White spots on the throat, known medically as pharyngeal or tonsillar exudate, signal inflammation usually caused by an underlying infection. Although many symptoms have been associated with SARS-CoV-2, these distinct white spots are generally considered an atypical presentation for a primary COVID-19 infection. Understanding the common causes of this specific symptom is important for seeking appropriate testing and care. This distinction guides accurate diagnosis, as treatments for conditions causing throat exudate vary widely.
COVID-19 and Typical Throat Manifestations
A sore throat is a frequent symptom of COVID-19, particularly with the emergence of variants like Omicron, which tends to affect the upper respiratory tract more prominently. This soreness is typically described as a scratchy, dry, or painful sensation that can make swallowing uncomfortable. A COVID-19 sore throat usually appears alongside other symptoms, such as fever, cough, fatigue, and sometimes the loss of taste or smell.
The physical appearance of the throat in a COVID-19 infection usually involves generalized redness, known as pharyngeal erythema. The SARS-CoV-2 virus is less likely to produce visible white patches or streaks of pus, which are collections of inflammatory cells, dead tissue, and microbes. While rare cases of white spots have been reported, this remains an unusual finding and is an unreliable marker for identifying the virus.
Primary Causes of White Spots on the Throat
When white spots are present, attention shifts to other, more common infectious culprits. These exudates are visible signs of a strong immune response to an infection on the tonsils or back of the throat. The two most frequent causes are bacterial and other viral infections, which require different diagnostic and treatment approaches.
Bacterial Infections (Strep Throat)
The most common bacterial cause is Group A Streptococcus, which leads to strep throat. This infection is characterized by the rapid onset of a severe sore throat, often accompanied by a fever, and white patches or streaks of pus on the tonsils. Unlike COVID-19, strep throat rarely involves a cough or runny nose, which helps distinguish it from many viral illnesses.
Viral Infections (Mononucleosis)
Another frequent cause of white spots is Infectious Mononucleosis (mono), typically caused by the Epstein-Barr virus. Mono can cause a severe sore throat that resembles strep throat, including white exudate on the tonsils. However, mono often includes profound fatigue that can linger for weeks, along with swollen lymph nodes in the neck and armpits.
Fungal Infections (Oral Thrush)
Fungal infections, such as oropharyngeal candidiasis (oral thrush), can also present with creamy white, raised patches on the throat and tongue. This condition is caused by an overgrowth of Candida yeast. Thrush is more common in infants, those with weakened immune systems, or individuals using inhaled corticosteroids. These patches can sometimes be wiped away, leaving a reddened area underneath, which differentiates them from the pus associated with bacterial or other viral infections.
When Diagnostic Testing is Necessary
A visual inspection of the throat is insufficient to determine the cause of white spots, as symptoms of strep, mono, and COVID-19 can overlap. Diagnostic testing is required to confirm the pathogen because treatment for bacterial infections (antibiotics) differs significantly from supportive care for most viral infections. Untreated strep throat can lead to serious complications like rheumatic fever, so self-diagnosis should be avoided when exudates are present.
A rapid strep test or a throat culture is the standard procedure to check for Group A Streptococcus bacteria. If the strep test is negative, and symptoms suggest a viral cause, a blood test may be used to check for mononucleosis. A COVID-19 test is also often necessary to rule out SARS-CoV-2, as a viral illness can lower the body’s defenses, allowing a secondary bacterial infection to take hold.
The presence of white spots, regardless of other symptoms, is a strong indication to seek professional medical advice for proper swabbing and diagnosis. Receiving an accurate diagnosis ensures the correct treatment is prescribed, preventing unnecessary antibiotic use or ensuring timely treatment for bacterial infections.
Specific symptoms should prompt a medical consultation:
- A sore throat that starts very quickly.
- Difficulty swallowing.
- A high fever.
- A sore throat that persists beyond a few days.