Last reviewed: 2 Sep 2023
Last updated: 02 Aug 2023
Summary
Definition
History and exam
Key diagnostic factors
- child or adolescent age
- winter or spring season (in bacterial pharyngitis)
- summer/fall season (in enteroviral pharyngitis)
- rhinorrhea, nasal congestion, and cough (in viral infection)
- sore throat
- pharyngeal exudate
- cervical adenopathy
- fever
- 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)
More key diagnostic factors
Other diagnostic factors
- sexual activity or abuse (in HIV, gonorrheal, or chlamydial infection)
- treatment failure of penicillin
- pharyngeal ulceration (in tularemia)
- pharyngeal gray membrane (in diphtheria)
Other diagnostic factors
Risk factors
- nasal colonization with group A Streptococcus (GAS)
- GAS-infected contact
- sexual activity or abuse
- ingestion of nondomestic meats
- immunocompromised host
- use of inhaled corticosteroids
- lack of immunization or vaccine failure
- irradiation
More risk factors
Diagnostic investigations
1st investigations to order
- rapid antigen test for group A Streptococcus (GAS)
- nucleic acid amplification (via polymerase chain reaction) for group A Streptococcus (GAS)
More 1st investigations to order
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
More investigations to consider
Treatment algorithm
ACUTE
all patients
Contributors
Authors
Jeffrey R. Donowitz, MD
Pediatrician
Pediatric Infectious Diseases
Children’s Hospital of Richmond
Virginia Commonwealth University
Richmond
VA
Disclosures
JRD declares that he has no competing interests.
Acknowledgements
Dr Jeffrey R. Donowitz would like to gratefully acknowledge Dr William A. Petri, Jr, a previous contributor to this topic.
Disclosures
WAP declares that he has no competing interests.
Peer reviewers
Richard Roberts, MD, JD, FAAFP, FCLM
Professor of Family Medicine
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
RR declares that he has no competing interests.
Remco de Bree, MD, PhD
Otolaryngologist
Head and Neck Surgeon
VU University Medical Center
Amsterdam
The Netherlands
Disclosures
RdB declares that he has no competing interests.
Differentials
- Epiglottitis
- Retropharyngeal, peritonsillar, and lateral abscess
- Infectious mononucleosis
More DifferentialsGuidelines
- Pharyngitis (strep throat)
- Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
More GuidelinesPatient leaflets
Sore throat
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