Streptococcal pharyngitis is one of the most common diseases affecting the oral cavity, being responsible for up to 37% of throat infections in children over 5 years of age [1]. The responsible pathogen is group A beta-hemolytic Streptococcus. The clinical presentation of streptococcal pharyngitis starts after a small incubation period of 2-5 days and after being previously exposed to streptococci through respiratory secretions of infective individuals [1] [2]. Regardless of the etiology, throat infections commonly present with a sudden onset of a sore throat, fever of > 38° C, chills, headaches, myalgias, and possibly gastrointestinal complaints [1] [2] [3] [4]. Signs that are highly suggestive of streptococcal pharyngitis are the presence of cervical lymphadenopathy and tonsillar enlargement with the production of a yellow exudate [2] [3] [4]. Scarlatiniform rash and palatal petechiae are very specific but are rarely seen in streptococcal pharyngitis [1] [2] [3] [4]. If upper respiratory tract signs such as a cough, coryza, or conjunctivitis, accompany constitutional and throat-related symptoms, it is highly likely that the infection is of viral origin [1] [2] [3] [4].

• Fever

  Data were analysed separately for general practice and the school programmes for rheumatic fever prevention. [ncbi.nlm.nih.gov]

  Potential complications include rheumatic fever and peritonsillar abscess. [en.wikipedia.org]

  If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage. [mayoclinic.com]

• Streptococcal Pharyngitis

  […] of streptococcal pharyngitis in a pediatric population. [dx.doi.org]

  Pichichero ME, McLinn SE, Gooch WM III et al (1995) Ceftibuten vs. penicillin V in group A beta-hemolytic streptococcal pharyngitis. The Ceftibuten Pharyngitis International Study Group. [oadoi.org]

• Streptococcal Infection

  For each risk level defined by the rule (low v. intermediate v. high risk of group A streptococcal infection), we compared the probability of group A streptococcal infection seen in our validation cohort (observed probability) to that reported by the [doi.org]

  The reemergence of serious group A streptococcal infections and acute rheumatic fever. Am J Med Sci 1996;311:41-54. Kaplan EL. Recent epidemiology of group A streptococcal infections in North America and abroad: an overview. [web.archive.org]

  The reemergence of serious group A streptococcal infections and acuterheumatic fever. Am J Med Sci. 1996;311:41–54. 10. Kaplan EL. Recent epidemiology of group A streptococcal infections in North America and abroad: an overview. [aafp.org]

• Pain

  To evaluate construct validity, we examined the correlation at entry between Strep-PRO scores and scores on other, previously validated measures of pain and functional status. [ncbi.nlm.nih.gov]

  Pain medication such as NSAIDs and paracetamol (acetaminophen) helps in the management of pain associated with strep throat. Viscous lidocaine may also be useful. While steroids may help with the pain, they are not routinely recommended. [en.wikipedia.org]

  The most common morbidity related to tonsillectomy was postoperative throat pain (mean length 13 days, SD 4). [doi.org]

  Symptoms Signs and symptoms of strep throat can include: Throat pain that usually comes on quickly Painful swallowing Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny red spots on the area at the back of the roof of the mouth [mayoclinic.com]

• Asymptomatic

  On stratified and multivariate multilevel analysis, RADT sensitivity was higher for children with pharyngitis than asymptomatic children (89 % vs. 41 %), children [ncbi.nlm.nih.gov]

  Except under special circumstances, neither repeat bacteriologic testing (culture or RADT) of patients who are asymptomatic after a course of antimicrobial therapy nor routine testing of asymptomatic household contacts of a patient with group A streptococcal [dx.doi.org]

  We conducted a meta-analysis to determine the (1) prevalence of streptococcal infection among children who presented with sore throat and (2) prevalence of streptococcal carriage among asymptomatic children. [doi.org]

• Pharyngitis

  Table 2 Microbial etiology of acute pharyngitis. Table 2 Microbial etiology of acute pharyngitis. [dx.doi.org]

  The survey included questions on diagnosis of streptococcal pharyngitis, knowledge on pharyngitis, and attitudes and control beliefs regarding antibiotic dispensing. [ncbi.nlm.nih.gov]

  Chronic Pharyngeal Carriage Chronic pharyngeal carriage is the persistent presence of pharyngeal GABHS without active infection or immune/inflammatory response. Patients may carry GABHS for one year despite treatment. [web.archive.org]

• Sore Throat

  Clinical characteristics were reviewed, and sore throat score was analyzed. RESULTS: A total of 342 throat cultures met the inclusion criteria of sore throat and fever. The positive rate of GAS was 4.1%. [ncbi.nlm.nih.gov]

  Strep throat is a common type of sore throat in children, but it's not very common in adults. Healthcare professionals can do a quick test to determine if a sore throat is strep throat and decide if antibiotics are needed. [web.archive.org]

• Cough

  Four variables (tonsillar swelling and one of tonsillar exudate, no rhinorrhea, no cough), when used in a cumulative score, showed 83.7% sensitivity and 32.2% specificity for GAS pharyngitis. [ncbi.nlm.nih.gov]

  When a person who has strep throat breathes, coughs, or sneezes, tiny droplets with the strep bacteria go into the air. These droplets can be breathed in by other people. [northshore.org]

  Teach your children to cover their mouths when they cough or sneeze. Don't share personal items. Don't share drinking glasses or eating utensils. Wash dishes in hot, soapy water or in a dishwasher. Sept. 28, 2018 [mayoclinic.com]

  It is especially important for anyone with a sore throat to wash their hands often and cover their mouth when coughing and sneezing. There is no vaccine to prevent strep throat. [web.archive.org]

• Hoarseness

  […] a scarlatiniform rash or palatal petechiae, the latter being an uncommon but highly specific finding.Symptoms typically begin one to three days after exposure and last seven to ten days.Strep throat is unlikely when any of the symptoms of red eyes, hoarseness [en.wikipedia.org]

  […] use of RADTs. 47 The recent US guidelines recommend RADTs for the diagnosis of GAS pharyngitis in adults and children at least 3 years of age with acute sore throat who do not have clinical features suggestive of a viral etiology (cough, rhinorrhea, hoarseness [doi.org]

  The exceptions to these is when patients present overt clinical features of viral infection including rhinorrhea, cough, oral ulcers, and/or hoarseness, in which case a positive test result might reflect a carriage state. [1] If left untreated, S pyogenes [emedicine.medscape.com]

• Nausea

  A headache, and nausea or vomiting may also occur. Some develop a sandpaper-like rash which is known as scarlet fever. [en.wikipedia.org]

  […] on quickly Painful swallowing Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) Swollen, tender lymph nodes in your neck Fever Headache Rash Nausea [mayoclinic.com]

  […] usually starts quickly and can cause severe pain when swallowing A fever (101°F or above) Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny, red spots (petechiae) on the roof of the mouth (the soft or hard palate) Headache, nausea [web.archive.org]

  […] suddenly and is often the highest on the second day Chills Red, sore throat that may have white patches Pain when swallowing Swollen, tender neck glands Other symptoms may include: General ill feeling A loss of appetite and abnormal sense of taste Headache Nausea [nlm.nih.gov]

• Vomiting

  A 7-year-old girl with an unremarkable medical history presented to a local paediatric emergency department with a 7-day history of fever, sore throat and vomiting, and a 1-day history of rash. [ncbi.nlm.nih.gov]

  A headache, and nausea or vomiting may also occur. Some develop a sandpaper-like rash which is known as scarlet fever. [en.wikipedia.org]

  […] quickly Painful swallowing Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) Swollen, tender lymph nodes in your neck Fever Headache Rash Nausea or vomiting [mayoclinic.com]

  […] starts quickly and can cause severe pain when swallowing A fever (101°F or above) Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny, red spots (petechiae) on the roof of the mouth (the soft or hard palate) Headache, nausea, or vomiting [web.archive.org]

• Abdominal Pain

  BACKGROUND: Several pathologies, including pharyngitis, are associated with abdominal pain that can mimic appendicitis. We sought to further understand the link between appendicitis-like symptoms and streptococcal (strep) pharyngitis. [ncbi.nlm.nih.gov]

  Pain medication such as NSAIDs and paracetamol (acetaminophen) helps in the management of pain associated with strep throat. Viscous lidocaine may also be useful. While steroids may help with the pain, they are not routinely recommended. [en.wikipedia.org]

  Children, for example, may present with abdominal pain or emesis. [web.archive.org]

  tonsillar exudate, palatal petechiae, nausea, abdominal pain, vomiting, diarrhea, presence of anterior cervical lymph nodes, size of the nodes (< 1, 1–2 or > 2 cm), tenderness of the nodes, skin rash, and aspect of the rash (scarlatiniform or nonspecific [doi.org]

• Aphthous Stomatitis

  Tonsillitis or “sore throat” may also include cases of entities such as periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis syndrome (PFAPA); clear characterization of children in studies is key for understanding effects on subpopulations [pediatrics.aappublications.org]

• Erythema

  They were screened for enrollment and if he/she presented pharyngitis with clinical criteria of sore throat, erythema, exudate and tender or enlarged anterior cervical lymph nodes. [ncbi.nlm.nih.gov]

  […] endorsed by the CDC and AAFP) AAP IDSA UKNHS Screening for acute pharyngitis Use Centor criteria (see Figure 1 ) Use clinical and epidemiologic findings to assess patient’s risk of GABHS (e.g., sudden onset of sore throat, fever, odynophagia, tonsillar erythema [aafp.org]

  The following clinical features were recorded for each patient: age, sex, sudden onset of sore throat, maximum body temperature (as reported by a parent), throat pain, cough, rhinorrhea, conjunctivitis, headache, erythema of the pharynx, tonsillar swelling [doi.org]

• Skin Rash

  Culture-positive cases were associated with higher odds for a skin rash [adjusted odds ratio (AOR): 14.66, 95% confidence interval (CI): 4.63-46.40, p CONCLUSION: Pediatric streptococcal pharyngitis in Southern Taiwan is uncommon. [ncbi.nlm.nih.gov]

  Less common symptoms are a red skin rash, vomiting, not feeling hungry, and body aches. Strep throat can be passed from person to person. [northshore.org]

  However, gastrointestinal side effects and skin rash may be more common with amoxicillin. Macrolides. [web.archive.org]

  rash, and aspect of the rash (scarlatiniform or nonspecific). [doi.org]

  However, gastrointestinal side effects and skin rash may be more common with amoxicillin. [aafp.org]

• Myalgia

  Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. [ncbi.nlm.nih.gov]

  Regardless of the etiology, throat infections commonly present with a sudden onset of a sore throat, fever of > 38° C, chills, headaches, myalgias, and possibly gastrointestinal complaints. [symptoma.com]

  Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. (Am Fam Physician 2004;70:1279-87,1289-90. Copyright© 2004 American Academy of Family Physicians.) [web.archive.org]

  C 32 Strength of Recommendations Key clinical recommendations Label References Fatigue, myalgias, and need for sleep may persist for several months after the acute infection has resolved. [aafp.org]

• Headache

  Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). [ncbi.nlm.nih.gov]

  Regardless of the etiology, throat infections commonly present with a sudden onset of a sore throat, fever of > 38° C, chills, headaches, myalgias, and possibly gastrointestinal complaints. [symptoma.com]

  A headache, and nausea or vomiting may also occur. Some develop a sandpaper-like rash which is known as scarlet fever. [en.wikipedia.org]

  […] usually comes on quickly Painful swallowing Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) Swollen, tender lymph nodes in your neck Fever Headache [mayoclinic.com]

  […] throat, usually starts quickly and can cause severe pain when swallowing A fever (101°F or above) Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny, red spots (petechiae) on the roof of the mouth (the soft or hard palate) Headache [web.archive.org]

The diagnosis of streptococcal pharyngitis rests on a thorough clinical assessment and appropriate microbiological studies. Firstly, the physician should obtain a comprehensive patient history that will determine the onset of symptoms, their duration, as well as recent exposure to other individuals with similar complaints. The physical examination, on the other hand, is sufficient to make a presumptive diagnosis through recognizing inflammatory changes in the throat. In addition to clinical findings, younger age (children over 3 years of age and adolescents) must be taken into account as a risk factor that will promote testing [5].

Rapid antigen detection testing (RADT) on previously obtained throat swabs is described as the first and most important study for detecting streptococci in the throat, as it provides results within minutes and carries very high sensitivity rates [1] [2] [5] [6] [7]. If RADT is negative, but the signs and symptoms strongly point toward a bacterial cause, throat cultures should be performed in order to make a definitive diagnosis [1] [2] [4] [5] [8]. The test requires approximately 18-24 hours to show a significant growth of bacteria [1].

Although serological tests for streptococcal antibodies (antistreptolysin-O titers) exist in clinical practice, they are not routinely used because of their delayed appearance in the case of streptococcal pharyngitis (up to several weeks) [2] [4]. Their measurement is indicated when either rheumatic fever or poststreptococcal glomerulonephritis is suspected [2]. However, they may be useful for discriminating between an acute infection and a chronic carrier state [2] [4].

• Neisseria Gonorrhoeae

  Group A beta-hemolytic streptococci (GABHS) are responsible for most bacterial cases of acute pharyngotonsillitis, although other pathogens, such as Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Mycoplasma pneumoniae, and Chlamydia pneumoniae, [ncbi.nlm.nih.gov]

  gonorrhoeae ) is suspected. [dx.doi.org]

  gonorrhoeae, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus. 2 Pharyngitis caused by group A beta-hemolytic streptococci, commonly called "strep throat" or streptococcal pharyngitis, has an incubation period of two to five [web.archive.org]

  gonorrhoeae, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus. 2 Pharyngitis caused by group A beta-hemolytic streptococci, commonly called “strep throat” or streptococcal pharyngitis, has an incubation period of two to five [aafp.org]

• Francisella Tularensis

  N. gonorrhoeae can occasionally cause acute pharyngitis in sexually active persons, and infections with other bacteria, such as Francisella tularensis and Yersinia enterocolitica, and mixed infections with anaerobic bacteria (e.g., Vincent's angina) are [dx.doi.org]

For the comparison of 10 days of treatment with cephalosporins versus 10 days of treatment with penicillin, there were ten European and 25 U.S. trials, all involving pediatric subjects. [oadoi.org]

Both treatments were well tolerated; and most adverse events (AEs) were mild to moderate in intensity. The most frequent treatment-related AE was diarrhoea, or loose stools, in 11% of both treatment groups. [ncbi.nlm.nih.gov]

Alternative treatments must be used in patients with penicillin allergy, compliance issues or penicillin treatment failure. [web.archive.org]

Prognosis GABHS pharyngitis is usually a self-limited illness. Throat symptoms resolve within 3-4 days in untreated patients. [emedicine.medscape.com]

Relation of bed rest and activity to prognosis. Postgrad Med 1964;35:345-9. 22. Torre D, Tambini R. Acyclovir for treatment of infectious mononucleosis: a meta-analysis. Scand J Infect Dis 1999;31:543-7. 23. [web.archive.org]

Relation of bed rest and activity to prognosis. Postgrad Med. 1964;35:345–9. 22. Torre D, Tambini R. Acyclovir for treatment of infectious mononucleosis: a meta-analysis. Scand J Infect Dis. 1999;31:543–7. 23. [aafp.org]

Most types of pharyngitis are caused by infectious etiologies. [ncbi.nlm.nih.gov]

Table 3 Clinical and epidemiological findings and diagnosis of pharyngitis due to group A β-hemolytic streptococci (GABS). Table 3 Clinical and epidemiological findings and diagnosis of pharyngitis due to group A β-hemolytic streptococci (GABS). [dx.doi.org]

Author information 1 INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France. [email protected] Abstract We investigated mechanisms of the false-positive test results on rapid-antigen [ncbi.nlm.nih.gov]

While the natural history of carditis complicating acute rheumatic fever is well established, the incidence, pathophysiology and clinical course of nonrheumatic myopericarditis are ill defined. [ncbi.nlm.nih.gov]

Pathophysiology Beta-hemolytic streptococci have the ability to cause large zones of hemolysis on blood agar, aiding in microbiological identification. [2] Lancefield antigens, carbohydrates in the cell wall, provide further differentiation of streptococci [emedicine.medscape.com]

[…] physicians should expect to diagnose one to four patients with infectious mononucleosis per year, depending on the number of adolescents in their practice. 3,5 The incidence of infectious mononucleosis shows no consistent seasonal peak. 2 Etiology and Pathophysiology [web.archive.org]

There is no vaccine to prevent strep throat. [web.archive.org]

Data were analysed separately for general practice and the school programmes for rheumatic fever prevention. [ncbi.nlm.nih.gov]

Prevention To prevent strep infection: Clean your hands. Proper hand cleaning is the best way to prevent all kinds of infections. [mayoclinic.com]

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2. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009;79(5):383-390.
3. Lieberman D, Shvartzman P, Korsonsky I, Lieberman D. Aetiology of respiratory tract infections: clinical assessment versus serological tests. Br J Gen Pract. 2001;51(473):998–1000.
4. Anjos LM, Marcondes MB, Lima MF, Mondelli AL, Okoshi MP. Streptococcal acute pharyngitis. Rev Soc Bras Med Trop. 2014;47(4):409-413.
5. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ: Canadian Medical Association Journal. 1998;158(1):75-83.
6. Ezike EN, Rongkavilit C, Fairfax MR, Thomas RL, Asmar BI. Effect of using 2 throat swabs vs 1 throat swab on detection of group A streptococcus by a rapid antigen detection test. Arch Pediatr Adolesc Med. 2005;159(5):486–490.
7. Neuner JM, Hamel MB, Phillips RS, Bona K, Aronson MD. Diagnosis and management of adults with pharyngitis. A cost-effectiveness analysis. Ann Intern Med. 2003;139(2)113–122.
8. Pelucchi C, Grigoryan L, Galeone C, et al. Guideline for the management of acute sore throat. ESCMID Sore Throat Guideline Group. Clin Microbiol Infect. 2012; 18 (suppl 1):1-28.