Can You Get Strep Throat Without Tonsils?
Yes, you can absolutely get strep throat even if you don't have tonsils, because Group A Streptococcus infects the pharynx (throat) itself, not just the tonsils.
Why Tonsils Are Not Required for Strep Throat
The term "strep throat" refers to Group A β-hemolytic streptococcal pharyngitis, which is an infection of the pharynx and surrounding tissues 1. The bacteria colonize and infect the posterior pharyngeal wall, not exclusively the tonsils 1.
- Throat swab specimens for diagnosis are obtained from both the tonsils (or tonsillar fossae if tonsils are absent) AND the posterior pharyngeal wall 1
- This diagnostic approach confirms that the infection involves the entire pharyngeal area, not just tonsillar tissue 1
- The tonsillar fossae (the areas where tonsils once were) remain susceptible to streptococcal colonization and infection after tonsillectomy 1
Clinical Presentation Remains the Same
Patients without tonsils who develop strep throat will present with the same characteristic features 1, 2:
- Sudden onset of sore throat
- Fever (typically >38°C or 100.4°F)
- Headache
- Tender, enlarged anterior cervical lymph nodes
- Pharyngeal inflammation and exudate (on the posterior pharyngeal wall rather than tonsils)
- Absence of viral features (no cough, coryza, or conjunctivitis) 1
Diagnosis and Treatment Are Unchanged
The diagnostic approach for patients without tonsils is identical to those with tonsils 1:
- Rapid antigen detection testing (RADT) and/or throat culture remain the standard diagnostic methods 1, 2
- Swabs should be obtained from the tonsillar fossae and posterior pharyngeal wall 1
- Penicillin V for 10 days or amoxicillin for 10 days remains first-line treatment 2
- Alternative antibiotics for penicillin-allergic patients include first-generation cephalosporins, clindamycin, azithromycin, or clarithromycin 1, 2
Important Clinical Considerations
The absence of tonsils does not eliminate the risk of streptococcal complications 1:
- Suppurative complications (peritonsillar abscess, cervical lymphadenitis, acute sinusitis) can still occur, though peritonsillar abscess is obviously less common without tonsils 1
- Non-suppurative complications (acute rheumatic fever, acute glomerulonephritis) remain possible if infection is untreated 1
- The 10-day antibiotic course is still necessary to maximize bacterial eradication and prevent rheumatic fever 2
Common Pitfall to Avoid
Do not assume that absence of tonsillar exudate rules out strep throat in a patient without tonsils 1. Look for pharyngeal wall inflammation and exudate instead, and rely on microbiological confirmation rather than clinical features alone 1.