Acute pharyngitis is characterized by acute onset of sore throat; the absence of cough, nasal congestion and discharge suggests a bacterial etiology.
Rapid antigen detection tests allow immediate point-of-care assessment of group A Streptococcus (GAS) pharyngitis. However, nucleic acid amplification (via polymerase chain reaction) testing for GAS is becoming more common and is comparable to throat culture in sensitivity and specificity but is more rapid.
The goal of treatment of GAS infection is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission.
Acute pharyngitis is generally a self-limited condition with resolution within 2 weeks. Infected individuals are not immune to reinfection with most etiologic pathogens. Treatment typically involves supportive care (e.g., analgesics) and treatment of the causative pathogen (e.g. antibiotics for GAS infections).
The only situation in which antibiotic prophylaxis to prevent GAS infections is recommended is for individuals with a history of rheumatic fever.
Acute pharyngitis is characterized by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). It can be caused by a variety of viral and bacterial pathogens, including group A Streptococcus (GAS), as well as fungal pathogens (e.g., Candida albicans). Absence of cough, nasal congestion, and nasal discharge suggests a bacterial, rather than viral, etiology. Bacterial pharyngitis, in temperate climates, is more common in winter (or early spring), while enteroviral infection is more common in the summer and fall. Acute pharyngitis is generally a self-limited condition with resolution within 2 weeks.
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
- 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, gonorrheal, or chlamydial infection)
- treatment failure of penicillin
- pharyngeal ulceration (in tularemia)
- pharyngeal gray membrane (in diphtheria)
- 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
1st investigations to order
- rapid antigen test for group A Streptococcus (GAS)
- nucleic acid amplification (via polymerase chain reaction) 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
- Retropharyngeal, peritonsillar, and lateral abscess
- Infectious mononucleosis
- Pharyngitis (strep throat)
- Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
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