STD Tonsillitis: A Differential to Consider in Sexually Active Individuals

Oral Intercourse

Sexual practices are becoming more versatile, with people exploring and engaging in other practices. Mouth-related STDs are also becoming more commonly heard of. Oral intercourse can be pleasurable to many, but on the other hand, oral intercourse can pose health risks that one may not be aware of. The lips, tongue, buccal mucosal membrane (inner cheeks), tonsils, and pharynx (throat) can be affected by sexually transmitted infections. 

In certain STDs, high-risk STD infection in the mouth can increase the risk of oral and throat cancer in years to come. Untreated oral STD infections can also be passed to the urinary tract, vagina, or even the anus during sexual intercourse, leading to further transmission of infections.

Symptoms of STD-related Tonsillitis

Common symptoms that one can present following exposure to oral STDs include:

• Fever
• Sore throat
• Lymph nodes over the neck
• Ulcers in the mouth
• Lumps and bumps on the lips, in the mouth, inner cheek and back of throat
• Feeling generally unwell

Clinically, when the tonsils are infected with STD, they can be 

• Inflamed and swollen, 
• Exudative with pus
• White and red spots, ulcers on the tonsils and surrounding throat

Symptoms of STD-related tonsillitis can be indistinguishable when compared to non-STD-related tonsillitis.

Frequently, the infected person can be completely asymptomatic yet behave as a reservoir to spread the disease to others sexually.

STD infections that can cause tonsillitis

Chlamydia trachomatis and Neisseria gonorrhea

Chlamydia trachomatis and Neisseria gonorrhea are two of the most common bacterial infections that are passed from an infected sexual partner during oral intercourse. Less commonly, deep kissing can also be a cause of both bacterial tonsillitis. Symptoms of bacterial STD tonsillitis can be very similar to non-STD-related tonsillitis; hence, without a PCR throat swab test, both conditions can be difficult to distinguish. Yet, treatment of bacterial STD tonsillitis is very specific; without nailing down the diagnosis, the right treatment will be missed and delayed.

Herpes Simplex Virus (HSV)

While HSV-1 is commonly known as the culprit of oral-pharyngeal infection including tonsillitis, it is possible for HSV-2 infection to cause pharyngeal-tonsilar symptoms as well. 

HSV-related tonsillitis, if left untreated (or treated wrongly with antibiotics), tends to run a longer course of symptoms with fever and inflammatory ulcers, resulting in severe pain, difficulty swallowing, or lymph nodes. With appropriate antiviral, the symptoms tend to improve and resolve rapidly.

Syphilis

This is an important bacterial infection caused by Treponema pallidum and should not be missed due to its association with long-term health complications. While it is sexually spreadable, it can also be transmitted from mother to child during pregnancy. Syphilitic tonsillitis has been reported in secondary syphilis and in the later stages of syphilis. It can present with localized symptoms, focusing mainly on the oral and throat region. 

Occasionally, there can be involvement of surrounding lymph nodes swelling, the presence of unusual rashes/ ulcers/ lumps over the face, genital region, or even the body. However, syphilitic tonsillitis is a tricky one to diagnose as syphilis is a great mimic of many diseases with multi-organ presentation and can be confused with other medical conditions. Untreated syphilis increases the risk of acquiring HIV infection.

HIV 

During early seroconversion of HIV infection, one can present with viral-like symptoms such as fever, flu, or even tonsillitis and sore throat. This is due to the immune response during the initial phase of acquiring HIV. Interestingly HIV virus can replicate in the tonsils. Symptoms tend to be transient and resolve with or without medication, following lifelong establishment of HIV disease in the infected person. This is a crucial phase to pick up, as it gives a good opportunistic window period for one to be started on antiviral medication (HAART) to control and halt the progression of HIV in an infected person, and prevent further damage to the body's immune system. This can slow or even prevent eventual development of HIV complications- AIDS.

Human Papillomavirus (HPV) 

HPV generally does not cause tonsillitis, though it can be associated with oral HPV lesions such as warts and can be associated with oral and throat cancer. Sometimes one can develop a sore throat or swollen lymph nodes/ tonsils. HPV vaccination is effective in preventing HPV related oral, head, and neck cancers.

Implications of not treating STD-related tonsillitis

While treatment of STDs involving the oral and throat region is usually similar to treatment of genital STD infections, tonsil/ throat STD infections can be difficult to treat due to different antibiotic tissue penetration over the throat versus the usual genital region. This commonly results in treatment failure, requiring repeated treatment or even a higher dose of medication to eradicate the infection.

STD related tonsillitis, if left unaddressed, can be spread to sexual partners during unprotected intercourse and further viciously spread to one's own genital region later on, resulting in long-term STD comorbidities and complications such as pelvic inflammatory disease, scarring, chronic pelvic pain, and infertility both in men and women. 

How can I screen for STD-related tonsillitis?

Regardless of whether you have any symptoms or not, if you do engage in receptive oral-genital sexual intercourse, you should consider screening tests for throat or oral STD infections. 

Contact us to schedule a confidential consultation and determine which screening tests are right for you.

What treatments are available for STD-related tonsillitis?

Treatment for STD tonsillitis is similar to treatment for genital STD infections. Treatment will be dependent on the underlying causative pathogen(s). Treatment can be in the form of antibiotics and antivirals to eradicate or control the infection and prevent further spread of infection to self and others.

Do I need to inform my partner(s) if I am diagnosed with STD-related tonsillitis?

You should inform your sexual partner if you are diagnosed with STD tonsillitis. This is important so that your partner can be screened and receive appropriate STD treatment without further delay. Reinfection is possible with subsequent sexual exposure if sexual partner(s) are left untreated.

Take Charge of Your Sexual Health

STD-related tonsillitis can sometimes cause symptoms that are similar to those of a common throat infection, so it may not always be easy to tell the difference without appropriate assessment. If you have a persistent sore throat after oral sexual contact or have concerns about your sexual health, it may be helpful to speak with a doctor for further advice.

At DB Clinic, we offer confidential consultations, STD screening, and personalised care to help you better understand your sexual health. Contact us to arrange a consultation.

What have I learnt today?

• Infection of the tonsils by sexually transmitted diseases is possible in those who engage in oral intercourse.
• Symptoms of STD-related tonsillitis can be similar to non-STD-related tonsillitis.
• STDs that can cause tonsillitis include bacterial pathogens such as Chlamydia trachomatis, Neisseria gonorrhea, syphilis and viruses such as Herpes Simplex Virus, HIV and Human papillomavirus.
• Untreated STDs in the tonsils or oral region may have long term health repercussion to self and loved ones.

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