Red Spots on the Roof of Mouth: Strep Throat and More

Doughnut lesions, or tiny red spots with a lighter center, on the roof of the mouth can be a telltale sign of strep throat. You’ll likely have a few other symptoms, including a fever, painful swallowing, and swollen tonsils.

A sore throat can come on for several reasons. Knowing what’s causing your sore throat is important because that will determine how to treat it. Here’s how to tell what’s causing your sore throat and why getting proper treatment for this bacterial infection is important.

When a sore throat won’t go away and you begin to have other symptoms, you may wonder if it’s strep throat. Strep throat is caused by bacteria called group A Streptococcus or Streptococcus pyogenes.

Tiny red spots on the roof of your mouth, among other symptoms, are a giveaway of strep infection. Doughnut lesions are small, round red spots with a pale center. They’re also called petechiae. These lesions can appear as a rash on the soft palate. The soft palate is the flexible part toward the back of the roof of your mouth.

Here are some case examples: A 9-year-old girl presented with a fever of around 101.3 degrees and a sore throat. She also had doughnut lesions in addition to swollen tonsils and lymph nodes and an inflamed uvula. The uvula hangs down at the back of your throat. The child’s tongue was also coated with a white film.

The throat swab for group A strep came back positive. Treatment with oral amoxicillin cleared the infection.

A 7-year-old boy similarly presented with a sore throat for the last two days and a fever of 101.2 degrees. He did not have a headache, cough, muscle pain, joint pain, skin rash, or bleeding. The classic doughnut lesions were spotted on the roof of his mouth. This child also recovered after taking amoxicillin and had no long-term complications.

The red spots on the roof of your mouth can be a sign of strep throat. They likely won’t be the only signs and symptoms of strep throat you’re having.

You may also develop symptoms like:

• Fever
• Pain when you swallow
• Red and swollen tonsils
• Sore throat that can start very quickly and may look red
• Swollen lymph nodes in the front of your neck
• White patches or streaks of pus on your tonsils

In Children

Children may have many strep throat symptoms. Strep throat is common in children between the ages of 5 and 15, especially in the winter and early spring. As many as 30% of children with a sore throat in the winter will have strep throat. School-aged children and their younger siblings can get it.

Children younger than 2 to 3 don’t get strep throat as often as older children. In addition to those mentioned above, symptoms in children older than 3 years include:

• A fever of 100.4 degrees or more
• Abdominal pain
• Headache
• Nausea or vomiting

In Adults

Sore throats are common in adults. Having school-aged children or being around children often increases the risk of strep throat.

The cause is often a viral or bacterial infection. A sore throat is most often caused by a virus. You’ll likely have a fever of 100.4 degrees or more.

You probably have a viral infection instead of strep throat if you have any of these symptoms:

• Cough
• Hoarseness (raspy, breathy, or strained voice)
• Pink eye (conjunctivitis)
• Runny nose

Your symptoms can tip you off to strep throat. You’ll likely have a combination of them, maybe a fever, swollen neck glands, red spots in your mouth, and no cough.

Doughnut lesions are a classic sign of strep. A healthcare provider can’t diagnose strep just by looking at your throat. They can perform a throat swab to test you for the bacteria that causes strep throat. The results may be available in a few minutes if you get a rapid test or in a day or two if your sample is sent to the lab for a throat culture.

Children and adolescents are at risk of getting rheumatic fever if strep throat goes untreated. Throat cultures are more accurate and are recommended for this group. Adults can get a rapid test because they aren’t as likely to get rheumatic fever from strep throat.

Strep throat is treated with antibiotics, usually either penicillin or amoxicillin. Other options are available if you have a penicillin allergy.

It’s important to finish all of the antibiotics you were prescribed. The infection may not be fully eliminated, even if you are feeling better, if you stop taking them early.

The bacteria can spread to other body parts if you don’t get strep throat treated. You could get a complication like:

Strep throat is not the only thing that can cause spots on the roof of your mouth. Other conditions that can cause lesions to appear include:

• Cancer of the mouth: Various cancers can show up as spots in your mouth.
• Canker sores: These lesions are usually round white or yellow sores with a red border. You’re most likely to find them on the inside of your lips, cheeks, or tongue.
• Hand, foot, and mouth disease: This usually causes spots on the cheeks and tongue. They can also appear on the soft palate.
• Immune thrombocytopenia (ITP): Red spots can appear on the roof of the mouth due to this bleeding disorder of blood platelets.
• Infectious mononucleosis: This disease is caused by the Epstein-Barr virus and can cause red spots on the roof of the mouth, among other symptoms.
• Oral herpes: These lesions are usually found on the border of the lip, but they can also appear on your hard palate.
• Oral thrush (oral candidiasis): This can cause white and red spots to appear all around your mouth, including on your tongue.
• Other viruses and bacteria: Some examples include cytomegalovirus, human herpes virus-6 and -7, measles virus, adenoviruses, dengue, zika virus, and scarlet fever.
• Physical injury: Injury to the roof of the mouth—such as from fellatio, or oral sex that stimulates the penis—can also cause red spots.

A sore throat that goes away on its own is likely caused by a virus. A sore throat may persist for five to seven days. You may want to get tested if symptoms last longer than this. 

A healthcare provider can perform a physical exam and conduct a rapid test or throat culture. They will generally only prescribe antibiotics if these tests are positive. Keep in mind that research has shown that there are limitations in these scoring systems, so it might be difficult for a healthcare provider to diagnose strep throat.

Call a healthcare provider if you or your child are not feeling better after taking antibiotics for two days. It’s also important to get medical attention if you have:

• Difficulty breathing
• Drooling because of difficulties swallowing
• Skin rash
• Stiff neck or difficulty opening your mouth
• Swelling of the neck or tongue
• Underlying chronic (long-term) illnesses or medication that may impair your immune system

Strep throat is caused by bacteria. One symptom is small red spots that appear on the roof of the mouth. Other symptoms, like fever and swollen glands, usually accompany these spots.

See a healthcare provider if you have a sore throat that won’t go away. There’s a chance it could be strep throat, and you’ll want to get it treated. A healthcare provider can prescribe antibiotics to clear a bacterial infection.