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Hello, This Question Is For Dr. XXXXXXX Branch. Hi Dr.

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Posted on Mon, 28 Sep 2020
Question: Hello, this question is for Dr. XXXXXXX Branch.

Hi Dr. Branch,
I’m not sure if you’ll remember me but I am the patient who had multiple UTIs last summer and asked you several questions!

So, on August 22 and 23 I was having a sore throat, no other symptoms. On the 24th I looked inside my throat and saw a white spot in the back of my throat (on the left side which is mostly where I felt the pain). I often get that with strep throat (I’ve had strep throat several times over the years) so I called my doctor. He didn’t have me come in because of my history. He prescribed me Amoxicillin 500mg 3/day for 7 days. Later that day I did begin to get the usual strep symptoms such as upset stomach, aches, fatigue, etc. After 48 hours of taking the amoxicillin I noticed I was feeling better and after 72 hours I was back to myself as I would usually expect. My doctor did send me for a Covid test just in case and it was negative.

I must admit I took my antibiotic faithfully the first half of the week, but I would sometimes forget after that so I would just take it at the next time. If I forgot my morning pill I would take it at lunch so it took a couple of extra days to finish them all. I finished them around Sept. 2.

Today I began to notice that my throat was feeling a little off again. Not really sore but dry feeling. I looked in my throat and saw the white spot is still there and it’s either the same size or larger. I started to panic. This has not happened to me before that I am aware of. I was unable to speak with my family doctor but I was able to see a doctor at our clinic. She took a look inside and seemed concerned which freaked me out. She said maybe it’s an abscess but she wanted to do a strep test first which she did and it came back positive. She said she wants to treat the strep with a stronger antibiotic so she gave me Azithromycin 250mg for 5 days. I have to take 2 today and 1 a day for 4 days. She said if it’s not better and I still have the spot in my throat, I have to see my doctor as soon as possible.
I really have no symptoms at this point. I’m surprised I really even checked my throat. It was just feeling a bit dry and like sand paper so I thought I would see if the spot is still there. Otherwise I wouldn’t have noticed. I think the white dot is either the same size but if it’s bigger, it’s only a little bit bigger. It’s hard to tell. I did attach a picture of my mouth. I’m sorry it’s not the best picture. The white dot appears on the right side in the back of my throat in the photo (but it’s actually on the left side). Sorry my tongue looks so pasty!

I haven’t really eaten much today but I’m not sure if that’s partly due to my nerves now being all anxious about this. Otherwise I feel like myself.

I am such an anxious person. While I was waiting for my strep result to come back I googled abscess in the throat and now I’m in a huge panic!! What I read scared me.

I am just concerned about why the amoxicillin didn’t fully take the strep away, although it must have helped to some degree because I ended up feeling better. I am also concerned that this is an abscess.
Have you heard of strep doing this? Is Azithromycin an effective antibiotic against strep? Have you ever seen the white dots not going away with the first round of antibiotic? If this is an abscess, will the Azithromycin help it? Or should I expect it to not really help?
I’m just so scared because what I read on google scared me about abscesses. It said they can block your airways.
Anyway, I really appreciate any help or advice you can give me. I’m sorry for all of the questions but the doctor was in a bit of a hurry and didn’t really have much time to chat. Thank you.
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Follow up: Dr. Aaron Branch (0 minute later)
Hello, this question is for Dr. XXXXXXX Branch.

Hi Dr. Branch,
I’m not sure if you’ll remember me but I am the patient who had multiple UTIs last summer and asked you several questions!

So, on August 22 and 23 I was having a sore throat, no other symptoms. On the 24th I looked inside my throat and saw a white spot in the back of my throat (on the left side which is mostly where I felt the pain). I often get that with strep throat (I’ve had strep throat several times over the years) so I called my doctor. He didn’t have me come in because of my history. He prescribed me Amoxicillin 500mg 3/day for 7 days. Later that day I did begin to get the usual strep symptoms such as upset stomach, aches, fatigue, etc. After 48 hours of taking the amoxicillin I noticed I was feeling better and after 72 hours I was back to myself as I would usually expect. My doctor did send me for a Covid test just in case and it was negative.

I must admit I took my antibiotic faithfully the first half of the week, but I would sometimes forget after that so I would just take it at the next time. If I forgot my morning pill I would take it at lunch so it took a couple of extra days to finish them all. I finished them around Sept. 2.

Today I began to notice that my throat was feeling a little off again. Not really sore but dry feeling. I looked in my throat and saw the white spot is still there and it’s either the same size or larger. I started to panic. This has not happened to me before that I am aware of. I was unable to speak with my family doctor but I was able to see a doctor at our clinic. She took a look inside and seemed concerned which freaked me out. She said maybe it’s an abscess but she wanted to do a strep test first which she did and it came back positive. She said she wants to treat the strep with a stronger antibiotic so she gave me Azithromycin 250mg for 5 days. I have to take 2 today and 1 a day for 4 days. She said if it’s not better and I still have the spot in my throat, I have to see my doctor as soon as possible.
I really have no symptoms at this point. I’m surprised I really even checked my throat. It was just feeling a bit dry and like sand paper so I thought I would see if the spot is still there. Otherwise I wouldn’t have noticed. I think the white dot is either the same size but if it’s bigger, it’s only a little bit bigger. It’s hard to tell. I did attach a picture of my mouth. I’m sorry it’s not the best picture. The white dot appears on the right side in the back of my throat in the photo (but it’s actually on the left side). Sorry my tongue looks so pasty!

I haven’t really eaten much today but I’m not sure if that’s partly due to my nerves now being all anxious about this. Otherwise I feel like myself.

I am such an anxious person. While I was waiting for my strep result to come back I googled abscess in the throat and now I’m in a huge panic!! What I read scared me.

I am just concerned about why the amoxicillin didn’t fully take the strep away, although it must have helped to some degree because I ended up feeling better. I am also concerned that this is an abscess.
Have you heard of strep doing this? Is Azithromycin an effective antibiotic against strep? Have you ever seen the white dots not going away with the first round of antibiotic? If this is an abscess, will the Azithromycin help it? Or should I expect it to not really help?
I’m just so scared because what I read on google scared me about abscesses. It said they can block your airways.
Anyway, I really appreciate any help or advice you can give me. I’m sorry for all of the questions but the doctor was in a bit of a hurry and didn’t really have much time to chat. Thank you.
doctor
Answered by Dr. Aaron Branch (3 hours later)
Brief Answer:
Not likely an abscess

Detailed Answer:
Hello again, it's good to hear from you.

I'm glad it sounds like your health hasn't been too much of an issue since we last talked, but sorry you are now dealing with this strep throat issue.

I looked at the picture and can see fairly well what you are talking about. It looks like a pustule, or pus-filled pimple, in the back of the throat, which can happen with strep throat. I would expect this to resolve with the treatment, but it could be that it is persisting even though the infection has been cured. But the fact that you don't really have any symptoms is the most important thing and is reassuring that this is not anything serious, such as an abscess.

If this was an abscess, you would be feeling very sick, with fever and pain. Since you say you are feeling overall well, I would suspect this is just a leftover pimple from the strep infection, which will eventually pop or heal on its own.

In the meantime, I wouldn't be surprised if you felt some irritation in your throat, but it wouldn't be anything that would concern me.

I hope that helps! Please let me know if you have any other questions, I would be glad to help any way I can.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Not likely an abscess

Detailed Answer:
Hello again, it's good to hear from you.

I'm glad it sounds like your health hasn't been too much of an issue since we last talked, but sorry you are now dealing with this strep throat issue.

I looked at the picture and can see fairly well what you are talking about. It looks like a pustule, or pus-filled pimple, in the back of the throat, which can happen with strep throat. I would expect this to resolve with the treatment, but it could be that it is persisting even though the infection has been cured. But the fact that you don't really have any symptoms is the most important thing and is reassuring that this is not anything serious, such as an abscess.

If this was an abscess, you would be feeling very sick, with fever and pain. Since you say you are feeling overall well, I would suspect this is just a leftover pimple from the strep infection, which will eventually pop or heal on its own.

In the meantime, I wouldn't be surprised if you felt some irritation in your throat, but it wouldn't be anything that would concern me.

I hope that helps! Please let me know if you have any other questions, I would be glad to help any way I can.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Aaron Branch (1 hour later)
Hi Dr. Branch,
Thank you so much for your response! It has made me feel so much better. I really appreciate that. I was so concerned when the doctor mentioned an abscess (then I googled it which I really shouldn’t have done!). It scared me and yet I was surprised I had so few symptoms of anything.

Yes, (I’m sorry my photo wasn’t the greatest) but you’re right. That is what the spot looks like to me when I shine a flashlight in my throat. It looks like a pus-filled pimple.

Yes, overall I feel fine. I wouldn’t have even checked my throat except that it felt a bit dry and like sand paper.
I know I have definitely had the white spots before, sometimes more than one, but once I feel better I kind of forget about them so I’m not sure how long they have hung around in the past. I feel like this one looks the same or similar to the ones in the past.
I know I definitely had strep too because I felt exactly the way I normally do when I get it and got better in the same amount of time I normally do. I was kind of surprised by what happened today. I am hoping the spot either goes away with the Azithromycin or on its own. Do you know how long the white spots can hang around after treatment or once you are feeling better?

I do notice my stomach is a bit upset this evening. It could be my nerves because I was in a panic for a few hours until I read your message. I am not sure if I’ve had Azithromycin before so maybe that could be it, too. I did take it with food. Unfortunately the box it came in didn’t list the side effects. Do you know if it can cause upset stomach? My stomach is really not that bad though. Probably just nerves.

A friend of mine said she gets strep a lot too and has had to take 2 or 3 rounds of antibiotics to clear it up. I didn’t realize that happens. I have not usually had an issue.

Thank you so much again for your help. I really appreciate it. I will let you know if I have any more questions.
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Follow up: Dr. Aaron Branch (0 minute later)
Hi Dr. Branch,
Thank you so much for your response! It has made me feel so much better. I really appreciate that. I was so concerned when the doctor mentioned an abscess (then I googled it which I really shouldn’t have done!). It scared me and yet I was surprised I had so few symptoms of anything.

Yes, (I’m sorry my photo wasn’t the greatest) but you’re right. That is what the spot looks like to me when I shine a flashlight in my throat. It looks like a pus-filled pimple.

Yes, overall I feel fine. I wouldn’t have even checked my throat except that it felt a bit dry and like sand paper.
I know I have definitely had the white spots before, sometimes more than one, but once I feel better I kind of forget about them so I’m not sure how long they have hung around in the past. I feel like this one looks the same or similar to the ones in the past.
I know I definitely had strep too because I felt exactly the way I normally do when I get it and got better in the same amount of time I normally do. I was kind of surprised by what happened today. I am hoping the spot either goes away with the Azithromycin or on its own. Do you know how long the white spots can hang around after treatment or once you are feeling better?

I do notice my stomach is a bit upset this evening. It could be my nerves because I was in a panic for a few hours until I read your message. I am not sure if I’ve had Azithromycin before so maybe that could be it, too. I did take it with food. Unfortunately the box it came in didn’t list the side effects. Do you know if it can cause upset stomach? My stomach is really not that bad though. Probably just nerves.

A friend of mine said she gets strep a lot too and has had to take 2 or 3 rounds of antibiotics to clear it up. I didn’t realize that happens. I have not usually had an issue.

Thank you so much again for your help. I really appreciate it. I will let you know if I have any more questions.
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Follow up: Dr. Aaron Branch (22 minutes later)
I forgot to ask a couple of questions. The doctor didn’t ask what medications I am taking. I have PVCs and I take Bisoprolol. Is that ok that I’m taking Azithromycin?
Also, I had to take erythromycin a few years ago for a tooth infection. It made me feel so ill. I don’t usually have reactions to antibiotics but that one made me feel very nauseous and tired. I felt worse each day on it so the dentist told me to stop taking it. Are Azithromycin and Erythromycin similar? I am just hoping I won’t have a reaction like that on this med. Maybe I think they sound like they would be the same since their names are so alike.
Thank you!
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Follow up: Dr. Aaron Branch (0 minute later)
I forgot to ask a couple of questions. The doctor didn’t ask what medications I am taking. I have PVCs and I take Bisoprolol. Is that ok that I’m taking Azithromycin?
Also, I had to take erythromycin a few years ago for a tooth infection. It made me feel so ill. I don’t usually have reactions to antibiotics but that one made me feel very nauseous and tired. I felt worse each day on it so the dentist told me to stop taking it. Are Azithromycin and Erythromycin similar? I am just hoping I won’t have a reaction like that on this med. Maybe I think they sound like they would be the same since their names are so alike.
Thank you!
doctor
Answered by Dr. Aaron Branch (1 hour later)
Brief Answer:
Azithromycin and erythromycin are similar antibiotics

Detailed Answer:
Yes, you are right, azithromycin and erythromycin are similar antibiotics, called macrolide antibiotics. Like most antibiotics, azithromycin can cause GI upset, so it is possible this is the cause, but it could be from nerves as well like you said. Usually azithromycin is only given for a few days, so if you are able to tolerate it, I would just try to finish them, and hopefully the stomach issues will clear up soon. However, it does sound like you may not have needed the azithromycin, since you didn't have any symptoms, and so if it starts to cause more serious GI problems, I think you could safely stop it as well, and follow up with your doctor as soon as you can. Also, it is safe to use Azithromycin with bisoprolol and PVCs.

As far as how long these white spots tend to last, I can't say for sure, I've never had a patient tell me about them after getting treated for strep throat. But since it is not common to see them, I would guess they don't last for long. I would expect it to be gone within a few weeks.

Let me know if you have any other questions, I hope you are feeling back to normal soon!
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Azithromycin and erythromycin are similar antibiotics

Detailed Answer:
Yes, you are right, azithromycin and erythromycin are similar antibiotics, called macrolide antibiotics. Like most antibiotics, azithromycin can cause GI upset, so it is possible this is the cause, but it could be from nerves as well like you said. Usually azithromycin is only given for a few days, so if you are able to tolerate it, I would just try to finish them, and hopefully the stomach issues will clear up soon. However, it does sound like you may not have needed the azithromycin, since you didn't have any symptoms, and so if it starts to cause more serious GI problems, I think you could safely stop it as well, and follow up with your doctor as soon as you can. Also, it is safe to use Azithromycin with bisoprolol and PVCs.

As far as how long these white spots tend to last, I can't say for sure, I've never had a patient tell me about them after getting treated for strep throat. But since it is not common to see them, I would guess they don't last for long. I would expect it to be gone within a few weeks.

Let me know if you have any other questions, I hope you are feeling back to normal soon!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aaron Branch (9 hours later)
Thanks again for your help! I am feeling less stressed now so my stomach is feeling better. I didn’t realize that the white spots can linger for a while after treatment.

I guess I will continue to take the Azithromycin. I’ll see if the spot is still there next week. I should be able to speak with my doctor on Wednesday to follow up.

I know you said if this was an abscess I would be in pain and feel worse. I was just curious, is it a similar thing to cellulitis? I had that in my leg a few years ago. The area was quite sore, I had a fever, terrible fatigue, aches, etc. I felt horrible. It all came on very quickly too - within 24 hours of getting my leg scratched. Anyway, I was just curious if an abscess would be similar to that? I’m assuming it doesn’t usually linger in your throat with no symptoms.

Someone else mentioned to me a tonsil stone. I don’t know much about them. I do know I had strep throat for sure though so I am kind of guessing this is related to that - like you said.

Thanks again for your help!
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Follow up: Dr. Aaron Branch (0 minute later)
Thanks again for your help! I am feeling less stressed now so my stomach is feeling better. I didn’t realize that the white spots can linger for a while after treatment.

I guess I will continue to take the Azithromycin. I’ll see if the spot is still there next week. I should be able to speak with my doctor on Wednesday to follow up.

I know you said if this was an abscess I would be in pain and feel worse. I was just curious, is it a similar thing to cellulitis? I had that in my leg a few years ago. The area was quite sore, I had a fever, terrible fatigue, aches, etc. I felt horrible. It all came on very quickly too - within 24 hours of getting my leg scratched. Anyway, I was just curious if an abscess would be similar to that? I’m assuming it doesn’t usually linger in your throat with no symptoms.

Someone else mentioned to me a tonsil stone. I don’t know much about them. I do know I had strep throat for sure though so I am kind of guessing this is related to that - like you said.

Thanks again for your help!
doctor
Answered by Dr. Aaron Branch (11 hours later)
Brief Answer:
Could be a tonsil stone

Detailed Answer:
That is a good point, it could be a tonsil stone, or tonsillolith, as well. This is just hardened material after an infection, which usually doesn't cause any problems, but can cause bad breath. If it is bothering you, and ENT doctor might be able to do a procedure to remove them, but I've never had a patient that needed to do that. You could try to gargle saltwater at night and see if that helps get rid of it.

Yes, you are right that it would be similar to cellulitis, since both cellulitis and an abscess would be active infections, which would cause significant pain and swelling. Typically an abscess would be even worse than cellulitis and is more difficult to treat. But your throat does not appear to have an active infection.

I hope you can get this taken care of soon! Please let me know if I can help with anything else.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Could be a tonsil stone

Detailed Answer:
That is a good point, it could be a tonsil stone, or tonsillolith, as well. This is just hardened material after an infection, which usually doesn't cause any problems, but can cause bad breath. If it is bothering you, and ENT doctor might be able to do a procedure to remove them, but I've never had a patient that needed to do that. You could try to gargle saltwater at night and see if that helps get rid of it.

Yes, you are right that it would be similar to cellulitis, since both cellulitis and an abscess would be active infections, which would cause significant pain and swelling. Typically an abscess would be even worse than cellulitis and is more difficult to treat. But your throat does not appear to have an active infection.

I hope you can get this taken care of soon! Please let me know if I can help with anything else.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Aaron Branch (2 days later)
Hi Dr. Branch,
So I have had 5 of the 6 Azithromycin pills. I still feel the same and the white spot is still there. Thankfully I don’t seem to be any worse. Just the same.

I am a bit concerned because tonight I ended up getting the diarrhea. I am assuming it’s likely from the Azithromycin. I don’t usually get diarrhea with antibiotics but I’ve heard this drug can be bad for that. Since I am feeling the same and I only have one pill left (for tomorrow) do you think I can safely stop the antibiotic? I am going to try and follow up with my doctor on Wednesday or Thursday.

Also, if the diarrhea persists, can I take peptide bismol to try and get the diarrhea to stop? I usually have luck getting diarrhea to stop with pesto bismol. I just read that you shouldn’t take anything to stop it while I’m Azithromycin unless you ask a doctor first.

Also if I feel nauseous, can I take Zofran? I have a prescription for it.
The other meds I take are Bisoprolol, Wellbutrin, Dexilant, Marvelon and a probiotic.

If you could get back to me as soon as possible, I would really appreciate it.
Thank you very much!
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Follow up: Dr. Aaron Branch (0 minute later)
Hi Dr. Branch,
So I have had 5 of the 6 Azithromycin pills. I still feel the same and the white spot is still there. Thankfully I don’t seem to be any worse. Just the same.

I am a bit concerned because tonight I ended up getting the diarrhea. I am assuming it’s likely from the Azithromycin. I don’t usually get diarrhea with antibiotics but I’ve heard this drug can be bad for that. Since I am feeling the same and I only have one pill left (for tomorrow) do you think I can safely stop the antibiotic? I am going to try and follow up with my doctor on Wednesday or Thursday.

Also, if the diarrhea persists, can I take peptide bismol to try and get the diarrhea to stop? I usually have luck getting diarrhea to stop with pesto bismol. I just read that you shouldn’t take anything to stop it while I’m Azithromycin unless you ask a doctor first.

Also if I feel nauseous, can I take Zofran? I have a prescription for it.
The other meds I take are Bisoprolol, Wellbutrin, Dexilant, Marvelon and a probiotic.

If you could get back to me as soon as possible, I would really appreciate it.
Thank you very much!
doctor
Answered by Dr. Aaron Branch (12 minutes later)
Brief Answer:
Pepto-bismol would be fine

Detailed Answer:
Yes, the diarrhea is likely from the azithromycin. I think it would be safe to stop the antibiotic. As long as you aren't having a lot of abdominal pain or fever, it would be safe to use Pepto-bismol. You could also take the probiotic, which may help as well. Taking Zofran would be fine if you get nauseous.

Hopefully the diarrhea doesn't get worse and goes away quickly. Please let me know if I can help with anything else!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Aaron Branch (0 minute later)
Brief Answer:
Pepto-bismol would be fine

Detailed Answer:
Yes, the diarrhea is likely from the azithromycin. I think it would be safe to stop the antibiotic. As long as you aren't having a lot of abdominal pain or fever, it would be safe to use Pepto-bismol. You could also take the probiotic, which may help as well. Taking Zofran would be fine if you get nauseous.

Hopefully the diarrhea doesn't get worse and goes away quickly. Please let me know if I can help with anything else!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Hello, This Question Is For Dr. XXXXXXX Branch. Hi Dr.

Hello, this question is for Dr. XXXXXXX Branch. Hi Dr. Branch, I’m not sure if you’ll remember me but I am the patient who had multiple UTIs last summer and asked you several questions! So, on August 22 and 23 I was having a sore throat, no other symptoms. On the 24th I looked inside my throat and saw a white spot in the back of my throat (on the left side which is mostly where I felt the pain). I often get that with strep throat (I’ve had strep throat several times over the years) so I called my doctor. He didn’t have me come in because of my history. He prescribed me Amoxicillin 500mg 3/day for 7 days. Later that day I did begin to get the usual strep symptoms such as upset stomach, aches, fatigue, etc. After 48 hours of taking the amoxicillin I noticed I was feeling better and after 72 hours I was back to myself as I would usually expect. My doctor did send me for a Covid test just in case and it was negative. I must admit I took my antibiotic faithfully the first half of the week, but I would sometimes forget after that so I would just take it at the next time. If I forgot my morning pill I would take it at lunch so it took a couple of extra days to finish them all. I finished them around Sept. 2. Today I began to notice that my throat was feeling a little off again. Not really sore but dry feeling. I looked in my throat and saw the white spot is still there and it’s either the same size or larger. I started to panic. This has not happened to me before that I am aware of. I was unable to speak with my family doctor but I was able to see a doctor at our clinic. She took a look inside and seemed concerned which freaked me out. She said maybe it’s an abscess but she wanted to do a strep test first which she did and it came back positive. She said she wants to treat the strep with a stronger antibiotic so she gave me Azithromycin 250mg for 5 days. I have to take 2 today and 1 a day for 4 days. She said if it’s not better and I still have the spot in my throat, I have to see my doctor as soon as possible. I really have no symptoms at this point. I’m surprised I really even checked my throat. It was just feeling a bit dry and like sand paper so I thought I would see if the spot is still there. Otherwise I wouldn’t have noticed. I think the white dot is either the same size but if it’s bigger, it’s only a little bit bigger. It’s hard to tell. I did attach a picture of my mouth. I’m sorry it’s not the best picture. The white dot appears on the right side in the back of my throat in the photo (but it’s actually on the left side). Sorry my tongue looks so pasty! I haven’t really eaten much today but I’m not sure if that’s partly due to my nerves now being all anxious about this. Otherwise I feel like myself. I am such an anxious person. While I was waiting for my strep result to come back I googled abscess in the throat and now I’m in a huge panic!! What I read scared me. I am just concerned about why the amoxicillin didn’t fully take the strep away, although it must have helped to some degree because I ended up feeling better. I am also concerned that this is an abscess. Have you heard of strep doing this? Is Azithromycin an effective antibiotic against strep? Have you ever seen the white dots not going away with the first round of antibiotic? If this is an abscess, will the Azithromycin help it? Or should I expect it to not really help? I’m just so scared because what I read on google scared me about abscesses. It said they can block your airways. Anyway, I really appreciate any help or advice you can give me. I’m sorry for all of the questions but the doctor was in a bit of a hurry and didn’t really have much time to chat. Thank you.