Appearance of Tonsils with Streptococcal Pharyngitis
Tonsils infected with Group A streptococcal pharyngitis characteristically show tonsillopharyngeal erythema (intense redness) with or without exudates (yellow or white patches), often accompanied by edema (swelling) of the tissues. 1
Key Visual Features
Primary Tonsillar Findings
- Intense erythema (redness): The tonsils and pharynx display marked inflammation with a beefy red appearance 1
- Exudates: Yellow or white patches may cover the tonsillar surface, though exudates are present in only a subset of cases—approximately 20-30% of patients present with classic exudative disease 2
- Edema: The tonsillar tissues appear swollen 1
Associated Oropharyngeal Findings
- Beefy red, swollen uvula: The uvula often appears enlarged and intensely erythematous 1
- Soft palate petechiae: Small red spots may appear on the soft palate, sometimes described as "doughnut lesions" 1
- Tender, enlarged anterior cervical lymph nodes: While not visible on the tonsils themselves, this finding is strongly associated with streptococcal infection 1, 3
Important Clinical Context
Variability in Presentation
The classic exudative appearance occurs in only 20-30% of streptococcal pharyngitis cases 2. Many patients with confirmed Group A streptococcal infection will have tonsillopharyngeal erythema without exudates 1. The absence of exudates does not rule out streptococcal infection.
Age-Related Differences
- School-aged children (5-15 years): Most likely to present with classic exudative pharyngitis 1
- Teenagers and adults: Often present with atypical findings, making visual diagnosis more challenging 1
- Young children (<3 years): May show less specific findings, such as excoriated nares or purulent nasal discharge rather than classic tonsillar findings 1
Critical Diagnostic Caveat
None of these visual findings is specific for Group A streptococcal pharyngitis—identical appearances can occur with viral and other bacterial upper respiratory infections. 1 Physicians overdiagnose streptococcal pharyngitis by a wide margin based on visual examination alone 2. Therefore, microbiological confirmation with either throat culture or rapid antigen detection testing is required for definitive diagnosis, as clinical findings alone predict positive cultures only 80% of the time at best 1.