Strep throat is a common bacterial infection that causes swelling and pain in the throat, often making it hard to swallow. For those who are prone to frequent strep infections, a doctor may recommend a tonsillectomy – a surgical procedure to remove tonsils.

While a tonsillectomy may relieve symptoms of a swollen throat, it doesn’t mean you’re immune to a strep throat infection. It is still possible to get strep even without your tonsils.

Yes, you can get strep throat without tonsils

Even if you’ve had your tonsils removed, you can still become sick with strep throat. That’s because the bacteria that causes strep, called Group A. Streptococcus, is still able to populate the tissues in the back of your throat even without your tonsils.

The advantage of having your tonsils removed is that your sore throat symptoms will probably be less severe, says Rob Darzynkiewicz, MD, Chief Medical Officer at Hazel Health, a healthcare service that provides students with on-demand doctor visits via telemedicine.

However, just because a tonsillectomy provides symptom relief, does not mean it reduces the frequency of strep throat infections.

Since the 1970s, the number of tonsillectomies in the US have significantly and progressively declined, with the majority now being done for obstructive sleep problems rather than recurring tonsillitis (sore throat). A 2014 review published in the Cochrane Database involving 987 children found that a tonsillectomy prevented an average of just one less sore throat a year, compared to those who didn't have their tonsils removed.

The same review concluded that adults should also typically forego a tonsillectomy for tonsillitis, because its minimal benefits in easing sore throat symptoms do not outweigh the pain of the procedure - which is especially uncomfortable in adults.

When you should consider a tonsillectomy

The pros and cons of tonsillectomy vary depending on a patient's needs. "If the throat infections significantly affect the patient's life, for example a child missing school often, surgery may be recommended," says Darzynkiewicz. "On the other hand, throat infections naturally decline as a child ages, so a doctor may recommend monitoring the patient closely over time and treating infections with antibiotics to avoid surgery."

Like every surgery, Darzynkiewicz says a tonsillectomy carries a risk of bleeding, pain, secondary infection, and adverse reactions to anesthesia. Therefore, it should be a last resort procedure when it comes to recurring tonsillitis.

A tonsillectomy may be suggested as treatment for a child who has what are defined as "frequent" throat infections. Those who have more than seven strep throat infections in the span of one year or more than five over the span of two years, would fall into the "frequent" category.

How do you get strep throat?

When someone has strep throat, the bacteria responsible lives in their nose and throat, whether or not they have tonsils.

Strep is spread through infected droplets in the air, from talking or sneezing, or through saliva left on surfaces like a handrail. That makes it possible to catch strep without coming into direct contact with an infected person.

Touching a shared surface, such as a doorknob or table, and then touching your mouth or eyes is all it takes for transmission to occur, Darzynkiewicz says. Sharing drinks and personal items can also spread strep. Children are more likely to engage in these behaviors, which is part of the reason why school-aged children and their teachers get infected at higher rates than the rest of the population.

To prevent infection, be sure to disinfect surfaces and wash your hands properly. For more information, read about how to kill germs and reduce your risk of illness.

Symptoms of strep throat

Even if you have had your tonsils removed, you can still experience symptoms of strep throat. According to the Mayo Clinic, these symptoms can include:

  • Scratchy, painful throat
  • Swollen lymph nodes
  • Fever
  • Nausea
  • Difficulty swallowing
  • Red or white patches on the inside of the throat

One of the tell-tale indications that you do not have strep throat is a cough, as it's more typical of a viral infection, says Darzynkiewicz.

When you go to the doctor with a sore throat, the first thing they will do is take your vital signs. Abnormal vital signs, like a fever, can be the first clue that you have an infection. Your care provider will then perform a physical exam, looking for signs and symptoms such as enlarged tonsils, redness or white patches on your throat, or swollen lymph nodes.

If symptoms of strep are identified, your doctor might swab your tonsils and throat for a fluid sample to test for strep. Darzynkiewicz says doctors usually swab your throat twice. That's because the first swab will be used for a rapid test which can give results within 15 minutes. Rapid tests check for proteins called antigens that indicate the presence of strep bacteria. If the test is positive, antibiotic treatment can start right away.

However, if your rapid test is negative and your doctor still suspects you have strep, they will use the second swab for a throat culture test, says Darzynkiewicz. Then lab techs will wait for bacteria to grow on the swab before checking it under a microscope for strep. While this test takes more time than a rapid test, it sometimes catches strep infections the first test misses.

How to get rid of strep throat

You should see your doctor if you suspect you or your child has strep throat. While symptoms of strep throat can sometimes be resolved with at-home treatment, there's a risk of serious complications from an untreated strep infection.

According to Darzynkiewicz, secondary complications from strep include a throat abscess where strep bacteria spreads past your tonsils and into your throat or acute rheumatic fever which can cause long-term heart damage. Strep bacteria can also travel to the kidneys if left untreated leading to kidney inflammation and possible damage.

While you wait to get tested for strep, you may want to manage symptoms with an over-the-counter pain reliever like acetaminophen (Tylenol) or ibuprofen (Advil).

Once you are diagnosed, strep is most often treated with antibiotics. Oral antibiotics can manage symptoms and control your ability to transmit the infection to others, usually within 48 hours. Even if you don't have tonsils, an antibiotic will still be recommended.

The bottom line

It is possible to get strep throat even if you've had your tonsils removed. If you are someone who experiences frequent strep throat infections, a tonsillectomy may reduce symptoms of a sore throat, but sometimes the risks outweigh the benefits.

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