While working in the Urgent Care it is not uncommon to see multiple patients on the same day with the same complaint. One of our most common visit reasons is for a complaint of “sore throat”. While there may be many different reasons for a sore throat, one of the most widely familiar causes is Group A Streptococcus (GAS) or “strep throat”. GAS is the leading cause of tonsillopharyngitis in both adults and children throughout the world.
Most common clinical features include fever, headache and sore throat with an abrupt onset. Patients may also have associated nausea, vomiting and abdominal pain. Possible physical exam findings include tonsillar exudates, palatal petechiae, rash and enlarged/tender anterior cervical lymph nodes. Both rapid testing and throat culture are used for diagnosis and confirmation. If initial rapid testing in office is negative in a child or adolescent, it is recommended to have a follow-up throat culture due to the possibility of missing up to 30% of cases on the initial rapid testing. Providers also used what is known as the Centor Criteria to assist in determining which adults should be tested for GAS. All criteria receive one point if positive and patients with greater than 3 points should be tested. Criteria include: tonsillar exudates, tender anterior cervical lymphadenopathy, fever and absence of a cough. However, patient’s with less than 3 points should be tested if there is reasonable suspicion.
First-line treatment for children and adults positive for GAS is an oral penicillin. For patients with a penicillin allergy an oral cephalosporin, clindamycin or azithromycin are other options. Supportive care is also recommended, including rest, increased fluid intake, soft diet, and NSAIDs/acetaminophen for pain control. The transmission of GAS is reduced through improved general hygiene, hand washing, and testing for GAS after exposure to known positive contacts. It is important that we quickly identify and treat all positive GAS patients to avoid potential complications like otitis media, peritonsillar abscess and acute rheumatic fever.
While there are many different reasons why a patient may have a sore throat, GAS should continue to be tested for and treated when necessary. Thank you!
By: Emily Reiser, PA-C