic standard) 1
  • Swab should be taken from the posterior pharyngeal wall 1

Treatment Considerations

Treatment for strep throat in patients without tonsils is the same as for those with tonsils:

• First-line therapy: Penicillin V or amoxicillin for 10 days 2

• For penicillin-allergic patients:

  • Non-anaphylactic allergy: First-generation cephalosporins
  • Anaphylactic allergy: Clindamycin, azithromycin, or clarithromycin 2

• Complete the full course of antibiotics to:

  • Prevent treatment failure
  • Reduce risk of rheumatic fever
  • Ensure complete eradication of GAS 2

Effect of Tonsillectomy on Strep Throat Incidence

While tonsillectomy may reduce the frequency of strep throat in some patients, it does not eliminate the risk:

• The Infectious Diseases Society of America does not recommend tonsillectomy solely to reduce the frequency of GAS pharyngitis 1
• Tonsillectomy may decrease recurrences of symptomatic pharyngitis in selected patients, but only for a limited period of time 1
• Tonsillectomy should only be considered for patients with severe recurrent infections meeting specific criteria (Paradise criteria: ≥7 well-documented episodes in the preceding year, OR ≥5 episodes in each of the preceding 2 years, OR ≥3 episodes in each of the preceding 3 years) 2

Important Considerations for Post-Tonsillectomy Patients

• Symptoms may present differently without tonsils (no tonsillar exudate, but pharyngeal erythema will still be present)
• Throat swabs should focus on the posterior pharyngeal wall
• Patients without tonsils may still become chronic carriers of GAS
• The risk of complications (including rheumatic fever) remains present, so appropriate diagnosis and treatment are still important

In summary, while tonsillectomy may reduce the frequency of strep throat in some individuals, it does not provide complete protection against streptococcal pharyngitis, and proper diagnosis and treatment remain essential for patients without tonsils who develop symptoms of sore throat.