Pharyngeal lymphoid tissues are the primary sites for the spread of EBV, and can cause pharyngitis, which can be either exudative (inflammation of pharynx with secretions) or non-exudative (without secretions). Non-exudative pharyngitis is common in infectious mononucleosis patients; it may present with or without tonsillar enlargement. This pharyngitis is often superinfected by group A streptococcus. Vulvar edema is also very common in patients with EBV pharyngitis. Palatal petechiae (red spots) are also seen in association with some cases of EBV pharyngitis.