Rarer causes of tonsillopharyngitis should be considered when the following are present: Posterior cervical or generalized adenopathy, hepatosplenomegaly, and fatigue and malaise present for > 1 week: Infectious mononucleosis No URI symptoms but possible recent oral-genital contact: Pharyngeal gonorrhea A dirty-gray, thick, tough membrane on the posterior pharynx that bleeds if peeled away: Diphtheria (rare in the United States) Risk factors for HIV infection: HIV infection Testing If supraglottitis / epiglottitis is considered possible after evaluation, specific testing is required.