What would you do?

Antibiotics, absolutely. Blood cultures as well, and obviously throat cultures. I’d probably give a dose of parenteral antibiotics such as ceftriaxone, and then some Pen VK. Any risk fx’s for GC? How’s his dentition? I’d consider imaging, depending on the overall look of the patient. I like ultrasound, either in the office or if radiology is nearby, done there. Relatively cheap and no radiation.

I’d also order an HIV. Because it makes my ID wife happy. And a monospot. The lack of adenopathy is a bit unusual for, well, just about everything. I’m sure there is some bug for which it is common, but I don’t know it. GABHS, GC, diphtheria, mono… Adenopathy.

Lastly, close follow-up.

Blood Cultures/Blood Schmultchures, I’d drain his Peri-Tonsilar-Abscess, and give him a Buttock full of Rocephin to get any surviving Gonnococci…

As a non-doctor, I’d do cultures, wbc, and pharyngeal biopsy, as well as rule out carotid artery blockage.