Last reviewed: 23 May 2021
Last updated: 01 Apr 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • child or adolescent age
  • winter or spring season (in bacterial pharyngitis)
  • summer/autumn season (in enteroviral pharyngitis)
  • rhinorrhoea, nasal congestion, and cough (in viral infection)
  • sore throat
  • pharyngeal exudate
  • cervical adenopathy
  • fever >37°C (98.6°F)
  • headache
  • nausea, vomiting, and abdominal pain
  • conjunctivitis (in measles)
  • maculopapular rash (in measles)
  • Koplik spots (in measles)
  • scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)

Other diagnostic factors

  • sexual activity or abuse (in HIV, gonorrhoeal, or chlamydial infection)
  • treatment failure of penicillin
  • pharyngeal ulceration (in tularaemia)
  • pharyngeal grey membrane (in diphtheria)

Risk factors

  • nasal colonisation with group A Streptococcus (GAS)
  • GAS-infected contact
  • sexual activity or abuse
  • ingestion of non-domestic meats
  • immunocompromised host
  • use of inhaled corticosteroids
  • lack of immunisation or vaccine failure
  • irradiation

Diagnostic investigations

1st investigations to order

  • rapid antigen test for group A Streptococcus (GAS)

Investigations to consider

  • culture of throat swab for group A Streptococcus (GAS)
  • culture of throat swab for gonococcus or chlamydia
  • serum monospot for Epstein-Barr virus infection
  • polymerase chain reaction for group A Streptococcus (GAS)

Treatment algorithm



Pediatric Infectious Diseases

Children’s Hospital of Richmond

Virginia Commonwealth University




JRD declares that he has no competing interests.

Dr Jeffrey R. Donowitz would like to gratefully acknowledge Dr William A. Petri, Jr, a previous contributor to this topic.


WAP declares that he has no competing interests.

Peer reviewersVIEW ALL

Professor of Family Medicine

University of Wisconsin School of Medicine and Public Health




RR declares that he has no competing interests.


Head and Neck Surgeon

VU University Medical Center


The Netherlands


RdB declares that he has no competing interests.

Use of this content is subject to our disclaimer