Can you get strep throat if you don't have tonsils?

Can You Get Strep Throat Without Tonsils?

Yes, you can absolutely get strep throat even if you don't have tonsils, because Group A streptococcal bacteria infect the entire pharynx (throat), not just the tonsils. 1

Why Tonsils Are Not Required for Strep Throat

The fundamental misconception is that strep throat is a tonsillar infection—it is not. Group A β-hemolytic streptococcal pharyngitis involves colonization and infection of the posterior pharyngeal wall and surrounding throat tissues, with or without tonsils present. 1 The bacteria target the entire pharyngeal area, and the tonsillar fossae (the spaces where tonsils once were) remain fully susceptible to streptococcal colonization and infection after tonsillectomy. 1

Clinical Presentation in Patients Without Tonsils

Patients who have had tonsillectomies will present with identical symptoms when they develop strep throat: 1

• Sudden onset of severe sore throat 1
• Fever (typically >38°C or 100.4°F) 1, 2
• Tender and enlarged anterior cervical lymph nodes 1
• Pharyngeal inflammation and exudate on the posterior throat wall 1
• Absence of viral features such as cough, runny nose, or conjunctivitis 1, 3

The key difference is that exudate will appear on the posterior pharyngeal wall and tonsillar fossae rather than on tonsils themselves. 1

Diagnostic Approach

The diagnostic strategy is identical whether tonsils are present or absent: 1

• Throat swab specimens must be obtained from both the tonsillar fossae (if tonsils are absent) AND the posterior pharyngeal wall 1
• Rapid antigen detection testing (RADT) and/or throat culture should be used to confirm Group A Streptococcus 1, 4
• The modified Centor score can help guide testing decisions 2

This approach recognizes that the infection involves the entire pharyngeal area, not just one anatomical structure. 1

Treatment Remains Unchanged

Treatment for strep throat in patients without tonsils follows the same guidelines: 1

• First-line: Penicillin V for 10 days or amoxicillin for 10 days 1, 4
• For penicillin allergy (non-anaphylactic): First-generation cephalosporins (cefalexin, cefadroxil) for 10 days 4
• For penicillin allergy (anaphylactic): Clindamycin, azithromycin, or clarithromycin 1, 4

The full 10-day course is essential to maximize bacterial eradication and prevent rheumatic fever, regardless of tonsil status. 1, 4

Risk of Complications

The absence of tonsils does not eliminate the risk of streptococcal complications. 1 Patients without tonsils remain at risk for:

• Suppurative complications (peritonsillar abscess, though less common) 1
• Non-suppurative complications including acute rheumatic fever and post-streptococcal glomerulonephritis 1, 3

This is why proper diagnosis and complete antibiotic treatment remain critical even after tonsillectomy. 1

Common Pitfall to Avoid

The most dangerous misconception is assuming that patients without tonsils cannot develop strep throat and therefore not testing or treating appropriately. This can lead to untreated streptococcal infection with potential progression to serious systemic complications. 1, 5 Always maintain the same clinical suspicion and diagnostic rigor in post-tonsillectomy patients presenting with acute pharyngitis symptoms. 1