Can a Patient Get Strep Throat After Tonsillectomy?
Yes, patients can still develop strep throat after tonsillectomy, though the frequency is significantly reduced. The American Academy of Otolaryngology-Head and Neck Surgery explicitly states that tonsillectomy achieves only a "modest reduction in frequency of group A streptococcal infection for 1 year after surgery," not complete elimination 1.
Why Strep Infections Still Occur Post-Tonsillectomy
The tonsils are not the only site where Group A Streptococcus can colonize and cause pharyngitis. The pharyngeal mucosa, adenoids, and other lymphoid tissue in the throat remain intact after tonsillectomy and can harbor streptococcal bacteria 1.
Key Evidence on Post-Tonsillectomy Strep Risk
Tonsillectomy reduces but does not eliminate strep infections: Clinical trials demonstrate that while tonsillectomy decreases the frequency of streptococcal pharyngitis, breakthrough infections still occur in approximately 3% of patients within 90 days post-operatively, compared to 24% in non-surgical controls 2.
The benefit is time-limited: The reduction in streptococcal infection frequency is most pronounced in the first year after surgery, with diminishing benefits in subsequent years 1.
Rare but serious post-operative strep complications can occur: Invasive group A streptococcal infections have been documented as post-tonsillectomy complications, though these are infrequent 3.
Clinical Implications for Management
Patients who develop pharyngitis symptoms after tonsillectomy should still be tested for Group A Streptococcus using rapid antigen detection test (RADT) or throat culture before initiating antibiotics 4.
Treatment Approach Post-Tonsillectomy
Standard antibiotic therapy remains appropriate: Penicillin V for 10 days or amoxicillin for 10 days should be prescribed for confirmed streptococcal pharyngitis, even in post-tonsillectomy patients 4.
The 10-day course is necessary: This duration maximizes bacterial eradication and prevents complications like rheumatic fever, regardless of tonsillectomy status 4.
Important Caveats
Do not assume all post-tonsillectomy sore throats are viral. The absence of tonsils does not confer immunity to streptococcal pharyngitis, and appropriate diagnostic testing remains essential 4.
Recurrent streptococcal infections after tonsillectomy may indicate treatment failure rather than surgical failure. Beta-lactamase-producing bacteria can shield Group A Streptococcus from penicillin in up to 75% of cases, potentially requiring alternative antibiotics like cephalosporins, clindamycin, or amoxicillin-clavulanate 5.