Developed by

Sore Throat

By Bjarne Lühr Hansen PhD, MD and Philipp Skafte-Holm MD, Mentor Institute

Tonsillitis is often caused by a virus and should not be treated with penicillin. By performing a graft on your throat the doctor can determine whether the tonsillitis is caused by bacteria and therefore should be treated with antibiotics. There is reason to suspect mononucleosis in the case of tonsillitis that lasts longer than 1 week.

The most common cause of tonsillitis is virus. Only one in every five cases of tonsillitis with adults is caused by bacteria and should be treated with penicillin. Mono (Kissing disease/mononucleosis) that is caused by a virus is a more rare kind of tonsillitis. You can only have mono once in a lifetime. The illness is not treatable with antibiotics.

Virus that causes tonsillitis especially occurs during the winter. First, there is a light irritation in the throat. Then light pain in connection with swallowing, rise in temperature to around 38,0°C, stuffiness in the nose and possibly the nose runs with a thin secrete and you cough. It is almost similar to a common cold with a sore throat. Your throat becomes red and on the neck small sore lumps appear. Sometimes, you are able to see white spots on the tonsils. There is no treatment for the illness and antibiotics do no good. The illness passes by itself after a few days but can possibly be soothe by painkilling medication bought over the counter.

If the tonsillitis is bacterial the nuisances are worse. The temperature is often high, which means around 39.0°C to 40.0°C. You feel more ill and prefer staying in bed. There is aching pain in the throat that worsens when you swallow. Usually, there is no running nose or cough. Your throat becomes crimson red and the tonsils become greatly enhanced with grey-white spots. It can be hard to distinguish between whether the tonsillitis is caused by virus or bacteria and should be treated with antibiotics.

Scarlet fever is regular tonsillitis only caused by a certain bacteria that causes a rash. The rash starts in the face and later spreads to neck, chest and arms. The rash looks likes goose bumps but is completely red. The goose bumps are tangible. Scarlet fever is treated with antibiotics. After you have taken antibiotics for 2 days, you are free of fever and feel much more comfortable. Scarlet fever is no more serious than regular tonsillitis.

Mono (kissing disease) is a special kind of tonsillitis that especially occurs with larger children and teenagers. At first mono appears as tiredness, muscle pain and headache for a couple of weeks. Then comes fever, pain in connection with swallowing and swelling on the neck. The tonsils are greatly enhanced with thick white confluent spots. The illness lasts around 2 to 4 weeks. Often mono is discovered by a case of tonsillitis not improving in the course of a week. The doctor can determine whether you have mono by taking a blood sample. There is no treatment for mono.

The contagion depends on which kind of tonsillitis it is. Viral tonsillitis is highly contagious since virus is transmitted from person to person through the air. Bacteria are not as contagious as virus. Most often, the contagion is transmitted by direct contact and not through the air. In the case of mono, a transfer of a considerable amount of spit is required for the illness to infect – hence the name kissing disease.


To soothe the pain, you can use painkilling medication (paracetamol or ibuprofen) up to 3 to 4 times a day. Only bacterial tonsillitis should be treated with antibiotics. Scarlet fever is treated with antibiotics. There is no treatment for mono.

What can you do?

In the case of high fever, you should dress lightly, stay in a cool room and drink plenty of fluid. If you have mono, you should avoid very heavy physical activity (e.g. elite sports) for 3 months while regular exercise is still recommended.

If the child does not want to eat because it hurts to swallow it should not be forced but instead encouraged to drink plenty. Cold and warm beverages can soothe the pains. Some children prefer other warm beverages, you have to feel your way. It can also help to raise the bedhead 15-20cm with cushions or books so that the child sleeps with the head elevated. To soothe the pain in the throat you can give the child painkilling medication. In the case of high fever, you should undress the child.

Contact the doctor tomorrow

If your temperature is more than 38,0°C, you have strong pain in connection with swallowing and your throat is red. If you suspect scarlet fever (sore throat, fever and a rash). If you have been given penicillin for tonsillitis and you still have a fever and a sore throat after 2 days. If your throat is sore for more than 1 week.

Contact the doctor immediately

If you have mono and your stomach starts to hurt. If you have trouble breathing. If your child is drowsy (lies completely still in bed and does not want to hear story or pay. If the child has trouble swallowing, dribbles and is hoarse.