White Patches in Throat: Differential Diagnosis and When to Worry

White/yellow throat patches (exudates) have infectious and non-infectious causes.

Infectious

Condition	Key Features
Acute tonsillitis (viral/bacterial)	Exudative tonsils, sore throat, fever, cervical adenopathy
Strep throat (GAS)	Exudates, fever, NO cough, anterior adenopathy; Centor criteria; rapid test/culture
Infectious mononucleosis (EBV)	Massive exudative tonsillitis, fatigue, splenomegaly, atypical lymphs, heterophile +
Oral candidiasis (thrush)	Creamy white plaques on mucosa (buccal, palate, tongue) scraping leaves erythema; immunosuppressed, antibiotics, steroids
Herpes simplex (primary)	Vesicles → ulcers on gingiva, palate, lips; gingivostomatitis; fever
Hand-foot-mouth (coxsackie)	Oral vesicles/ulcers + palm/sole vesicles; child

Non-Infectious / Premalignant

• Leukoplakia: White adherent plaque (tobacco/alcohol); biopsy for dysplasia.
• Lichen planus: Reticular white striae (Wickham's), erosive ulcers.
• Geographic tongue: Migratory erythematous patches with white border; benign.

Red Flags – Urgent ENT/Oral Medicine Referral

• Persisting >2 weeks despite treatment.
• Induration, fixation, ulceration, bleeding.
• Neck mass, weight loss, otalgia, dysphagia.
• Immunocompromised host.

Diagnosis: history, exam, rapid strep, mono spot, culture, biopsy if indicated.