Peritonsillar abscess, also known by its older medical name, quinsy, is a deep infection that forms near the tonsils and can cause severe throat pain, difficulty swallowing, and voice changes. Despite the similarity in spelling, quinsy should not be confused with “Quincy,” the name of several well-known towns and cities across the United States, including Quincy in Massachusetts and Illinois.
In medicine, quinsy is a pocket of pus that forms near one of the tonsils, between the tonsillar capsule and the surrounding muscles at the back of the throat.
Often arising as a complication of unresolved or severe tonsillitis, PTA can also follow viral throat infections or dental/gum disease in some cases.
Its symptoms include a severe sore throat (usually on one side), pain when swallowing, difficulty opening the mouth (trismus), muffled “hot-potato” voice, swollen neck lymph nodes, fever, and sometimes swollen face or neck.
Because the abscess can push tonsillar tissue and shift the uvula, and in severe cases swell to obstruct the airway Peritonsillar Abscess is considered a medical emergency if there is trouble breathing or swallowing.
Most peritonsillar abscesses involve bacteria common to the mouth and throat. Typical pathogens include:
Group A beta-hemolytic Streptococcus (the same bacteria that cause "strep throat")
Staphylococcus aureus
Several anaerobic bacteria, for example Fusobacterium, Prevotella, Peptostreptococcus, Bacteroides.
Often the infection is polymicrobial (i.e. involves several kinds of bacteria at once), reflecting the complex ecosystem of the oral cavity.
Risk factors include recurrent tonsillitis, gum disease, smoking, and in some cases immunosuppression or poor oral hygiene.
Management of PTA typically involves:
Drainage of pus - either by needle aspiration or a small incision to evacuate the abscess.
Antibiotic therapy - effective against both aerobic and anaerobic bacteria. Oral or intravenous antibiotics targeting common pathogens are standard.
Supportive care - pain relief, hydration, sometimes steroids to reduce swelling and speed recovery.
With timely treatment, most patients recover without long-term complications. However, delayed care can lead to serious outcomes, including spread of infection into deeper neck spaces or airway obstruction.
A recently published case3 report in Ear, Nose & Throat Journal (2024) documented an unusual instance of recurrent peritonsillar abscess (PTA) in a healthy male patient, ultimately traced to exposure to vaginal flora through oral sex.
According to the report, the patient initially presented with typical features of PTA, severe unilateral throat pain, swelling, muffled voice, and difficulty swallowing. Standard management was initiated, including needle aspiration and broad-spectrum antibiotics commonly effective against oral pathogens. The patient improved temporarily, but symptoms returned repeatedly, requiring multiple drainage procedures over a relatively short period.
Because most PTAs are polymicrobial and respond well to empiric antibiotic therapy, recurrence prompted clinicians to perform detailed microbiological analysis of the aspirated pus. Notably, culture results identified Gardnerella vaginalis, an anaerobic Gram-variable bacterium typically associated with bacterial vaginosis and rarely found in the oropharynx.
Further history revealed that the patient had engaged in recent unprotected oral sex with a female partner who had symptoms consistent with altered vaginal flora.
The presence of G. vaginalis in the tonsillar/peritonsillar area suggested direct transmission from the genital tract, making this an extremely rare example of genital-to-throat bacterial transfer leading to deep neck infection.
Once the causative organism was identified, physicians modified treatment to include antibiotics specifically active against G. vaginalis. After receiving targeted antimicrobial therapy, the patient experienced full resolution of symptoms with no further recurrences of PTA.
The case highlights that although peritonsillar abscesses usually arise from oral and pharyngeal bacteria, clinicians should consider obtaining cultures in persistent, atypical, or treatment-resistant cases, as uncommon pathogens, including those introduced during oral sex can play a role. This case also emphasizes the importance of sexual history in diagnostic evaluation when standard treatment fails.
A 2025 case report describes a very unusual cause of recurrent peritonsillar abscess: infection by Gardnerella vaginalis, a bacterium normally found in the vaginal microbiome following oral sex on a female partner.
G. vaginalis is commonly associated with bacterial vaginosis and is rarely found in the throat, which reinforces how exceptional this case was.
In this patient, repeated drainage and standard antibiotic treatments failed to prevent recurrence. Only after laboratory culture of the aspirated pus identified G. vaginalis did clinicians adjust therapy to cover this pathogen after which no further abscesses occurred.
This case remains rare but highlights important clinical lessons:
Not all peritonsillar abscesses arise from classical oral-throat bacteria.
In recurrent or treatment-resistant cases, aspirate cultures may be critical to identify unusual pathogens.
Unusual sources such as oral sex involving genital flora can rarely contribute to throat infections.
Oral–genital transmission of bacteria is possible but uncommon; maintaining general sexual hygiene reduces risk.
References:
WebMD. “Peritonsillar Abscess.” WebMD. Accessed December 1, 2025. https://www.webmd.com/oral-health/peritonsillar-abcess.
Galioto, Nicholas J. “Peritonsillar Abscess.” StatPearls, 2019. Accessed December 1, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC6755033/.
Owen, Alexander G., Abigail L. Ramstead, Michael C. Tam & Colin A. MacDougall. “Recurrent Peritonsillar Abscess Caused by Vaginal Flora — A Common Bacterium in an Uncommon Site.” Ear, Nose & Throat Journal, 2024. https://journals.sagepub.com/doi/10.1177/01455613241246486.
Edited by M Subha Maheswari
