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Last reviewed: 21 Mar 2025
Last updated: 30 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain on swallowing
  • fever (>38°C [>100.5°F])
  • tonsillar exudate

Other diagnostic factors

  • sudden onset of sore throat
  • headache
  • abdominal pain
  • nausea and vomiting
  • presence of cough or runny nose
  • tonsillar erythema
  • tonsillar enlargement
  • enlarged anterior cervical lymph nodes

Risk factors

  • age between 5 and 15 years
  • contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)

Diagnostic investigations

1st investigations to order

  • throat culture
  • rapid streptococcal antigen test

Investigations to consider

  • serological testing for streptococci
  • WBC count and differential
  • heterophile antibodies
  • vaginal and cervical, or penile, and rectal cultures
  • HIV viral load assay
  • lateral cervical view x-ray, exposed for soft tissue

Treatment algorithm

Contributors

Authors

Christos Georgalas, PhD, DLO, FRCS (ORL-HNS)
Christos Georgalas

Professor of Surgery - Head and Neck

University of Nicosia

Cyprus

Disclosures

CG declares that he has no competing interests.

Eleftherios Margaritis, PhD, MSc, MD
Eleftherios Margaritis

Otolaryngologist - Head and Neck Surgeon

Collaborator in Otolaryngology

ENT Department

Hippokration University Hospital

Athens

Greece

Disclosures

EM declares that he has no competing interests.

Peer reviewers

Itzhak Brook, MD, MSc

Professor of Pediatrics and Medicine

Georgetown University

Washington

DC

Disclosures

IB declares that he has no competing interests.

Chris Del Mar, MB BChir, FRACGP MD, MA, FAFPHM

Dean

Faculty of Health Sciences and Medicine

Bond University

Gold Coast

Queensland

Australia

Disclosures

CDM is an author of a number of references cited in this topic.

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