Management of Symptomatic Patients with Negative Strep Test Results
Rationale for Not Treating
- The Infectious Diseases Society of America (IDSA) guidelines clearly state that routine culture or treatment of asymptomatic household contacts of patients with group A streptococcal pharyngitis is not recommended, except in specific situations with increased risk of frequent infections or nonsuppurative sequelae 1
- A negative rapid antigen detection test (RADT) or throat culture in a symptomatic patient indicates that streptococcal infection is unlikely to be the cause of symptoms 3
Understanding Household Contact Dynamics
- Approximately 25% of asymptomatic persons in households with a strep case harbor group A streptococci in their upper respiratory tracts 1
- Despite this carriage rate, it is not necessary to test or treat these asymptomatic contacts 2
- Streptococcal carriers are unlikely to spread the organism to close contacts and are at very low risk for developing suppurative or nonsuppurative complications 2, 4
When to Consider Testing/Treatment of Contacts
- Testing and treating household contacts should only be considered in rare situations such as when there is increased risk of frequent infections or risk of nonsuppurative streptococcal sequelae (like rheumatic fever) 1
Distinguishing Carriers from Active Infection
- During winter and spring, up to 20% of asymptomatic school-aged children may be streptococcal carriers 2
- A negative test in a symptomatic patient suggests that symptoms are likely due to a viral cause rather than streptococcal infection 3