Diagnostic Approach for Viral Pharyngitis

Initial Assessment and Diagnostic Algorithm

• The American College of Physicians and the Infectious Diseases Society of America recommend that a throat swab for rapid antigen detection testing (RADT) should be performed to rule out Group A Streptococcal (GAS) infection in patients with suspected viral pharyngitis, with no need for backup culture if negative in adults 1, 2
• Clinical features of viral pharyngitis include jaw pain, swollen glands (lymphadenopathy), and often accompanying symptoms such as coryza (nasal discharge), cough, hoarseness, and possibly oral ulcers, which are more suggestive of viral etiology than bacterial infection 1, 2
• The presence of rhinorrhea, cough, hoarseness, and oral ulcers strongly suggests viral etiology rather than bacterial infection, according to the Infectious Diseases Society of America 1, 2
• The Infectious Diseases Society of America recommends assessing for features suggesting viral etiology, including presence of cough, rhinorrhea, hoarseness, or oral ulcers, which strongly suggests viral cause 1, 2
• If RADT is negative in children/adolescents, a backup throat culture should be performed, as recommended by the American Academy of Pediatrics and the Infectious Diseases Society of America 1, 2
• The American Heart Association recommends that if mononucleosis is suspected, consider Monospot test or EBV-specific antibody testing 4
• For persistent symptoms or atypical presentation, consider throat swab for viral PCR panel to identify specific viral pathogens, as suggested by the Infectious Diseases Society of America 5, 6
• Treating only confirmed cases of streptococcal pharyngitis helps prevent antibiotic resistance, according to the Infectious Diseases Society of America 2
• Unnecessary antibiotic use for viral pharyngitis contributes to antimicrobial resistance and should be avoided, as recommended by the Centers for Disease Control and Prevention and the Infectious Diseases Society of America 1, 2