Strep Throat Infection and Diagnosis

Introduction to Strep Throat

The American Academy of Family Physicians notes that strep throat, or Group A β-hemolytic streptococcal pharyngitis, is an infection of the pharynx and surrounding tissues 1, 2
The Infectious Diseases Society of America states that the bacteria colonize and infect the posterior pharyngeal wall, not exclusively the tonsils 3, 4

The American Academy of Family Physicians recommends that throat swab specimens for diagnosis are obtained from both the tonsils (or tonsillar fossae if tonsils are absent) AND the posterior pharyngeal wall 3, 4
The Centers for Disease Control and Prevention confirms that this diagnostic approach involves the entire pharyngeal area, not just tonsillar tissue 1
The American College of Physicians notes that the tonsillar fossae remain susceptible to streptococcal colonization and infection after tonsillectomy 4

The American Academy of Family Physicians states that patients without tonsils who develop strep throat will present with the same characteristic features, including sudden onset of sore throat 2
The American Academy of Pediatrics notes that other symptoms include fever, headache, tender and enlarged anterior cervical lymph nodes, pharyngeal inflammation and exudate, and absence of viral features 1, 2, 5

The American Academy of Family Physicians recommends that the diagnostic approach for patients without tonsils is identical to those with tonsils, using rapid antigen detection testing and/or throat culture 2, 3
The Infectious Diseases Society of America states that penicillin V for 10 days or amoxicillin for 10 days remains first-line treatment, with alternative antibiotics for penicillin-allergic patients including first-generation cephalosporins, clindamycin, azithromycin, or clarithromycin 2, 5

The American Heart Association notes that the absence of tonsils does not eliminate the risk of streptococcal complications, including suppurative and non-suppurative complications 6
The Centers for Disease Control and Prevention states that a 10-day antibiotic course is necessary to maximize bacterial eradication and prevent rheumatic fever 5, 6